Normal newborn heart rate:
120-150bpm
normal newborn resp rate:
40
In addition to the normal stuff you do during an adult abdominal exam, what else are you doing for the newborn?
palpate kidneys, check umbilicus
This is a genetic anomaly that is characterized by the stomach pushed out through abdominal abnormality and covered in umbilical sheath.
omphalocele
This abdominal abnormality is similar to the omphalocele, but is not a/w with a genetic disease, and does not involve the umbilical sheath.
gastrochisis
T/F: you should retract the foreskin on all newborn exams to check for hypospadias
FALSE: don’t retract foreskin, phimosis is normal until age 5. (but do check for hypospadias)
Mom is worried, her newborn girl seems to be having a vaginal bloody discharge. What should you tell her?
It is very common as a result of w/d from maternal hormones
Where is a common place for a newborn to have a fracture as result of difficult vaginal birth?
clavicles
When this abnormality is missed, it is a common source for litigation because if caught and treated before 6 months of age, any future sequelae can be avoided. You can identify this condition using what 2 special tests?
hip dysplasia. Barlow and Ortaloni
During the ________ special test, the hip is dislocated due to internal rotation. During the _______ test, the hip clunks back into place with external rotation
barlow, ortaloni
singal palmar crease is indicative of ________
down’s/trisomy
clinical term for “webbed digits”
syndactly
clinical term for “club foot”
congenital talipes equinovarus
what are some spinal defects that would lead you to suspect spina bifida?
Mild: hairy tufts, pigmentation change, clefts
Moderate: meningocele
Severe: Meningomyelocele, teratomas, sinus tracts
How can you edu mothers about prevention of spinal defects/spina bifida?
take folic acid!!
This newborn skin abnormality is important to document b/c it looks like bruising and could be confused with child abuse
Mongolian spots
This skin finding is pretty common, it involves papules filled with eosinophils. Benign, no tx required
ETN–Erythema toxicum neonatorum
This skin finding involves papules that are filled with neutrophils. They do NOT have an erythematous base, and are completely benign. They often heal as freckles.
TPN–Transient pustular melanosis
These 2 skin findings are a result of withdrawal from mom’s hormones. They are benign and will self resolve after several days if newborn’s skin is kept clean.
neonatal acne and sebaceous gland hyperplasia
This is a self-limited skin finding known as an “angel kiss” or a “stork bite”
hemangioma
This is a common skin irritation of the scalp in newborns
cradle cap aka seborrhea dermatitis
Average head circumference for newborn
34-35cm
Term for when both nares are NOT patent bilaterally
coanal atresia
When examining the skull, the ________fontanelle is easiest to palpate, and should close by _________months of age
anterior, 12
Head trauma from vaginal birthing is common. Which type is well localized (does not cross suture lines), and can be a/w jaundice or skull fx?
cephalohematoma
Which birthing head trauma is generalized, boggy feeling, and likely benign?
Caput succedaneum
absent red reflex is indicative of what?
leukocoria–>retinoblastoma
Newborn reflexes:
1) palmar/plantar grasp
2) rooting
3) moro (drop)
4) stepping reflex
At what gestational age do you declare an infant “premature”?
<37 weeks
At what gestational age do you declare an infant “post-term”?
> 42 weeks
post term infants are at risk for? (3)
1) asphyxia
2) mesoconium aspiration
3) trisomies
What is the most accurate way to assess gestational age?
early US
If mom had no prenatal care, and no US prior to giving birth in the ED, what test could you use to determine gestational age?
Ballard test
The Ballard tests adds what two scores together (and compares with gestational estimation of age) to determine true gestational age?
1) neuromuscular maturity (involve general posture)
2) physical maturity (development)
added scores are ideally 40 = 40 weeks
What’s the preferred tx of neonatal jaundice?
phototherapy converts bilirubin to urobilirubin to be excreted in urine
Aside from a single palmar crease, what are some other physical exam findings that would indicate Down’s/Trisomy 21?
1) sandal toe
2) poor tone
3) almond eyes
4) flat nose
5) small ears
6) Brushfield (white) spots on iris
7) large fontanelles
50% of Down’s babies will also have what congenital defect?
AV septal defect
Fetal development of the lungs is finishing around ___ weeks. So if baby is born sooner than this, _________disease is common.
34-36 weeks, hyaline membrane dz (no surfactant production)
What will hyaline membrane dz look like on CXR?
ground glass
You see lots of air in the abdomen on a neonatal KUB. What do you suspect?
necrotizing enterocolitis (bacteria producing gasses as waste product)
Infant comes in with parents c/o ABDOMINAL DISTENSION, blood in stool, diarrhea, feeding intolerance, lethargy, temperature instability and vomiting. What tests will you order to help dx? What do you suspect prior to getting results?
Suspect necrotizing enterocolitis. Order CBC, lactic acid level, CXR
How will you tx necrotizing enterocolitis?
1) rest gut
2) decompress gut w/ NG tube
3) IV fluids
4) abx
Undescended testicle?
cryptorchidism
Cryptorchidism is common, especially in premature males. At what age do you start to become concerned if there are no signs of dropping? And then what do you do?
6 months. (Most will descend by 3 mo). If not, refer to Uro for sx intervention
Apgar scores should be recorded how long after birth?
1 minute and 5 minutes. (20 minutes is ok for depressed/distressed baby)
There are 5 Apgar categories. What are they?
1) HR
2) resp effort
3) muscle tone
4) response to cath in nose
5) color
Apgar scores are doled out 0-2 for each category with a max healthy score of 10. What are the criteria?
1) 0–no pulse, 1– 100bpm, reg
2) 0–no effort, 1–slow/irreg, 2–strong, crying
3) 0–no tone, 1–some flexion, 2–active movement
4) 0–no response, 1–grimace, 2–cough/sneeze
5) 0–pale/blue, 1–pink trunk, blue extremities, 2–all pink