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Pediatrics > The Newborn Infant > Flashcards

The Newborn Infant Flashcards

1
Q

3 components to a complete newborn hx

A
  1. Maternal and paternal medical history
  2. Maternal past obstetric history
  3. Current antepartum and intrapartum history
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2
Q
  • Courtesy of most Pediatric office – usually no charge for the visit
  • Valuable for 1st time parents or families searching for right provider
  • Allows family to meet and visit with PCP and their office

what type of visit is this?

A

Prenatal visit

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3
Q

components of a maternal an paternal hx

A
  • Chronic medical issues in the family ?
  • Dietary habits
  • Smoking or substance abuse ?
  • Occupational history ?
  • Social history – abuse or neglect ?
  • Family illnesses and congenital anomalies ?
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4
Q

components of a maternal OB hx

A
  • Maternal age ?
  • How many time pregnant ? Gravida
  • How many times has she given birth ? Para
  • Pregnancy outcomes ? ( TPAL = Term, preterm , abortus , living )
  • Maternal blood type
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5
Q

occuring right prior to delivery

what is this term

A

antepartum

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6
Q

occuring during labor or delivery

what is this term

A

intrapartum

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7
Q

time after delivery up to 6 wks

what is this term?

A

post partum

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8
Q

wha to Review on antepartum and intrapartum Hx

A
  • Review mom’s hx – US , amnio, screening labs (HBV, RPR, HIV and Rubella)
  • Look at tests that determine fetal well being – NST, dopplers of blood flow and BPP
  • Did mom have prenatal issues like Gestational DM, UTI’s, HTN , pre-eclampsia, preterm labor ?
  • Siginificant issues - maternal fevers , difficult delivery, meconium stained fluid, vaginal vs C/S, forceps used, and any resuscitation at birth ?
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9
Q

what viral hx do you want to receive for the maternal/newborn hx

A

Hep B

Routinely give a Hep B vaccine shortly after birth to ALL newborns ( with parents consent )

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10
Q

For women who are + for what antigens through vertical transmission is about 90 %

A

HBsAg and HBeAg

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11
Q

If mom has HBsAg +, the baby needs ?

A
  • HBIG (Hep B immune globulin)
  • AND the Hep B vaccine ASAP after birth . Opposite legs .
  • Then Hep B is given again at 1 and 6 months of life.
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12
Q

IfHBsAg is NOT tested, and mom is high risk, what is the next step?

A

give Hep B vacine ASAP and do labs. IfHBsAg is + can give HBIG up to 48 hours after

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13
Q

T/F: there is a Hep C vaccine and prevention for newborns

A

F: no vaccine or prevention

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14
Q

If mom is HIV +, babies receive antiretroviralswithin ?

A

6-12 hours

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15
Q

Mothers who have Hep B, what is completely CI for newborns?

A

Breast feeding is NOT recommended

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16
Q
  • system that helps determine overall condition at birth = neonatal survival
  • Recorded at 1 and 5 minutes after birth ( every 5 minutes if needed )
A

APGAR

Appearance
Pulse
Grimace
Activity
Rsp

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17
Q

T/F: APGAR does NOT predict long term outcomes

A

T

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18
Q

What is the scoring of APGAR and what is the minimum you want?

A

1-10, you want at least a 7

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19
Q

exam of the newborn that evaluates both physical characteristics AND neurological characteristics of a newborn

A

Dubowitz / Ballard Exam and Scoring

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20
Q

The total score of Dubowitz / Ballard Exam estimates ?

A

gestational age

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21
Q

Why is it important to know gestation

Ballard Age

A

due to knowing what behavior and medical issues can arise at different ages

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22
Q

What is the best indicator of gestational age (if known)?

Ballage Age

A
  • Date of LMP
  • If periods were regular

Physical and neurological development are cues to gestational age also

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23
Q

What imaging can also add to predictive value for Ballard Age?

A

Fetal US

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24
Q

When is it best to perform the Ballard Postnatal assessment?

