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COMPLETE ASSESSMENT OF THE NEWBORN Flashcards

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1
Q

HEAD
Specifics: __________________
Usual Findings:

A

Shape;
- symmetrical
- molded
- round
- Palpable anterior and posterior fontanels and sutures
- Anterior fontanel flush with neighboring parts
- suture are normelly felt as ridges

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2
Q

Head
Variations:

A
  • asymmetry due to molding
  • scalp lesions or abrasion
  • cephalhematoma
  • caput succedaneum
  • Posterior fontanel may be difficult to palpate if sutures are overriding
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3
Q

HEAD
Abnormalities:

A
  • overriding of the sutures
  • severe molding
  • Tension of the anterior fontanel
  • Remarkable pulsation of fontanels
  • Depressed fontanel
  • Full bulging fontanel (intracranial
    pressure)
  • Depressed skull fracture
  • Unusually large or small head
    in relation to body size
  • Unusual hair pattern or texture
  • Subgaleal hemorrhage
  • Craniosynostosis
  • Widened sutures or fontanels
  • Craniotabes
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4
Q

immature
fusion of the newborn’s cranial
bones

A

Craniosynostosis

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5
Q

EYES
* Specifics:

A

Symmetry, Appearance,
Discharge, Sclera

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6
Q

EYES
Usual Findings:

A

o Correct placement on face in relation to one another
o Absence of tears and ability to follow midline with rudimentary fixation on objects
o Edemao Blue or gray irises; permanent color: 3-12 months
o Blink reflex present
o Cornea is round
o Strabismus due until 4-6 months
o Gets Subconjunctival hemorrhage – red spot on the sclera (absorbed in 2- 3 weeks)
o Has red reflex
o No Discharges
o Bluish-white

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7
Q

Eyes:
Abnormalities:

A

o Centered or deviated to right or left
o Marked edema or inflammation
o Drooping
o Setting-sun sign
o Purulent discharge
o Pink Iris
o Upward slant in non-oriental
o Hypertelorism
o Hypotelorism
o Congenital cataracts
o Retinal hemorrhage
o Constricted or dilated fixed pupil
o Absence of red reflex, pupillary
or corneal reflex
o Inability to follow object or bright
light to midline
o Blue or yellow sclera

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8
Q

EARS
* Specifics:

A

Shape

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9
Q

EARS
* Usual Findings:

A

o Well-formed
o Cartilage present
o Upper part of ear should be on same
plane or above angle of eye

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10
Q

EarS:
Variations

A

o Preauricular papillomas (ear tags)
may be present
o Amt. of cartilage varies (less
with prematurity)
o May be folded or creased

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11
Q

Ears
Abnormalities

A

o Malformations
o Low placement or low set of ears
indicate:
- Chromosomal defect
- Kidney disease
- Craniofacial lesions

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12
Q

Low placement or low set of ears
indicate:

A
  • Chromosomal defect
  • Kidney disease
  • Craniofacial lesions
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13
Q

NOSE
* Specifics:

A

Symmetry, Shape, Patency

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14
Q

NOSE
Usual Findings:

A

Midline of face
o Appears flattened
o Should breathe easily
through nose when mouth
is closed

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15
Q

NOSE
Variations:

A

Some mucous present in nares
may interfere with breathing

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16
Q

NOSE
* Abnormalities:

A

o Deviated to the right or left
o Malformation or unusual flattening
o Flaring of nares
o Stenosis of naris (choanal atresia)

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17
Q

MOUTH
* Usual Findings:

A

➢ Pink lips, gums, tongue and palate
➢ Normal size tongue
➢ Observe frenulum
➢ Uvula in midline
➢ There is rooting, gag, extrusion
and sucking reflex
➢ Having minimal salivation

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18
Q

MOUTH
Variations:

A

➢ There is presence of EPSTEIN
PEARL (small white epithelial
cysts along midline of hard
palate)
➢ Circumoral cyanosis
➢ Rear gums whitish
➢ Teeth can be present or
inclusion cysts (whitish toothlike cysts)

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19
Q

MOUTH
Abnormalities

A

➢ Cleft lip or palate
➢ Persistent cyanosis
➢ Tongue thrush
➢ Protrusion of tongue
➢ Frenulum linguae (tongue tie)
(may interfere with sucking)
➢ Large and thick (prominent tongue)
➢ Moniliasis/Candidiasis – white
cheesy patches in mucous
membrane and tongue
o Usually blowing bubbles,
mucus, drooling indicates
tracheoesophageal fistula and
esophageal atresia

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20
Q

FACE /NECK
➢ Specifics:

