Newborn Assessment

Question 1

What are the two methods for determining gestational age in newborns?

Answer 1

1) New Ballard
2) Dubowitz Method

Question 2

When should the New Ballard or Dubowitz method be used to ensure greatest accuracy?

Answer 2

Within 48 hours of life

Question 3

What are the 2 components examined when using New Ballard/Dubowitz Method?

Answer 3

1) Neuromuscular maturity
2) Physical maturity

Question 4

T/F: A higher score on the New Ballard or Dubowitz method is indicative of a higher gestational age?

Answer 4

True

Question 5

What is the normal weight for a newborn?

Answer 5

2500-4000 grams or 5.5-8 pounds

Question 6

What is considered a low birth weight?

Answer 6

<2500 Grams or 3.3-5.5 pounds

Question 7

What is considered a very low birthweight?

Answer 7

1000-1500 grams or 2.2-3.3 pounds

Question 8

What is considered an extremely low birthweight?

Answer 8

<1000 g or 2.2 pounds

Question 9

Describe Macrocephaly

Answer 9

head circumference that is greater than 2 standard deviations above the mean for given age, gender and gestation

Question 10

Describe microcephaly

Answer 10

head circumference that is two standard deviations below the mean for given age, gender and gestation

Question 11

What could pale skin be indicative of in a newborn?

Answer 11

1. Hypoxia
2. reduced peripheral perfusion
3. acute blood loss
4. anemia

Question 12

What is acrocyanosis?

Answer 12

blue discoloration of the hands and feet

Question 13

What is acrocyanosis indicative of?

Answer 13

peripheral vasoconstriction

Question 14

Is acrocyanosis normal in neonates?

Answer 14

Yes, it is normal and typically disappears within 72 hours after birth

Question 15

What does skin mottling look like?

Answer 15

A spider web on the skin

Question 16

What is can skin mottling be indicative of?

Answer 16

1. Hypotension
2. Anemia

Question 17

What is the normal heart rate for a neonate?

Answer 17

100-160 bpm

Question 18

What is normal respiratory rate for a neonate?

Answer 18

40-60 bpm

Question 19

What is a normal blood pressure for a neonate?

Answer 19

60-90/30-60 mmHg

Question 20

What is the normal MAP for a neonate?

Answer 20

gestational age + 5

Question 21

Where should heart rate be assessed on a neonate?

Answer 21

1. Brachial artery
2. Femoral artery

Question 22

What considerations should you make when assessing fetal heart rate?

Answer 22

1. Sleep vs awake
2. Premature vs mature

Question 23

What effect should stimulation have on a neonates heart rate?

Answer 23

Should increase with stimulation

Question 24

What is the correlation between gestational age and respiratory rate?

Answer 24

Lower the gestational age, the higher the respiratory rate

Question 25

When is a neonate considered tachypneic? Bradypneic?

Answer 25

Tachy > 60 Brady < 30

Question 26

When assessing a neonates respiration, how long should you do it and why?

Answer 26

Over the course of a minute because neonates can have irregular breathing patterns

Question 27

What are the components of the respiratory assessment of a neonate?

Answer 27

1. examination of the chest 2. evaluation of respiratory distress 3. auscultation of the chest 4. chest radiograph

Question 28

What findings on a chest examination of a neonate might be indicative of respiratory complications?

Answer 28

1. Barrel chest 2. rib deformities 3. absence of chest muscles 4. pectus excavatum or carinatum

Question 29

What are the clinical sighs of respiratory distress in the neonate?

Answer 29

1. Nasal flaring 2. Grunting 3. Tachypnea 4. Retractions

Question 30

Describe the Silverman Score

Answer 30

Tool used to quantify distress and lung disease

Question 31

What are the 5 areas examined during when calculating a Silverman score?

Answer 31

1. Upper chest 2. Lower Chest 3. Xiphoid retractions 4. Nares dilation 5. Expiratory grunting

Question 32

What score on the Silverman score is indicative of severe respiratory distress?

Answer 32

7 or greater

Question 33

Describe how a score of 0 would appear clinically

Answer 33

1. Synchronized expansion of upper and lower chest 2. No lower chest retractions 3. No xiphoid retractions 4. No nare dilations 5. No expiratory grunting

Question 34

Describe a silverman score of 5 would appear clinically

Answer 34

1. Lag on inspiration 2. Retractions of lower chest just visible 3. Xiphoid retractions just visible 4. Minimal nasal flaring 5. Grunting audible only to stethoscope

Question 35

Describe how a silverman score of 10 clinically presents

Answer 35

1. Seesaw between upper and lower chest 2. Marked lower chest retractions 3. Marked xiphoid retractions 4. Marked nare dilation 5. Grunting audible without stethoscope

Question 36

What should areas of focus be when performing cardiovascular assessment on a neonate?

Answer 36

1. Cardiac murmurs 2. peripheral pulses 3. capillary refill time 4. Preductal and post-ductal oxygen saturation

Question 37

What can a heart murmur be indicative of in a new born?

Answer 37

congenital heart defects

Question 38

What method is used to assess cardiac output and peripheral circulation in a neonate

Answer 38

capillary refill

Question 39

What is a normal capillary refill in a neonate?

Answer 39

fewer than 3 seconds

Question 40

What congenital disorders are neonates mandated to be screened for at birth?

Answer 40

sickle cell anemia cystic fibrosis hemoglobinopathies phenylketonuria galactosemia

Question 41

What is the moro reflex?

Answer 41

startle reflex infant is startled, arms extend and abduct outward with palms open which is quickly followed by bringing arms inward with hands clenched

Question 42

What is the grasp reflex?

Answer 42

neonates hand closes around the finger and grasp tightens when the finger is moved within the palm

Question 43

What is the rooting reflex?

Answer 43

neonate turns head toward the stroked cheek side and begins making sucking motions