Neonatal and gestational age assessment Flashcards
(27 cards)
components of the Ballard assessment
neurovascular maturity (posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear)
physical maturity (skin, lanugo, plantar surface, eyes/ears. genitals)
see notes for spectrums of each of these.
reflexes in the newborn
moro/startle reflexes: when the infant startles when you scare it, puts hands up and etc.
rooting and sucking: when baby is given a surface to suck on and they turn their head and mouth towards towards the surface.
not great in pre term babies, but better in term babies.
IF A BABY DOESN’T HAVE THESE REFLEXES, THERE IS CAUSE FOR CONCERN.
scalp assessment: molding
the baby’s head gets molded as it gets pushed down the birth canal. Will resolve itself but can cause fear in parents as it looks like a “conehead”
scalp assessment: caput succedaneum
boggy, edematous swelling of the fetal scalp, disappears without treatment, no pathological significance.
will go away within 24 hours
CROSSES SUTURE LINES
scalp assessment: cephalohematoma
A cephalohematoma is an accumulation of blood under the scalp, specifically in the sub-periosteal space. During the birthing process, shearing forces on the skull and scalp result in the separation of the periosteum from the underlying calvarium resulting in the subsequent rupture of blood vessels.
Will also go away on it’s own but if it has not resolved in 4-5 weeks, call the hcp.
assessment: milia
Milia is seen in a newborn infant as tiny, white, elevated spots in the skin. On occasion, there may be a narrow red halo around the base.
Goes away by themselves
assessment: hair tufts
abnormal finding that could indicate neural tube defect, need more diagnosis/follow through, must inform the hcp.
assessment: lanugo
Lanugo: a soft little hair that comes off initially. Probably to keep babies warm.
assessment: vernix
Vernix Caseosa: “cheesy”. DO NOT TRY TO RUB IT OFF. Helps babies to regulate temperature and blood sugar and has antibacterial properties and is thought to also prevent dry/pealy skin.
assessment: foot creases
foot creases in the baby indicate the baby is farther along in the term of pregnancy.
Preterm infants do not have fully formed foot creases
assessment: Mongolian spots
Blue discoloration on the babies, document Mongolian spots. More prevalent in African Americans, Asian Americans. Can be seen in Caucasian babies too. DOCUMENT.
EDUCATE PARENTS. Not a sign of abuse.
Will go away after first year of birth.
assessment: erythema toxicum
Erythema Toxicum: “little baby acne”. Not usually upon first birth. Hormone related from the hormones in mom’s system but an autoimmune response from baby’s system to the hormones. Don’t pop or get rid of them. Widespread is normal. One or two random pustule looking things is considerably more alarming.
assessment: telangiectatic nevi:
Nevi: called angel kisses or stork bites. Fades over the first year. When babies cry or they get hot it becomes more prominent. EDUCATE PARENTS.
assessment: pseudo menses
Hormonal changes in young baby girls. Shouldn’t be bleeding, but pink or red tinged is okay. Called pseudo menses.
strabismus
when the eyes tend to wander and cross during the first 4-6 months of life. Normal in newborns, but should be transient per months. Can occur up to one year though. If it occurs after one year, then call hcp.
subconjunctival hemorrhage
burst blood vessel in the eye , normal in newborns. generally subside within two weeks.
weight/measurements
weight 2500-4000 g or 5 lbs 8 ounces to 8 lbs 3 ounces
length 48-53 cm or 19-21 inches
head 13-15 inches
chest 12-14 inches
AGA will fall within these ranges
SGA will be below
LGA will be above
jaundice
Jaundice is NORMAL when: it develops by the second and third day of life
Jaundice is ABNORMAL and PATHALOGIC when: it develops within the first 24 hours of life, and if serum bilirubin levels increase by more than 6 mg/dL in 24 hours, or if serum bilirubin exceeds 15 mg at any time.
Treatment of jaundice: phototherapy
fontanels: normal/abnormal anterior
SWOLLEN OR SUNKEN FONTANELS ARE CAUSE FOR CONCERN
the anterior fontanel will be larger and diamond shaped, even with the skull and soft. (within 7-18 months of birth)
fontanels: normal/abnormal posterior
SWOLLEN OR SUNKEN FONTANELS ARE CAUSE FOR CONCERN
The posterior fontanel will be even with the skull and triangular shaped. posterior usually closes first (within 2 months)
respiratory findings: normal vs. abnormal findings:
flaring
grunting
retracting
assessment parameters
Respirations should be between 30-60 breaths/min. it is normal to have periods of apnea for 15 seconds or so.
some flaring is normal because babies breathe through their nose more, but want this to be transient.
grunting is normal so long as it is very transient in the first few hours of life. If continued, call hcp and do interventions.
**if not transient, notify hcp/care team and do interventions.
Barlow/Ortolani
to check for hip dysplasia.
stools/BMs
Meconium should be passed ideally within the first 24 hours and less frequently within the first 48 hours. If it takes longer than 48 hours, they may need further evaluation. Stools should generally be a version of yellow, green, or brown.
breast fed babies will poop more
polydactyly
when the baby is born with too many fingers. Tx: surgically remove the extra finger