A

Appearance and Motion

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21
Q

FACE /NECK
Usual Findings:

A

➢ Neck is short and straight with
creased skin
➢ Skin fold and unrestricted
range of motion
➢ Face is symmetrical
➢ Tonic neck reflex present

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22
Q

FACE /NECK
➢ Abnormality:

A

➢ Torticollis or wry neck – head
can’t be turned from side to side;
damaged sternocleidomastoid
muscles
➢ Opisthotonus
➢ Nuchal rigidy
➢ Masses
➢ Distended veins or edema
➢ Webbing

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23
Q

head
can’t be turned from side to side;
damaged sternocleidomastoid
muscles

A

Torticollis or wry neck

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24
Q

CHEST
➢ Specifics:

Study These Flashcards
A

Shape, clavicle,
expansion, respiration, breast
tissue, nipples

25
Usual Findings: CHEST
➢ Shape is almost circular, anteroposterior and lateral diameters are equal with prominent xiphoid process ➢ Clavicles are straight and smooth ➢ Symmetry of movement with respirations ➢ Respiratory Rate is 30-60 bpm ➢ Periodic respiration with episodic apnea is normal ➢ Breast tissue is present in both sexes ➢ Symmetrical placement of nipples
26
CHEST VARIATIONS
➢ Excessive amount of breast tissue ➢ Engorged breast due to influence of maternal hormone - witch milk ➢ Presence of supernumerary nipples
27
CHEST Abnormalities:
➢ Fractures on clavicle (tenderness, palpable mass) ➢ Wide-spaced nipples ➢ Depressed sternum ➢ Marked retractions of chest and intercostal spaces during respiration ➢ Asymmetric chest expansion diaphragmatic hernia, pneumothorax) ➢Retraction (drawing in of the chest wall with inspiration) ➢ Grunting on expiration, stridor, wheezing ➢ Tachypnea ➢ Asymmetrical placement of nipples
28
CIRCULATION Specifics:
Heart Rate, Capillary Refill, Murmur, Pulses
29
Heart Rate
100-160 bpm
30
CIRCULATION Usual Findings:
Rate increased following physical or emotional stimulus ➢ Capillary refill - < 3 seconds ➢ Absent murmur ➢ Pulses are equal bilaterally
31
CIRCULATION Variations:
➢ Murmurs are intermittent during first few days of life
32
CIRCULATION Abnormalities:
➢ Heart sounds heard on right side (dextrocardia) ➢ Tachycardia ➢ Capillary refill > 3-4 seconds (poor perfusion) ➢ Murmurs are persistent ➢ Muffled heart sounds ➢ Extra heart sound ➢ Absent or weak pulse ➢ Bounding (PDA) ➢ Upper pulses > lower pulses
33
ABDOMEN ➢ Specifics:
Shape, umbilical stump, sounds
34
ABDOMEN Usual Findings:
➢ Contour cylindrical and relatively prominent; Soft ➢ Umbilical stump appears bluish white with 3 vessels ➢ Umbilical stump appears dry within several hours after birth ➢ Bowel sounds occur 1 hour after birth and are transient in first 24 hrs. ➢ Liver is usually palpable 1 to 2 cm below the right costal margin. ➢ Edge of the spleen may be palpable 1 to 2 cm below the left costal margin ➢ Peristaltic waves must not be visible
35
Abdomen Variations:
Umbilical hernia may be present and is usually insignificant ➢ Intermittent sounds
36
Abdomen Abnormalities
➢ Asymmetry ➢ Bladder extropy ➢ Localized bulging (e.g. hernia) ➢ Umbilical stump with abnormal redness, bleeding or oozing, odor Omphalocele o Sounds: hypermobility o Palpable olive shape mass or sausage shaped mass ➢ Abdominal distension ➢ Sunken appearance may indicate missing abdominal contents or a diaphragmatic hernia (bowel positioned in the chest instead of the abdomen). ➢ Enlarged liver and spleen ➢ Ascites ➢ Visible peristaltic waves ➢ Gastroschisis or Omphalocele- protrusion or sac formation of abdominal content
37
ANUS ➢ Specifics:
Patency
38
Usual Findings: ANUS
➢ Normal position ➢ Dimpled or puckered appearance
39
Abnormalities: ANUS
➢ Imperforated anus
40
GENITALIA ➢ Specifics:
Appearance
41
GENITALIA➢ Usual Findings:
➢ Female: ➢ Labia minora is quite prominent and protrude over labia majora ➢ Male: ➢ Prepuce usually adherent to the glands ➢ Testicles usually in scrotum ➢ Scrotum small and firm or fairly loose, relaxed and pendulous with rugae ➢ Meatal opening should appear as a slit