Plantar creases

A

30-42 hrs of age

  • Takes about 3-4 minutes to complete – even on sick infants
  • New Ballard can test infants from 20-44 weeks
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25
Q

This is an unexplained death of a healthy baby that is younger than one
Usually happens during sleep
The true reason is unknown

A

SIDS (Sudden Infant Death)

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26
Q

theory of SIDS etiology

A

an area in the brainthat controls breathing and waking from sleep

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27
Q

RF for SIDS

A
  • Certain brain defects – brain area that controls breathing is underdeveloped
  • Low birth wt - similar to above - less control over autonomic processes
  • Rsp infections - Many infants who die recently had a cold .
  • Sleeping ontheir stomach or side
  • Sleeping on a soft surface (fluffy blanket , soft mattress or waterbed)
  • Sharing a bed- with parents, siblings or pets.
  • Overheating - Being too warm can increase the risk also.
  • Sex - males > females
  • Age- largest risk between 2 and 4 months
  • Race – for unknown reasons, it is more likely in Black , Native American and Alaskan Native babies .
  • FHx- babies with siblings who died of SIDShave a higher risk
  • 2nd hand smoke- babies who live with a smoker are at higher risk
  • Premature births - being born early and having a LBW increase the risk also
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28
Q

How to reduce the risk of SIDS

A
  • Placing baby on the back to sleep / never the side or stomach
  • Keep the crib as bare as possible. Firm/ flat mattress
  • No pillows, blankets or stuffed animals.
  • Don’t overheat the baby. Never cover the baby’s head
  • The baby should sleep in parents room for the first 6 months
  • Breast feed if possible
  • Do not rely on commercial devices that predict SIDS. They do not prevent it.
  • Offer a pacifier.
  • Get vaccines on time.
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29
Q

Components of the PE of the newborn

beginning/general

A
  • Simple observation is important - Note color, tone, cry and movement. Best if the baby is undressed and quiet.
  • Best if the baby is not hungry, and if the room is warm.
  • Make sure your hands are warm.
  • Talk to parents to tell them what you are doing.
  • Suggest eye exam and listening first (heart & lungs)
  • Then the ears, throat and groin for the latter – most upsetting
  • Listen to the cry
  • measurements - wt, height, head circumference
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30
Q

how should the cry of the newborn sound?

A

A normal cry is strong usually

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31
Q

abnormal cries from a newborn

A
  • High pitched cry can be a sign of an abnormality
  • Low , hoarse cry can be a sign of hypothyroidism
  • Weak, poor cry can mean a sick infant
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32
Q

how should the skin of a newborn look like?

A

Normal is pink and uniform

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33
Q

Skin has a “mottled look “- like a cobblestone street
More commonwhen skin is cold
Superficial blood vesselsdilate and give red color then constrict and give bluecolor

A

Cutis marmorata

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34
Q

bluish discoloration of the infants HANDS and FEET
This effect is due to vasomotor changes that results in peripheral vasoconstriction and is benign.

A

acrocyanosis

Thie is a normal finding in all newborns.

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35
Q

Cutis marmorata is a common skin finding in what condition?

A

Down syndrome

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36
Q

Normal finding-waxy or cheesy like appearance after birth .
It is a biofilm that covers the fetus during the last trimester
Protects newborn skinand also provides a barrier against infection.

A

Vernix Caseosa

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37
Q

Delayed bathingis common, why is it helpful for vernix caseosa?

A

delaying over 12 hoursmay help thermoregulation, hypoglycemia and and the rates ofbreast feeding

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38
Q

Light, fine hair that covers the newborn baby.

A

Lanugo

  • The earlier the baby is, the hairier it is
  • The hair is thought to insulate the baby and to help the vernix “stick” to the baby.
  • Disappears over time
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39
Q

4 common skin “rashes” in newborns

A
  • Erythema Toxicum
  • Newborn acne ( Ance neonatorum )
  • Milia
  • Sebaceous gland hyperplasia
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40
Q
  • Red base , papular - vesicular rash that is COMMON in newborns
  • Involves eosinophils in tiny vesicles
A

Erthythema toxicum

Appears 2-5 days after birth and resolves in weeks

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41
Q

Closed comedones – red and inflamed
Looks like real acne on the cheeks , forehead and sometimes chest and back

A

Acne neonatorium (Newborn acne)

Resolves on its own

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42
Q

Tiny, white epidermal cysts filled with keratin.

