Lecture 6: Management and Exam of the Healthy Neonate

Question 1

Describe the routine delivery room care of a healthy, term infant.

Answer 1

Warming, drying, and clearing of airways

Question 2

List the 5 clinical components of the APGAR score.

Answer 2

• Heart rate
• Respiratory effort
• Muscle tone
• Reflex irritability
• Color

*CHRMR*

Question 3

Explain why Vitamin K is injected and topical erythromycin ophthalmologic ointment applied immediately after birth?

Answer 3

• Vit K because babies don’t have the microflora to make it; need it for clotting.
• Eye care for prevention of N. gonorrhea and C. trachomatis conjunctivitis

Question 4

What is the age at which the majority of newborns regain their birth weight?

Answer 4

By 10-14 days

Question 5

What is the expected daily weight gain after the first week for newborn?

Answer 5

15-30 grams/day

Question 6

What is the the maximum acceptable weight loss in the week following birth?

Answer 6

• 7% loss or greater demands close follow-up
• Up to 10% is acceptable in most situations

Question 7

Describe acrocyanosis vs. central cyanosis in newborn.

Answer 7

• Acrocyanosis: blue discoloration of the perioral area, feet, and hands = normal for the first 24-hours
• Central cyanosis: bluish discoloration of tongue/mucous membranes; persisting after the first 10 mins. of life is always abnormal

Question 8

Micrognathia is a part of many syndromes, the most well known is what?

Answer 8

Pierre-Robin Sequence

Question 9

Choanal atresia in newborns may be associated with what syndrome?

Answer 9

• CHARGE syndrome
• Coloboma
• Heart defect
• Atresia choanne
• Retarded growth/development
• Genital abnormalities
• Ear abnormalities

Question 10

Describe the normal number of arteries and veins in an umbilical cord.

Answer 10

Normally 3 vessels (2 arteries and 1 vein)

Question 11

Compare and contrast cephalohematomas and caput succedaneums; which crosses suture lines?

Answer 11

• Cephalohematomas: subperiosteal blood, may be bilateral, takes weeks to months for resolution; does NOT cross suture lines
• Caput Succedaneum: boggy area of edema and/or bruising; crosses suture lines; present at birth and resolves in days.

Question 12

Define “molding” in the neonate?

Answer 12

Newborn head molding is an abnormal head shape that results from pressure on the baby’s head during childbirth.

Question 13

Re-examination of which area of the newborn before discharge has been shown to be the only consistent portion of the PE to pick up an abnormality not seen prior?

Answer 13

Hips

Question 14

What are the 2 maneuvers used to exam the hips in a newborn baby?

Answer 14

• Barlow test
• Ortolani test

Question 15

What is vernix in a newborn?

Answer 15

White cheesy stuff that babies have all over (especially inguinal/axillary), appear about 35 wks and may be gone at 41 weeks

Question 16

What is erythema toxicum of the newborn?

Answer 16

• aka Flea-bite syndrome
• Benign rash, usually appears 2nd-3rd day of life (gone in 7-14 days)
• Erythematous base w/ 1-2m pustules or papules; spares palms, soles

Question 17

What is Milia in the newborn?

Answer 17

• 1-2mm white, firm papules on face and bridge of nose
• Appear at 36 wks gestation and resolve spontaneously by a few months

Question 18

What is dermal melanosis (slate grey spots) in the newborn?

Answer 18

• Slate blue/grey or black; macular to patch size
• More common in darker skinned races, but affects all
• Can resemble bruises and should always be documented!