42
Genetalia Variations:
➢ Smegma ➢ Vaginal discharge - mucoid or blood tinged (pseudo menstruation)
43
GENITALIA Abnormalities:
Excessive vaginal bleeding ➢ Enlarged clitoris with urethral meatus at tip ➢ Fused labia o Absence of vaginal opening ➢ Meconium from vaginal opening ➢ No urination within 24 hours ➢ Location of urinary meatus of penis ➢ dorsal (above– epispadias) or ventral (hypospadias) ➢ Cryptorchidism: absence of one or two testicles in the scrotum (undescended testes); ➢ Malformations (phimosis), Hydrocele o Ambiguous (both male/female) o Chordee: ventral curvature of penis
44
EXTREMITIES ➢ Specifics:
Appearance, Movement
45
➢ EXTREMITIES: Usual Findings
o Maintains a posture of flexion with good muscle tone, and extremities return quickly to an attitude of flexion after extension ➢ Extremities are short in relation to the body, without deformities ➢ Full range of motion and movements are present in all joints. o Palms of the hands should have creases ➢ Hold the arms down by the sides and note their length. The fingertips should reach the proximal thigh. Unusually short arms may signify achondroplastic dwarfism o Equal and strong femoral and brachial pulses upon palpation ➢ Legs- bowed; feet- flat due to a fatty pad in the arch of the foot. ➢ Creases should cover at least two thirds of the bottom of the feet. ➢ * (-) Ortolani’s sign and (-) Barlow’s sign
46
➢ EXTREMITIES: Abnormalities
➢ Simian crease (a single palmar crease) – associated with Down syndrome ➢ * Digits Assessment: Syndactyly, polydactyly, adactyly ➢ * Plantar flexed feet- indicates clubfoot ➢ * Hip dislocation or dysplasia: ➢ Signs: ➢ *** (+) Ortolani’s Sign, (+) Barlow’s Sign ➢ *** uneven gluteal folds, one knee that is lower than the other ➢ *** when the newborn is supine with both knees flexed.
47
SKIN ➢ Normal:
- red pink skin, smooth at birth ➢ : 2nd and 3rd day- pink, flaky, dry ➢ : presence of lanugo and vernix caseosa o Pallor: Anemia o Yellow: Jaundice ➢ - Pathologic: progressive within 24 hours ➢ - Physiologic: Icterus Neonatorum- within 3-5 days after delivery ➢ Milia o Vernix Caseosa ➢ * Erythema Toxicum ➢ * Harlequin sign ➢ * Cutis Marmorata o * Lanugo ➢ * Birthmarks o A. Hemangiomas- Nevus Flammeus, Strawberry Hemangioma, Cavernous Hemangioma o B. Mongolian Spots
48
BACK/SPINE: Usual Findings
➢ Normally flat and straight in the lumbar and sacral areas ➢ Curve of back usually develops at 5-6 months ➢ Inspect the base of a newborn’s spine carefully to be sure there is no pinpoint opening, dimpling, or sinus tract in the skin
49
➢Abnormalities: BACK SPINE
A mass, tuft of hair or dimple incomplete closure of vertebrae indicates spina bifida – an opening in the spinal column with or without herniation of the meninges)
50
Babies experience growth spurts during the first year at about
3 months, 6 months, and 9 months;
51
FEEDING * every
2 to 4 hours
52
Feeding patterns become fairly regular in
approximately 2 weeks.
53
Regurgitation
(“spitting up”)
54
SLEEPING * approximately
16 to 20 hours per day.
55
difficult for infants to fall asleep by themselves
first 3 to 4 months
56
The Comprehensive Newborn Screening (NBS) Program was integrated as part of the country’s public health delivery system with the enactment of the
Republic Act no. 9288 otherwise known as Newborn Screening Act of 2004.
57
Inclusions: screening of six disorders:
1. Congenital Hypothyroidism (CH) 2. Congenital adrenal hyperplasia (CAH) 3. Phenylketonuria (PKU) 4. Glucose-6- phosphate dehydrogenase (G6PD) Deficiency 5. Galactosemia (GAL) 6. Maple syrup urine disease (MSUD).
58
The Expanded Newborn Screening will include 22 more disorders such as hemoglobinopathies and additional metabolic disorders, namely, organic acid, fatty acid oxidation, and amino acid disorders. The latter are included in the standard care across the globe.
Cystic Fibrosis * Biotinidase Deficiency * Organic Acid Disorders * Fatty Acid Oxidation Disorders * Amino Acid Disorders * Urea Cycle Disorders * Hemoglobin Disorders

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