The Newborn Exam Lecture Powerpoint Flashcards

1
Q

APGAR score

A

2 scores done at 1 and 5 minutes of birth to assess the integrity of the cardiopulmonary system based on appearance, pulse, grimace (reflex irritability to suctioning), activity (muscle tone), and respiratory effort rating each on a scale of 0-2 (appearance pale or blue, body pink extremities blue, or pink all over, pulse absent, below 100, or over 100, grimace none, weak, or strong, activity limp, some flexion, or spontaneous movement, and respiratory effort absent, hypoventilation gasping, or coordinated vigorous cry) with a maximum score being 10 and a score less than 7 indicating the infant at risk

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2
Q

Routine newborn care orders (11)

A
  • inject vit k 1mg IM
  • erythromycin opthalmic 1cm ointment to both eyes (prophylaxis, required in most states)
  • feed early and often (<2 hours) to prevent hypoglycemia
  • glucose screening
  • vitals
  • weight (weight loss is normal but stop losing around day 5 then weight gain, want to be at birth weight by 2 weeks of age)
  • routine hearing screening
  • routine metabolic/genetic screening
  • circumcision
  • bilirubin measures 8-12 hours and at discharge
  • hep B vaccine and hep B immunoglobin if mom is antigen pos
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3
Q

Jaundice/hyperbilirubinemia occurs when total serum bilirbuin is greater than…
Direct vs indirect is reabsorbed and which is excreted in colon?

A

…5mg/dl

Direct is not reabsorbed, it goes DIRECTLY out the body

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4
Q

___hyperbilirubinemia is the most commonly encountered jaundice of the newborn, while ____ hyperbilirubinemia is always pathologic and can indicate a serious underlying disorder

A

Unconjugated, conjugated

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5
Q

Physiologic jaundice

A

Becomes present on 2nd or 3rd day of life, peaks on 4th then decreases, exaggerated in breastfeeding jaundice but is harmless, typically due to unconjugated bilirubin depositing into skin and surface tissues, if unconjugated builds up it can cross the BBB (conjugated cannot) and this will lead to kernicterus

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6
Q

Pathologic jaundice

A

Jaundice that presents in the first 24 hours or if it increases by more than 5mg/dL per day or is >17 (total), or if the infant is showing signs and symptoms of serious illness, or if it is conjugated hyperbilirubinemia

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7
Q

Physical exam of hyperbilirubinemia of the newborn (3)

A
  • appearance (yellow coloration)
  • press on skin and look for blanching to reveal tone underneath
  • clears from bottom to top of body (can be used as an estimate to look at legs and see if they are clearing to estimate level)
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8
Q

High risk hyperbilirubinemia of the newborn treatment options

A
  • phototherapy

- exchange transfusion in severe cases

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9
Q

Dubowitz clinical assessment

A

Gestational age assessment based on 10 neurologic signs and 11 external criteria

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10
Q

Neuromuscular maturity assessments (dubowitz clinical assessment) (6) (there’s 10 idk why we aren’t going thru all of them)

A
  • Posture (more flexed the higher score 0-4)
  • Square window (wrist flexion -1 to 4)
  • arm recoil (flex forearms 5 sec then fully extend then see rxn, more they flex higher score 0-4)
  • Popliteal angle (alternating flexed and extended legs and measuring angle 180 -1 to <90 being 5)
  • scarf sign (how far can cross elbow, if reaches opposite shoulder then -1 to does not cross proximate axillary line 4)
  • Heel to ear (draw baby’s foot as near to head as it will go and grade on diagram)
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11
Q

Physical maturity assessments (dubowitz clinical assessment) (7) (technically 11 of them exist)

A
  • Skin (should be sticky, friable, transparent, superficial peeling)
  • Lanugo (range from none to abudnant to thinning to bald from least mature to most)
  • plantar creases (uhh)
  • breast (imperceptible to full areola -1-4)
  • eye and ear (lids fused or firm developed with thick cartilage)
  • male genital development (testes should have descended)
  • female genital development (clitoris should shrink and majora covers clitoris and minora)
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12
Q

History questions in the newborn examination (5)

A
  • pregnancy related health issues
  • blood types
  • medications
  • lactation
  • prenatal lab values
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13
Q

Physical exam of the newborn

A
  • height (length) weight and head circumference
  • temp (best is rectal)
  • measure other vitals
  • skin assessment (color, trauma, color change)
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14
Q

Cutis marmorata

A

Reticulated mottling of skin that symmetrically involves trunk and extremities, harmless and does not need to be treated

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15
Q

Harlequin color change

A

Occurs when a newborn lies on side and sees erythema of the dependent side of the body with simultaneous blanching on the contralateral side, benign and often unnoticed

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16
Q

Mongolian spots

A

Blue or slate gray color skin marks that resemble bruises but are not sensitive to touch, usually fade by school age and do not need treatment - but document so they are not confused with bruising

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17
Q

Benign infantile hemiangioma, complications and when does it need referral, treatment (1)

