The Newborn Assessment: History Flashcards
A comprehensive history of the newborn should include a detailed assessment of the ___ ___ ____ course
Pre/ Peri/ Postnatal course
________ history
a) course of prenatal care
b) xenobiotic used during the gestational period
c) health problems during pregnancy
d) Intrauterine fetal health problems in utero
e) How does the mother feel about this pregnancy?
Prenatal History
Preinatal History
1) ______ Process
a) vaginal delivery vs C-section
b) planned vs emergent c- section
c) induced labor
d) analgesia/ anesthesia
Delivery process
Preinatal History
2) __________
a) placenta previa/abruption
b) meconium
c) forceps/ vacuum
Complications
Perinatal History
3) __________
a) Low birth weight < 2500 g
b) very low birth weight < 1500 g
c) extremetly low birth weight < 1000 g
Birth size/ weight
Perinatal History
4) ____________
a) appropriate for gestational age: between the 10th and 90th percentile
Assessment of weight for gestational age
______________: weight 90th associated with maternal diabetes
large for gestational age
_________________: weight < 10th percentile; symmetric vs asymmetric
Small for gestational age
\_\_\_\_\_\_\_ scores (five areas of assessment for a toat of 10 points): Appearance, pulse, grimace, activity, and respiration a) Maximum score at 1 and 5 minutes = 10; however, there are 3 points possible for each 0, 1, 2
APGAR
APGAR: Normal color all over (hands and feet are pink)
2
APGAR: Normla color (but hands and feet are bluish)
1
APGAR: Bluish-gray or pale all over
0
APGAR: Normal (above 100 beats per minute)
2
APGAR: Below 100 beats per minute
1
APGAR: Absent (no pulse)
0
APGAR: Pull away. sneezes, or coughs with stimulation
2
APGAR: Facial movement only (grimace) with stimulation
1
APGAR: Absent ( no response to simulation)
0
APGAR: Active, spontaneous movement
2
APGAR: Arms and legs flexed with little movment
1
APGAR: No movment, “floppy” tone
0
APGAR: Normal rate and effort, good cry
2
APGAR: Slow or irregular breathing, weak cry
1
APGAR: Absent (no breathing)
0
Maternal problem
a) _______
b) volume problems
c) response to anesthesia
d) breastfeeding
e) depression
f) fever/infection
bleeding
Infant problems
a) ABO/Rh incompatibilities
b) ______________
c) hip dysplasia
d) murmurs
e) talipes equinovarus congenita (club feet)
f) genetic syndromes
hyperbilirubinemia
The average length of a newborn is?
20 to 21 inches (51 cm)
The average weight of a newborn is?
7 lbs (3.1 kg)
The average head circumference is?
13 to 14 inches (33 to 35 cm)
Ethnic ________ in weight
difference
Assessment of gestational age: Length of gestation also has an ________ variation
ethnic
Infants born at gestational period _____ weeks have the best health outcomes
37 to 41
Those born prior to ____ weeks of gestation are premature and those born after 41 weeks of gestation are post-term
37
SGA: Symmetric IUGR (____% of SGA infants)
33%
Head circumference, weight, and length are all ____ percentile
< 10th
This usually suggests a long-term compromise to the fetus or the presence of an intrinsic problem
a) ______: Congenital or chromosomal abnormalities
b) Intrauterine infection: viral, bacterial, protozoal, the spirochete
c) Inborn errors of metabolism
d) Environment: Drugs, nicotine, x-ray exposure
Genetic
SGA: Asymmetric IUGR (55% of SGA infants)
a) head circumference and length _____
b) weight less than 10th percentile
c) May be due to acute extra fetal compromise (usually occur greater than 24 weeks)
1) chronic hypertension
2) pre-eclampsia
3) renal disease
4) cyanotic heart disease
5) hemoglobinopathies
6) abruptio placentae
7) Multiple gestations
8) altitude
normal limits
LGA: Weight is (____ percentile)
greater 90th
LGA:
a) ________ diabetes
b) Beckwith- Wiedemann syndrome: Congenital growth disorder; hemihypertrophy, large organs and other symptoms
c) ______ fetalis: fatal condition defined as an abnormla accumulation of fluid in two or more fetal compartments
d) large mother
a) Maternal
c) Hydrops
Temperature > ____ considered a fever in newborn?