A

Milia

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43
Q

what are Epstein’s pearls?

A

Milia in the roof of the mouth

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44
Q

what are Hemangiomas

A
  • Very common vascular birth mark.
  • Cause is notknown.
  • MC on face, scalp, thorax, can be anywhere.
  • small, densely packed blood vessels
  • They grow rapidly, then remain fixed and then start to resolve.
  • Most are gone by the age of 9.
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45
Q

Hemangiomas may require immediate treatment if:

A
  • Visual, hearing, rectal, vaginal, nasal obstructions
  • Any airway obstruction
  • Huge hemangiomas may cause cardiac decompensation
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46
Q
  • Light red macules that are found over the nape of the neck ,upper eyelids and between eyebrows.
  • We also call this a “Stork Bite “
A

Nevus simplex

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47
Q

Dark red macules anywhere on the body
Thick , dilated blood vessels

A

Nevus Flammeus/ port wine stain

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48
Q

If a nevus flammeus is seen on the face along the opthalmic branch, they have a risk to develope what syndrome?

A

Sturge Weber Syndrome

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49
Q

Nevus flammeus is associated with what vision problem?

A

glaucoma

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50
Q

what neuro complications can happen if a newborn has a nevus flammeus

A
  • angiomas that grow in the brain
  • seizures
  • developmental disabilities
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51
Q
  • Darkish blue birthmark over the lower back and butt
  • More common in darker skinned babies .
  • Also known as a “Mongolian Spot “
A

Congenital dermal melanocytosis

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52
Q

light brown oddly shaped flat macules that can be anywhere
They persist for life and may even increase in number

A

Café au lait spots

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53
Q

if Café au lait spotsare > 6 macules over 1/2 a cm, this is a major diagnostic criteria for ?

A

neurofibromatosis1

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54
Q

what can cause the newborn head to eb elongated?

A

vaginal births

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55
Q

____ babies have a narrow face and head at times

A

Breech

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56
Q

what is Hydrocephalus and causes

A
  • Can be present at birth due to slowly increasing ICP ( intracranial pressure )
  • causes ventricles to enlarge = head
  • grows in circumference
  • d/t obstruction of flow (Malformations in the brain like blocked 4th ventricle , Dandy walker malformation or Arnold Chiari malformation)
  • overproduction ofCSF ( Choroid plexuspapilloma )
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57
Q

cause of Sunsetting eyes

A

increased pressure

58
Q

management for hydrocephalus

A
  • Serial head measurements
  • VP ( ventriculo- peritoneal ) shunt to shunt fluid from the brain into the abdominal cavity
59
Q

how many fontaelles do newborns have at birth

A

2 - anterior and posterior

60
Q

which fontanelle closes from 9-24 months?

A

anterior

posterior - closes 2-3 months

61
Q

Tense and bulging anterior fontanelle may indicate ?
Depressedfontanelle may show ?

A
  • increased intracranial pressure
  • dehydration
62
Q
  • Caused by swelling of scalp d/t pressure on head during a vaginal birth
  • decreased blood flow to the area = edema
  • Can extend across suture lines
  • Localized soft tissue edema with poorly defined borders
  • Resolves after 2-3 days
A

Caput Succedaneum

63
Q

Head feels soft like a cyst and usually occurs after a difficult delivery, or an instrument associated delivery
Well defined outline, does not cross suture lines and takes several weeks to resolve

A

Cephalohematoma ( Head bruise )

This is actually a subperiosteal hemmorhage

64
Q
  • abnormal thinning of the parietal bones in preterm babies
  • Gives the sensation of a ping pong ball on pressure
  • Usually disappears in a few weeks.
A

Craniotabes

65
Q

Craniotabes is usually along what parts of the skull

A

parietal bones , sometimes occipital , running along lambdoid suture lines .

66
Q

If craniotabes does not disppear in a few weeks, what must you start thinking?

