Healthy Term Infant

Question 1

post term definition?

Answer 1

> 41 weeks

Question 2

normal, over and under weight?

Answer 2

normal = 2.5-4kg
over = >4kg
under = <2.5kg

Question 3

average weight of male baby at 28 weeks?

how does this change?

Answer 3

1150g, 3.5% fat
will be around 3550g, 15% at term
= 24g weight gain per day (7g fat per day)

Question 4

why is labour dangerous?

Answer 4

hypoxic environment during contractions
foetal Hb helps release O2
prolonged labour = reduced foetal reserves
placental insufficiency
growth restriction or excess
increased cortisol and adrenaline enhances adaptation

Question 5

what important changes must occur after birth?

Answer 5

first breath/cry > alveolar expansion > change from foetal to newborn circulation > decreased pulmonary arterial pressure > increased PaO2
apgar score
early/immediate skin to skin and suckling

Question 6

what is apgar score?

Answer 6

objective measure of perinatal adaptation
score out of 10
0, 1 or 2 per component
- HR
- Resp rate
- responsiveness
- tone
- colour
normal = 8+

Question 7

most important things to consider immediately after birth?

Answer 7

keep warm
feed (skin to skin contact helps establish breast feeding, dramatic change from continuous glucose in utero)
attachment

Question 8

what is haemorrhagic disease of the newborn?

Answer 8

clotting disorder to do with vit K deficiency

can cause haemorrhage

Question 9

how is haemorrhagic disease of the newborn managed?

Answer 9

vit K (IM or oral)

Question 10

what infections are babies at risk of?

Answer 10

hepatitis B (can vaccinate if maternal history)
hepatitis C (dont need to stop breastfeeding if RNA is low)
HIV (can breastfeed if viral load undetectable)
syphilis
TB
group B strep

Question 11

vaccinations are all mothers given?

Answer 11

maternal pertussis and influenza

Question 12

baby vaccinations?

Answer 12

routine schedule
hep B at birth if needed
BCG first month?

Question 13

what are newborns screened for?

Answer 13

CF
haemoglobinopathies
thyroid function
metabolic disease
- all via blood spot test
hip screening - clinical and US scan
universal hearing screening

Question 14

what metabolic diseases may be picked up on blood spot screening?

Answer 14

PKA
medium chain acyl-CoA dehydrogenase deficiency
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria HCU

Question 15

newborn examination after birth?

Answer 15

midwife does top to toe examination immediately after birth

formal neonatal examination done by higher qualified practitioner at around 24 hrs

Question 16

what is looked for on head in neonatal examination?

Answer 16

OFC
moulding of head
overlapping sutures
cephalohaematoma (subperiosteal haematoma in periosteum between skull and epicranial aponeurosis)
fontanelles
caput succedaneum (swelling between skin and epicranial aponeurosis)
ventouse/forceps marks

Question 17

2 main head deformities to know about?

Answer 17

cephalohaematoma

• unnatural buldge on babies head
• within suture lines

caput succedanum

• scalp swelling over under the skin across midline and suture lines in baby;s skull
• not bound by suture lines?

Question 18

how are cephalohaematoma and caput succedanum managed?

Answer 18

usually self resolve

Question 19

what is looked for in eyes on neonatal examination?

Answer 19

size
red reflex (absence can indicate cataract)
conjunctival haemorrhage
squints (frequent)
iris abnormality

Question 20

risk of congenital cataract?

Answer 20

blindness

need light hitting the retina is needed to develop visual pathways

Question 21

what is looked for in ears on neonatal examination?

Answer 21

position (low set ears can indicate edwards syndrome )
external auditory canal
tags/pits
folding
be aware of family history of hearing loss

Question 22

what is looked for in the mouth on neonatal examination?

Answer 22

shape and thickness of mouth/lips
philtrum (long can indicate foetal alcohol syndrome)
tongue tie
palate (cleft etc)
neonatal teeth
ebsteins pearls (benign white pearly areas at joins of palate, gums etc)
sucking/rooting reflex

Question 23

what facial features are looked for on neonatal examination?

Answer 23

facial palsy

dysmorphism (foetal alcohol, downs syndrome etc)

Question 24

signs of resp distress on neonatal examination?

Answer 24

chest shape
nasal flaring
grunting
tachypnoea (>60)
in-drawing
breath sounds

Question 25

cardio signs on neonatal examination?

Answer 25

``` colour/saturation (SaO2) - CHD screening pulses (femoral) apex beat heaves and thrills heart sounds - common to have transient murmur - persistent murmur can indicate tetralogy of fallot (pulmonary stenosis) ```

Question 26

abdominal features on neonatal examination?

Answer 26

moves with respiration distension (acute abdomen eg due to volvulus) hernia umbilicus (infection here can be very dangerous) bile stained vomiting (obstruction) passage of meconium anus (ensure patent)

Question 27

GU features on neonatal examination?

Answer 27

normal passage of urine normal genitalia undescended testes hypospadias

Question 28

MSK features on neonatal examination?

Answer 28

``` movement and posture limbs and digits spine - spina bifida hip examination - DDH etc ```

Question 29

neurological features on neonatal examination?

Answer 29

``` alert/responsive crying tone posture movement primitive reflex ```

Question 30

what are the primitive reflexes?

Answer 30

``` suck rooting moro ATNR stepping grasp ```

Question 31

skin features on neonatal examination?

Answer 31

port wine stain haemangioma mongolian growth spot (looks like a bruise on back/buttocks) erythema