> 100.4
Pulse variant is ____ beats per minute
120 to 170
Respiration _____ to as high as ___ breaths per minute
30 to 80
Blood pressure < _______
<112/74 mmHg
In newborns, this is a pinpoint white papules on the face, prominent on cheeks, nose, chin, and forehead.
a) Spontaneously disappear within 3 to 4 weeks of life
b) If persistent or widespread distribution may indicate a genetic syndrome
Miliaria
Most common newborn rash, usually appears between days 2 to 5 after birth; characterized by blotchy red spots on the skin with overlying white or yellow papules on pustules; resolves by the 14th day
Erythema toxicum
Typically a subtle shade discoloration located on either flank; may not be present at birth but likely to increase in size with age; suspect neurofibromatosis if there are many large spots or if more than six spots in a child older than 5 years of age.
Cafe au lait spots
If present in large numbers, suspect tuberous sclerosis, xeroderma pigmentosus, or generalized neurofibromatosis.
Junctional nevi
Benign, flat, congenital birthmark with wavy borders and irregular shape; common color is blue; may last up to 3 to 5 years after birth, almost always disappear by puberty
Mongolian spots
Vascular birthmark consisting of superficial and deep dilated capillaries in the skin; produce a reddish to purplish discoloration of the skin; permanent. Rule out Sturge- Webber: serious neuro condition with seizures- Ocular (glaucoma) characteristics.
Port Wine Stain
Affects 2% or more of babies, raised, soft red lumps on the skin, more common in premature babies; hypo/hyperpigmented; after 6 months of age, the strawberry marks usually begin to shrink and fade.
Strawberry mark ( Hemangiomas)
Posture: Hips should be _______ and partially flexed with knees flexed, arms adducted, elbows flexed, and fists clenched
abducted
Head in a newborn should stay in line for 3 seconds all this is called muscle _____.
Tone
____ should be symmetrical
Reflexes
Rooting in newborns disappears in ____ months
3 to 4 months
Sucking reflex in newborns disappears in ___ months
3 to 4 months
Moro reflex in newborns disappears in ____ months
3 to 4 months
Grasp (Palmar; Plantar) reflex in newborns disappears in ____ months
3 to 6 months; 4 months
Placing/ stepping reflex in newborns disappears in ____ months
1 to 2 months
Tonic neck reflex in newborns disappears in ____ months
3 months
Babinski reflex in newborns disappears in ____ months
12 months or when walking
Head and neck of the newborn:
_____ _______ crosses midline (fluid under the skin, simple swelling); resolves in 2 to 3 days
Head shape/ size variations
Head and neck of the newborn:
Does not cross the midline (blood under periosteum); requires closer examination
Cephalohematoma
Head and neck of the newborn:
Rickets, prematurity
Bossing
Head and neck of the newborn:
Head circumference smaller than two standard deviations (SD); small brain
Microcephaly
Head and neck of the newborn:
Head circumference large than two SD, hydrocephalus
macrocephaly
Hair pattern in the newborn:
____ _____ with other anomalies are sometimes associated with deafness and retardation (Waardenburg syndrome)
White Forelocks
More than ____ hair could mean poor brain growth
one
_____ hair with unusual facies, SGA, and microcephaly are found in Down syndrome
Unruly
Fontanels:
______ fontanel is the largest (2 to 5 cm); closes by ruffly 18 months
Anterior
Fontanels:
______ fontanel may not be palpable at birth; closed by 2 to 3 months
Posterior
Common causes of wide fontanels:
a) Prematurity
b) _____
c) Hydrocephalus
d) Down Syndrome
e) Hypothyroidism
IUGR
___ ____ replaced by a black spot means there is no clear pathway from the lens to the retina
Red reflex
Red Reflex:
If replaced by a whitish color, this may suggest
a) ___________ or congenital cataracts; the sclera is normally white and may appear bluish in preemies; if the sclera is deep blue, b) _________ ______ should be ruled out
a) retinoblastoma
b) osteogenesis imperfecta
_______ (embryonic fissure defect): Mild forms only affect the iris; in more severe cases, the choroid and optic nerve can be involved with suspicion for central nervous system midline defects such as optic nerve hypoplasia
Colobomas
_____ ___ _____ (Brushfield spots of the iris) is associated with Down Syndrome
Salt- and - pepper