A

pathology - rickets, osteogenesis imperfectaor hydrocephalus

67
Q
  • Serious, but rare complication usually associated with vacuum-assisted delivery
  • Caused by rupture of the emissary veins, which are connections between dural sinuses and scalp veins
A

Subgaleal hematoma/hemorrhage

68
Q

cause of Subgaleal hematoma/hemorrhage

A
  • rupture of the emissary veins, which are connections between dural sinuses and scalp veins
  • Blood accumulates between the epicranial aponeurosis of scalp and periosteum
  • This space can easily accommodate up to one half of the blood volume of a neonate
  • Need to monitor blood pressure, hematocrit, bilirubin, signs of hypovolemia
69
Q

Why is examining the face important and what to look for?

A
  • Odd faces may mean a genetic condition
  • Should be examined carefully in regard to shape, size , eye position , ears , nose , mouth and chin
  • If there are several anomalies, one must think of an associated syndrome .
70
Q

Short jaw (Micrognathia) , cleft palate and airway obstruction
Life threatening congenital anomaly .

A

Pierre Robin Syndrome

71
Q

cause of Pierre Robin Syndrome

A
  • Happens due tofailure of the mandible to grow. Tongue blocks fusion of the palate- so a cleftforms
  • Tongue then obstructs the airway .
72
Q

tx for Pierre Robin syndrome

A

fixing the lower jaw
supporting the child with feeding help and breathing helpin the meantime

73
Q

What cranial nerve can be damaged during delivery?

A

CN VII - facial nerve palsy

It can be due to difficult/ forcep assisted delivery

74
Q

A newborn has an asymmetrical face while crying, what may you suspect?

A

facial nerve palsy

75
Q

tx for facial nerve palsy?

A

observation

76
Q
  • Collection of blood beneath the conjunctiva due to trauma
  • Likely due to the birth process.
  • A common eye finding
  • Goes away on its own and needs no treatment
A

Subconjunctival hemorrhage

77
Q

newborns with Conjunctivitis are all given?

A
  • erythromycin ointment to prevent chlamydia eye infection right after birth
  • leading cause of blindness in developing countries
78
Q
  • This is a clouding of the lens of the eye – present at birth .
  • May indicate medical issue- metabolic disease, congenital infection or problems with the thyroid
A

Congenital cataracts

79
Q
  • rarely affects newborn’s eyes and cause major damage to the optic nerve .
  • If undiagnosed and untreated, can lead toblindness.
  • These kids have tearing, tight eyelids and terrified of light
A

Glaucoma

80
Q

how to examine the red reflexes of the newborn eyes?

A
  • Red reflex with the ophthalmoscope
  • Examine about 6 inches away .
  • Every visit for the first 3 years .
81
Q

Absent,blunted or white reflex can mean what when testing red reflexes of the eyes?

A

glaucoma , congenital cataract or retinoblastoma

82
Q

White response during red reflex testing is indicative of?

A

Leukoria

This is an immediate referralto Opthalmology

83
Q

This is a rapidly developing eye tumor from immature cells in the retina.
white pupillary response ( cat’s eye) or luekocoria

A

Retinoblastoma

84
Q

The most common cause oftearing and discharge from the eye.
There is heavy mattingof the eye and debris on the lashes

A

Dacryostenosis

85
Q

T/F: redness of the conjunctiva is not normal

A

T

86
Q

management for Dacryostenosis

A

Spontaneous resolution occurs in 90 % ofbabies by 6 months
Can be referred for probing if not resolved

87
Q
  • when the tear duct becomes infected .
  • There is redness, warmth and swelling of the area
A

Acute dacryocystitis

88
Q

pathogenicity of Acute dacryocystitis

A

staph aureus

89
Q

Acute dacryocystitiscan lead to what other eye condition?

A

orbital cellulitis

90
Q

tx for acute dacryocystitis

A

consulting Ophthalmology , probing to open the area, and systemic antibiotics.

91
Q

cause of septal deviation

A

trauma with birth

  • Make sure the nares are patent on exam
  • Newborns all are obligate nose breathers and will have respiratory distress if not addressed.
  • Surgery can be used as the child grows older
92
Q

congenital disorder where the back of the nose is blocked due to abnormal bony tissue (happens during fetal development)

A

Choanal atresia

93
Q

tx for Choanal atresia

A
  • surgery to open the area .
  • This can cause feeding and breathing issues.
94
Q

how are natal teeth dangerous?

