chapter 5 cont'd.

Question 0

Sucking reflex

Answer 0

Touch newborns lips, will suck
Occurs till 10 months

Preterm or barbiturate mothers will not exhibit

Question 1

Rooting reflex

Answer 1

Stroke skin at corner of mouth
Infant turns head toward side stroked

Present 3-4 months

Absence of reflex : frontal lobe lesion

Question 2

Palmar grasp reflex

Answer 2

Finger placed across palm
Infants fingers will grasp finger

If present after 4 months, frontal lobe lesion

Question 3

Plantar grasp

Answer 3

Foot touched between toes
Toes will curl downward

Lasts about 8 months

Absent in one foot, lesion

Absent in both feet, neurological condition ( cerebral palsy)

Question 4

Tonic neck reflex

Answer 4

Fencing reflex

Infant supine, rotate head
Arm/leg on turned side will extend
Opposite arm/leg will flew

May not appear 6-8 weeks

Not seen after 6 months, cerebral damage

Question 5

Stepping reflex

Answer 5

Held under arms with feet on flat surface
Will lift alternate feet (walking)
Disappears 3 months

Question 6

Extrusion reflex

Answer 6

Tip of tongue touched/ depressed
Infant forces tongue outward

Disappears 4 months

Feeding infant with spoon before 4 months is difficult

Question 7

Moro

Answer 7

Startle reflex
Hit surface infant lies on
Infant <4 month: quickly extend/abduct arms
Fingers fanning out- thumb and forefinger form a c

Tremor may be present
birth- 4-6 months

Question 8

Gallant

Answer 8

Lying prone with hands under abd
Stroke one side of spine
Shoulders and pelvis should turn forwards stimulated side

Birth- 2 months

If not present: spinal cord lesion

Question 9

Babinskis reflex

Answer 9

Foot stroked heel to toe
Great toe should dorsiflex
Other toes fan out

Disappears when walking is present

If present at 12-18 months: abnormal
Adult: should flex all toes

Question 10

Crossed extension reflex

Answer 10

Infant supine
Hold leg with knee pressed down stimulate foot
Opposite side should flex abduct and extend

Present 1st 4 weeks of life

Question 11

Placing

Answer 11

Hold Infant under arms from behind, bring to standing position
Touch dorsum of one foot on edge of table
Infant will lift tested leg onto table

No responses is abnormal

Breech or paralysis may not respond

Question 12

Ballard Scoring system

Answer 12

Gestational age
Important to identify in 1st 4 hrs so age related problems can be identified with appropriate care

External physical characteristics
Neuromuscular maturity

If scores^^ do not match up, repeat in 24 hrs

Score corresponds to week of gestation

Question 13

LGA

Answer 13

Large for gestational age

Weight above 90th percentile

Question 14

AGA

Answer 14

Appropriate for gestational age

Weight between 90th and 10th percentile

Question 15

SGA

Answer 15

Small for gestation age

Weight below 10th percentile

Question 16

Resting posture

Answer 16

Term- fully flexed

Preterm-no flexing of extremities

Question 17

Skin

Answer 17

Term- less veins, less vernix, cracking and peeling

Preterm- transparent and thin

Question 18

Lanugo

Answer 18

Term: small amount

Preterm- abundant (28-32 weeks)

Question 19

Plants creases

Answer 19

Reliable sign of gestational age

Term- covers sole entirely

Preterm- no creases

Creases begin to develop around 32 weeks

Question 20

Breasts

Answer 20

Term- I cm

Preterm- non palatable

Question 21

Eye and ear

Answer 21

Term- rapid recoil of pinna

Preterm- ear remains folded

Eyelids fused till about 27 weeks

Question 22

Male genitals

Answer 22

Term- scrotum large and pendulous, testes descended, rugae

Preterm- flat scrotum, minimal rugae

Question 23

Female genetila

Answer 23

Term: labia minors covers labia minors and clit

Preterm: clit prominent, flat labia

Question 24

Circumcision

Answer 24

Surgical removal of the prepuce (foreskin) that covers glans penis Gomco clamp- Vaseline ointment applied with each diaper change for 24-48 hrs Check hourly for 12 hrs for voiding and bleeding Assess redness sweeping or discharge Ensure consent has been signed

Question 25

Newborn kcal requirements

Answer 25

110-120 kcal/kg each day Usually 20 oz per day

Question 26

Breast feeding mother requirements

Answer 26

Increase 500 calories per day Well balanced diet Every 2-3 hrs.. 8/12 times per day

Question 27

Fore milk

Answer 27

Watery first milk from breast High is lactose Effective in quenching thirst

Question 28

Hind milk

Answer 28

Higher in fat content Comes after fore milk

Question 29

Formula feeding

Answer 29

Modified cow milk - soy - PKU formulas - nutramign - preterm infants 24 kcals/feeding less Q 3 -4 hrs 20 KCAL/oz 1/4-1/2 oz -- 3-4 oz

Question 30

Growth spurts

Answer 30

Require more formula at 2 weeks 6 - 9 weeks 3-6 months

Question 31

Hyperbillirubinemia

Answer 31

``` Excess of bilirubin Normal: Less then 24 hrs: below 6 Less then 48 hrs: below 10 3-5 days: below 12 ``` Physiological at 24 hrs Pathological after 24 hrs ---- kernicterus. Bilirubin toxicity Preterm infants at higher risk

Question 32

Hyperbiillirubinemia tX

Answer 32

Phototherapy Exchange transfusion Blood type o. Rh - Fluid increased Feelings increased Assess jaundice q 4 hrs