____ ____ (narrowing or blockage of the nasal airway by tissue, present at birth)
Choanal atresia
_________ (small mouth) is observed in trisomy 13 and 18
Microstomia
___________ (large mouth) is present in micropolysaccharidoses; fish mouth is seen in fetal alcohol syndrome
Macrostomia
______ due to hypothyroidism, mucopolysaccharidoses
Macroglossia
________
a) Epstein pearls
b) natal teeth
Teeth
_____ newborn assessment
a) Micrognathia in Pierre- Robin syndrome
b) Treacher- Collins syndrome
c) Hallermann Streiff syndrome
Chin
_____ newborn assessment
a) Clavicular fractures
b) webbed neck
c) lymph nodes
Neck
___________/_______
a) Respiratory rate/Pattern: Abdominal breathing
b) Retractions
c) Grunting
d) Breast enlargement
Pulmonary/Chest
____________
a) Capillary refill
b) Radio femoral pulse delay: Consider coarctation, pulse oximeter reading of all 4 extremities
c) Character of pulses
d) Note the location and size of the point of maximum impulse (PMI): 3rd and 4th intercostal space (ICS)/ left midclavicular line (LMCL)
e) Murmurs: 85% of newborns have murmurs
Cardiovascular
_______
a) Contour: Flat abdomen is abnormal
b) Umbilical cord/ number of vessels ( two arteries and one vein)/ color
c) Hernias
d) Anal patency
Abdomen
__________
a) Inspect glans, urethral meatus (hypo/ epispadias)
b) note ability to retract the foreskin in uncircumcised penis
c) Note presence of tests: 97% of full-term males have descended testes at birth
Male genitalia
__________
a) discharge/ small amount of bleeding may be present
Female genitalia
____________
a) Scoliosis
b) Kyphosis
c) Lordosis
d) Spinal defects
e) Meningomyeloceles
f) Clavical fracture
g) Fingers/creases
h) Developmental Dysplasia of the hip (DDH).
Spine
With hips flexed at 90 degrees and knees together, begin by abducting, then adduct while the examiner’s fingers are over the greater trochanter
Developmental dysplasia of the hip (DDH)
A “click” is heard or felt as dislocation is related
Ortolani’s click
Feeling of a slip as the femoral head slips away from the acetabulum causing the dislocation
Barlow’s Maneuver
Screening has low false positive/false negative results
a) Sensitivity: + = ____
b) Specificity: - = ____
a) +
b) -
With screening test for over ____ conditions
50
Mandatory Screening Program Goal is?
Early identification of specific metabolic disorders
Do all 50 states require mandatory screening?
a) _____
b) galactosemia
c) hemoglobinopathies
d) congenital
e) hypothyroidism
a) PKU
A re-screen is mandatory for newborns tested at ____ hours of age
< 24 hours
_______ for newborn infants who appear symptomatic
Re-screen
Cogenital cyanotic heart diseases (_________)
hyperoxygenation
_____ reflex is observed the response to loud noise/voice
Stratel reflex
Hearing test brain stem auditory evoked response (____) test
BSAER (Brainstem Auditory Evoked Response)
Hearing screening should be identified but no later than ___ months and treated by 6 months
3 months
_________
a) Occurrence: 1: 10,000 to 25,000
b) Developmental delay
c) severe retardation
d) seizures
e) aggressive
f) Autism
g) Hyperactivity
Phenylketonuria (PKU)
_________: Liver dysfunction, coagulopathies
a) Occurrence: 1: 60,000 to 80,000
b) Special Consideration: 25% of unrecognized infants develop sepsis
Galactosemia
_______
a) Sick cell disease, thalassemia
b) Occurrence: 1: 400 African- Americans
c) Anemia
d) Sepsis
Hemoglobinopathies
_______
a) occurrence: 1: 3,600 to 5000
b) mental retardation
c) Neurological abnormalities
d) Metabolic abnormalities
e) Special consideration: Presents with a late onset in 10% of cases
Hypothyroidism
The disorder that may be present at birth: Cardiovascular, ophthalmic complications that may be present at birth are ________?
Rubella
The disorder that may be present at birth: Microcephaly, sensorineural hearing loss, chorioretinitis
CMV (Cytomegalovirus)
The disorder that may be present at birth: Skin, mouth, ophthalmic, CNS, Pulmonary manifestations
Herpes
The disorder that may be present at birth: Hepatitis, hemolytic anemia, nephrosis, myocarditis, bony findings
Congenital syphilis
The disorder that may be present at birth: Pulmonary disease, pancreatic insufficiency, cirrhosis, FTT; has a range of severity
Cystic fibrosis