A

They do not have strong roots and can be easy to aspirate.
These are usually removed and can be associated with several syndromes

95
Q

White , thick coating inside the mouth and inside the cheeks
Cannot be scraped off .
Painful for the baby and cause trouble eating .

A

Oral thrush

96
Q

tx for Oral thrush

A

antifungal applied inside the mouth

97
Q

hygiene considerations for oral thrush

A

If mom is breast feeding, she needs to clean her breasts well and apply the same medication
Boil all bottle nipples and pacifiers during treatment

98
Q

A normal location of the ears is determined by ?

A

drawing an imaginary line from inner canthus of the eye perpendicular to the vertical axis of the head

If the helix of the ear lies beneath this line , this can be associated with other syndromes

99
Q

small indentions in front of the ear of newborns

A

Preauricular pits of ears

  • Common, but can be associated with other congenital anomalies
  • Risk of permanent hearing loss with ear pits or tags is 5x than normal population
  • A simple ear pit alone does not increase the risk.
100
Q

cause of ear tags and pits

A

issues with the timing of congenital development

101
Q

if a child has an ear pit / tag and any other craniofacial developmental issue, what imaging should be obtained?

A

renal ultrasound

For kids with associated facial , dysmorphic appearance, they can have renal abnormalities.

102
Q

how to exam newborn lungs?

A
  • Lungs : Watch rate and effort in the infant
  • Newborns breathe about 30-60 bpm
  • Observe for any noisy breathing , increased effort, such as pulling the skin in between ribs. Watch for difficulty .
103
Q

how to examine heart of newborn?

A
  • murmurs - great majority are benign
  • Watch skin color and check pulse ox.
  • check pulses in the upper and lower body - delay/absence in LE could indicate coarctation of the aorta .
  • Look for central cyanosis – sign of congenital heart disease
104
Q

how to examine abdomen of newborn

A
  • Observe and palpate and complete the exam by looking at anus - imperforate anus means itis missing or blocked
  • abdomen is relaxed - kidneyscan be palpated .
  • Most abdominalmasses - kidney anomalies.
  • The liver and spleen are superficialand can be feltin the abdomen.
105
Q

a birth defect where there is an abnormal opening in the diaphragm that allows the abdominal content to move into the chest cavity

A

Diaphragmatic hernia

106
Q

management for Diaphragmatic hernia

A

Surgery is required for this . Diagnosed prenatally

107
Q

presentation of Diaphragmatic hernia

A
  • tachypnea , tachycardia and cyanosis .
  • One side of the chest islarger than the other
  • Concave abdomen
108
Q

what is omphalitis

A

umbilical cord area infection

109
Q

how do umbilical hernias happen?

A
  1. As the fetus develops , there is a small opening in the abdominal muscles.
  2. This allows umbilical cord to pass through connecting to mother to the baby.
  3. After the baby is born , the abdominal musclesclose (rectus abdominus).
  4. Sometimes the musclesdo not meet and growtogethercompletely , leading to an umbilical hernia.

MC in AA

110
Q
  • Appears as a soft bulge at the belly button.
  • Easy to reduce .
  • Usually gives no medical issues for the baby
  • Rarely could have the complication of incarceration.
  • Usually resolves spontaneously by 3-4 months.
A

Umbilical hernia

If not resolved by about 3, can send to surgery for an evaluation

111
Q

Soft, pink, friable lesion of granulation tissue at the belly button.
Somepersistent drainageof serous fluid , sometime greendischarge or moisture around the cord.

A

Umbilical granuloma

112
Q

Tx for umbilical granuloma

A
  • silvernitrate- cauterizes the area
  • This can be treatedseveral times with silvernitrate and may require surgery .
113
Q

what is leukorrhea

A

milky white or blood streaked vaginal discharge as a result of maternal hormone withdrawal

114
Q

how may the labia of a newborn look?

A

Can be swollen or even bruisedafter birth .

115
Q

how to perforn genitourinary exam for males?

