The Healthy Term Infant Flashcards
When is a baby considered to be Term and when are they considered Post Term?
Term after 37 weeks
Post term after 41 weeks
What is the normal weight of a Term baby?
“Normal” weight 2.5 kg – 4.0 kg
>4.0 Kg, large for gestational age (LGA)
<2.5 kg, small for gestational age (SGA)
Describe the difference in weight of a baby between 28 weeks and term
Average male at 28 weeks = 1150g, 3.5% fat
Average male at term = 3550g, 15% fat
=> Daily weight gain = 24 g
A post-term delivery increases the risk of a baby with cerebral palsy. TRUE/FALSE?
TRUE
Why does the placenta aim to deliver a foetus enough iron to last throughout their first year of life?
Not enough iron produced in breast feeding
How does the appearance of a term baby differ to that of a preterm baby?
Term:
- No bony bits poking out
- Good layer of s/c fat
- wrinkled hands/feet
- Flexed position
Pre-term:
- lying flat (not flexed)
- Bony bits prominent
- Fat yet to develop
Why may labour cause problems for a previously healthy baby?
- Hypoxic environment during contractions
- Prolonged labour reduces fetal reserves
HOw is perinatal adaptation assessed?
Apgar Score /10
- HR, RR, Responsiveness, Tone, Colour
Normal Score = 8 or above
What 2 things are most important after the baby is born?
- Keeping baby warm + skin-to-skin contact
- Establishing feeds - usually high calorific intake in first 24hrs
What is haemorrhagic disease of the newborn and how is this prevented?
- Coagulopathy => ability to clot is impaired
=> excessive bleeding at many sites in body - Given VItamin K to help with clotting (IM depot or drops)
- If formula fed then infant may get VItamin K from formula milks
What infections must you check if the baby is at risk?
- Hepatitis B - if yes => Immediate vaccine/immunoglobullin
- Hepatitis C
- HIV - transmission low if undetectable viral load
- Syphilis
- TB - BCG vaccine offered if family at high risk
- Group B Strep.
What is provided to Mums and Dads to help them understand what is required in the postnatal care of their baby?
Newborn Snuggle Bundle
- e.g. recommends keeping baby warm with hat, blankets etc. Tells them correct temperature of baby.
What vaccines is the mother given to help prevent infection in the baby?
Pertussis (whooping cough) and Influenza
What does the Newborn Blood Spot Screening look for?
- Cystic fibrosis (indirect test for immuno-reactive trypsin => if abnormal, babies will be offered genetic testing)
- Thyroid Function tests
- Haemoglobinopathies
- Metabolic disease (e.g. phenylketonuria (PKU))
What other screening tests are carried out in newborns and don’t require bloods to be taken?
- Universal hearing screening
- Hip screening (for DDH) - clinical diagnosis
When is a top-toe examination of the newborn usually carried out, and who completes this?
- Generally carried out at around 24 hours of age
- Usually by a midwife or member of neonatal team
What abnormal swellings can occur in a newborn and present in the examination at 24hours?
Caput Succedaneum
- swelling in outer layer of skin
- dramatic soft tissue swelling
- Usually reduces by 12 hours, but may not completely disappear until later
Cephalhaematoma
- bruising/bleeding between periosteum and epicranial aponeurosis
- often parietal
- doesnt cross suture line
Subgleal Haematoma
- RARE
- blood can extend from orbits to back of skull
What signs in the eyes are being looked for on neonatal examination?
- Size
- Red reflex
- Conjunctival haemorrhage (due to increased pressure in labour)
- Squints (frequent)
- Iris abnormality (e.g. Coloboma = keyhole shape)
What features of the ears must be assessed on neonatal examination?
- Position (this may be wrong if increased moulding at birth - they will move back very quickly)
- External auditory canal
- Tags/pits
- Folding
- Family history of hearing loss?
What parts of a babys mouth must be assessed on neonatal examination?
- Shape
- Philtrum
- Tongue tie (frenulum may need cut for breastfeeding)
- Palate
- Neonatal teeth
- Ebsteins pearls (white lesions along midline of palate)
- Sucking/rooting reflex
Cleft lip and palate surgery now has a very good outcome. TRUE/FALSE?
TRUE
What facial abnormalities may be picked up on an examination of the newborn?
- Facial palsy (often side of face without a Nasiolabial fold present)
- Dysmorphism (e.g. foetal alcohol syndrome [although this is usually picked up later])
How should you assess the respiratory system of the newborn in an examination?
- Chest shape - pectus excavatum?
- Nasal flaring
- Grunting/Breath sounds
- Tachypnoea
- Check for diaphragmatic hernia (loops on bowel in lung on CXR)
HOw do we carry out a cardiovascular examination of the neonate?
- Colour/Saturation (SaO2)
- Pulses: femoral
- Apex
- Thrills/heaves
- Heart sounds
A physiological murmur may be present during the neonatal examination. TRUE/FALSE?
TRUE
murmur from patent foramen ovale may be present whilst it is still closing after birth
What congenital heart disease needs to be screened for during a neonatal examination?
Tetralogy of Fallot
- VSD
- Overriding Aorta
- Pulmonary Stenosis
- RV Hypertrophy
What should be assessed on abdominal examination of the newborn?
- Distension?
- Umbilical Hernia (regresses by 1 year)
- Unguinal hernia (more common in boys)
- Umbilicus for signs of erosion/infection (may lead to SEPSIS)
- Bile stained vomiting
- Passage of meconium
- Anus
What should you assess in a newborn examination of the genitourinary tract?
- Normal passage of urine
- Normal genitalia
- Undescended testes
- Hypospadius
What parts of the MSK system are assessed in a neonatal examination?
- Movement/ posture
- Limbs and digits
- Spine (e.g. spina bifida lesions)
- Hip examination (if DDH - corrected with brace of Pavlik harness)
What is gastrochisis?
- Bowel comes out of abdominal cavity, twists and goes back in again
- good surgical outcome if noticed in utero
What neurological symptoms should be assessed in a neonatal examination?
- Alert, responsive
- Cry
- Tone
- Posture
- Movement
- Primitive reflexes
What primitive reflexes are tested in a neonatal neurological examination?
- Sucking and Rooting
- Moro
- Asymmetric Tonic Neck Reflex
- Stepping
- Grasp
Why are babies left to sleep on their back?
To prevent Sudden Infant Death Syndrome