A

Common 3 stage benign skin lesion that typically requires no treatment, most common complication is ulceration, need further eval for large or segmented, multiple, or those located near sacral spine, midline, or near eye, can be treated with propranolol

18
Q

Nevus complex (macular stain)

A

Benign ocurring in 40-60% of infants that fades in 1-2 years but can persist with no consequence

19
Q

Erythema toxicum neonatorum (rash of the newborn)

A

common benign skin condition of newborns in almost 50%, usually between day 3 and 2 weeks of life, appears as small yellow to white papules surrounded by red skin (“flea bitten”), usually on face, chest back, upper arms, and sometimes on thighs but palms and soles are spared, no treatment needed and usually fade or disappear over 2 weeks. If no other signs of infection present, then doesn’t need workup

20
Q

Acne neonatorum (infant acne)

A

Common in 20% of newborns, most resolves spontaneously without scarring with no treatment needed, in extreme cases can use benzoyl peroxide

21
Q

Seborrheic dermatitis (cradle cap) and treatment options (3)

A

Very common rash characterized by erythema and greasy scales on the newborn, can affect the face, ears, and neck, usually self limiting but can be treated with white petroleu, ketoconazole shampoo, or hydrocortisone cream

22
Q

Eczema of the newborn and treatment options (3)

A

Common in infancy and usually resolves by age 2, can be found all over body in dry patches and can be itchy, treat with vaseline, sensitive skin soaps, sometimes steroid creams

23
Q

Diaper dermatitis

A

Typically caused by candida infection of the newborn (sees satellite lesions) or strep B, can occur if diapers are not being changed resulting in skin breakdown, can treat with antifungal cream or antibiotic

24
Q

Bulging, sunken, early closure of the fontanel on assesment can indicate each of these codnitions

A
  • increased intracranial pressure
  • dehydration
  • craniosynctosis (early closure)
25
Q

When does the fontanel typically close?

A

9-15 months of age

26
Q

Caput succedaneum vs cephalohematoma

A

Depends on space where found, caput succedanoeum crosses suture lines and cephalhematoma does not, both are typically self resolving

27
Q

Red reflex exam on infants and fundoscopic exam on infants

A

Recommended to always do, not recommended need referral

28
Q

Small conjunctival hemorrhages are common during…

A

….birth

29
Q

Low set ears on newborn and association

A

Associated with congenital kidney defects and other chromosome disorders

30
Q

Choanal atresia

A

Blockage of nasal airways by tissue or bone congenitally, concern because infants require breathing thru nose, if concern can be tested patency with catheter

31
Q

Common conditions of the mouth and pharynx and what they are in the newborn (4)

A
  • tongue tie (ankyloglossia)
  • cleft palate
  • bifid uvula
  • epstein pearls (pinhead, whitish benign self resolving round lesions of heart palate)
32
Q

Torticollis and treatment (1)

A

Condition in which the head is tilted to one side while chin is rotated to the other shoulder, a hematoma of SCM muscle or birth injury can produce, can be repaired with physical therapy

33
Q

Study of choice in concern for fetal heart malformation

A

echocardiogram

34
Q

Dextrocardia

A

Heart oriented to the right side of the body opposed to the left

35
Q

Delay or absence of femoral pulse should raise suspicion of what in the newborn? What test do you order?

A

Coarctation of the aorta, echocardiogram

36
Q

Umbilical cord stump analysis

A

Should have 2 umbilical arteries and one vein, presence of only one artery may indicate congenital renal abnormalities

37
Q

Scaphoid abdomen

A

Abdomen that is not protruberant characteristic of the newborn, indicative of diaphragmatic hernia

38
Q

Umbilical hernia of the newborn

A

Common herniation that usually closes on its own by 2 years of age, surgical closure can be considered at later age

39
Q

Should the umbilical stump be treated when infected?

A

Normally just leave it and let it fall off, if infected can use topical antibiotic and rarely systemic

40
Q

Failure of meconium passage in first 24 hours indicates possibility of these 2 pathologies

A

cystic fibrosis

hirschsprungs disease

41
Q

Barlow and ortolani maneuvers

A

Downward force while hip is adducted andupward force while hip is abducted listening for a click indicative of hip dysplasia, requires ultrasound to rule out if positive (or if the baby is born in breech position then always)

42
Q

Primitive reflexes (7) and description of them***

A

1) Rooting reflex - turn head and mouth towards finger stroking cheek laterally
2) sucking reflex - tendency to isntinctivly suck vigorously at anything touching the mouth and swallow it regardless if hungry or not
3) moro reflex - as child is slowly lowered head down their upper limbs abduct (thrown up)
4) grasp reflex - instinctively grasp upon placing any object on palm and cannot voluntarily let go up until a year of age, same with toes
5) placing reflex - pick foot up if held in front of table edge and place it on table
6) asymmetrical tonic neck reflex/fencer reflex - when lying supine turn head 90 degrees they take on a fencing pose
7) walking reflex - when held above ground will place one foot in front of other