A
  • confirm both testicles are in the scrotum.
  • Scrotum has morefolds the closer they are to term
  • The foreskin cannot be retracted at birth.
  • Consent must be given for circumcision
  • If there are anomalies of the penis , circ is held
116
Q

what genitourinary function of a newborn must do to be considered for DC home?

A

baby must void

117
Q

how to exam newborn extremities?

A
  • Watch for equal and symmetric movements
  • Look for fusion of digits (Syndactyly)
  • Also look for extra digits (polydactyly)
  • All of these things can be isolated , or associated with syndromes
118
Q

where the head of the femur does not fit into the hip well

A

congenital hip dysplasia

119
Q

cause of congenital hip dysplasia

A

socket of the hip being too shallow and not holding the head of the femur in place

120
Q

congenital hip dysplasia is MC in who and which hip?

A
  • left hip
  • girls
  • firstborn children, also in multiples
  • FHx
  • Breech babies and multiples
121
Q

result of congenital hip dysplasia if left untreated or missed?

A

life long limp and osteoarthritis of the hip

122
Q

what are the test to use to observe for congenital hipe dysplasia?

A

barlow and ortolani tests

123
Q

MC used for treating congenital hip dysplasia
Helps keep hips and knees bent and thighs spread apart. It can also help promote healing in babies with broken thighbones (femurs).

A

Pavlick harness

124
Q

MC fracture in a newborn?

A

clavicular fracture

Associated with a difficult vaginal delivery .

125
Q

RF for clavicular fracture?

A

shoulderdystocia, post term, being induced and higher birth weight

126
Q

s/s of clavicular fracture

A

crepitus, swelling of the area , abnormal bone contour, crying with movement.

127
Q

management for clavicular fracture

A
  • immobilize with a sling
  • Will heal on its ownwith the formation of a callous
128
Q

what does the neurological exam observe for?

A

Looks at primitive reflexes , sensory systems and cranial nerves

129
Q

what is a Sucking reflex?

A

newborns suck in response to a nipple or pacifier in the mouth

130
Q

what is the rooting reflex?

A

newborn will turn their head to the side of facial stimulation

131
Q

what is the palmar grasp

A

newborns hand will grasp the examiners finger - develops by 28 wks

132
Q

what is babinski

A

The examiner takes an object such as a key or the back of a reflex hammer to stroke the bottom of a baby’s foot from heel up to big toe.

133
Q

what is the normal reaction when doing babinski?

A
  • The big toe should bend up and backwardwhile the other 4 toes fan out
  • This response is only normal in kids under 2 .
134
Q

how to perform Moro(startle) reflex

A

Hold the infant’s upper body off the table, and carefully allowthe head to drop 1-2cm

The arms should abduct at the shoulder and extend at the elbow.
Adduction with flexion will follow

135
Q
  • Turn the infants head to one side and the same side leg and arm will extend , and the opposite leg will flex
  • Appears like a “fencingposition” Gone by 8 months.

what is this reflex

A

tonic neck reflex

136
Q

An infant is pulled from lying by it’shands to a sitting position. FIrst the head will lag , then come to the midline, then flex forward . The baby will help a little

what is this reflex?

A

Traction response

137
Q

how can the brachial plexus be injured during delivery?

A
  • with a hard pull on the neck as the shoulders pass through
  • Pulling on the infant’s shouldersduring a head first delivery
  • Pressure on the baby’s raised armsduring a feet first delivery
138
Q

RF for brachial plexus injury

A
  • large babies ( diabetic moms)
  • Breech delivery
  • Difficulty getting the shoulder through ( Shoulder dystocia)

Much less common than before due to improved delivery techniques.

139
Q

tx for brachial plexus injury

A
  • Most recover by 3-6 months with observation
  • Massage and ROM exercises can help
  • Rarely – surgery is needed if nervesare ruptured or avulsed
140
Q

This is a small hole or dimple near an infants lower back in the gluteal folds . (above the rectum near the tailbone )

A

Sacral dimple

141
Q

when would a Sacral dimpleneed to be studied more and why?

A
  • if large or has tufts
  • could be related to a spina bifida occultacondition or a tethered cord. Ultrasound or MRI can help with the diagnosis.

Pediatrics (23 decks)

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