Newborn check

Question 1

what is apgar scoring

Answer 1

universally used method to assess newborn infant status immediately after birth

Question 2

what are normal vitals for newborns

Answer 2

Temp: 36.5-37.5˚C
HR: 110-160 awake, can be 85-90 when asleep
RR: 30-40
BP: 65-85/35-55

Question 3

what are some benefits for baby with skin to skin contact

Answer 3

thermoregulation, glucose regulation, lower/more stable HR, increase oxygenation / decrease apnea, neurobehavioral organization, increase analgesia, faster growth

Question 4

what are benefits of skin to skin for mom

Answer 4

decrease postpartum bleeding, increase positive feelings towards infant, increase responsiveness to infant, increase affectionate behavior, increase parenting confidence, decrease state anxiety/maternal stress, decrease sx of depression

Question 5

what are benefits of 1st breast feeding

Answer 5

Achieve effective BF 2x sooner, increase suckling efficacy
Increase oxytocin levels
Increase milk supply in first few days of life
Decrease neonatal mortality
Increase BF duration

Question 6

how long does colostrum last

Answer 6

3-5 days then converts to regular milk

Question 7

What are the three things you give baby within 1 hour for eyes and thighs

Answer 7

.5% erythromycin ophthalmic ointment, 1 mg IM vitamin K, Hepatitis B vaccine

Question 8

who gets glucose screening

Answer 8

Infants of GA < 37 weeks, post term > 42 weeks
Large for gestational age
Small for gestational age
Infants of diabetic mothers, hx of genetic form of hypoglycemia or physical findings suggestive of a syndrome associated with hypoglycemia,
Moms tx with beta adrenergic or oral hypoglycemic agents

Question 9

what are some dx to look for on cardiac screening

Answer 9

tetralogy of fallot, transposition of the great arterial, ebsteins anomaly

Question 9

how do you perform oximetry screening

Answer 9

perform pre ductal (right hand) and post ductal (either foot) saturations between 24-48 hours

Question 9

when do you send newborn to nicu for o2

Answer 9

O2 sat <90% in either extremity,
Abnormal HR or RR,
Ill appearance

Question 10

when do you do newborn hx and exam

Answer 10

within 24 hours

Question 11

what do we want to know for history of family/mother

Answer 11

prego, labor, delivery, past pregos and conditions, parental genetic and medical history

Question 12

gen appearance newborn

Answer 12

sex, malformation, fetal nutrition

Question 13

body position at rest newborn

Answer 13

reflects intrauterine position

Question 14

movement newborn

Answer 14

symmetric is normal - Abnormal can indicate birth injury

Question 15

color of newborn

Answer 15

pink is normal, acrocyanosis normal x few days, pallor, jaundice , ruddy, cyanosis = not normal

Question 16

respiratory effect newborn

Answer 16

tachypnea, nasal flaring, accessory muscle use, grunting, periodic breathing

Question 17

birth measurements newborn

Answer 17

plot weight using sex specific, gestation based standard growth curve
LGA: >90%
AGA: 10-90%
SGA: <10%
Plot length
Plot head circumference

Question 18

skin newborn exam

Answer 18

Common benign and transient findings: milia, transient pustular melanosis (baby acne), erythema toxicum neonatorum, mongolian spots (dermal melanocytosis), nevus simplex, nevus flammeus (aka port wine stain), infantile hemangiomas

Question 19

head and shape size newborn

Answer 19

fontanelles, sutures, caput succedaneum (caput crosses), cephalohematoma (fluctuant), subgaleal hemorrhage (firm and fluctuant)

Question 20

face newborn

Answer 20

symmetric, palsies (no tx except artificial tears, resolves in few days > weeks) if persistent, suspect central lesion/refer

Question 21

eye newborn

Answer 21

Spacing - abnorm: measure/think possible syndrome
Symmetric: epi cnathal folds rarely normal
Palpable fissures: slanting up or down of inner canthus - can indicate syndrome
EOMI: some asymmetry common in 1st month of life
Sclera, conjunctiva (hemorrhages common after traumatic delivery, purulent d/c > culture)
Cornea: large or hazy, suggests infantile glaucoma
Pupils: if not PEARL, think syndrome

Question 22

ears newborn

Answer 22

position (top of ear eben with outer canthus fo eye), look for cysts, sinus, skin tags or puts, dysplastic features, external anomalies associated with risk middle and inner ear anomalies and hearing loss, preauricular skin tags have increased risk of renal anomalies

Question 23

nose newborn

Answer 23

shape: bridge, asymmetric (septal deviation), patency (cotton or thread in front of each nears)

Question 24

mouth newborn

Answer 24

epstein's pearls, mucocele, frenulum, natal teeth (isolated figisn or syndrome, may be extracted if nots secure), palates (looking for clefts, bifid uvualr may indicate submucosal cleft

Question 25

neck newborn

Answer 25

Palpate for masses: cystic hygroma, branchial cleft cysts, hematom, thyroglossal duct cysts or enlarged thyroid, lymph nodes - common in newborns, but also consider congenital infection Torticollis: usually due to birth trauma or intrauterine malposition Hematoma or neck swelling, brachial plexus injury Redundant skin - gentic syndromes

Question 26

clavicles newborn

Answer 26

Congenital absence in some syndromes, fx from birth trauma, decrease motion, tenderness, crepitus, swelling, asymmetric Moro reflex

Question 27

chest wall newborn

Answer 27

symmetry, paradoxical movement normal in infants, retractions indicate distress/respiratory disorders

Question 28

breast newborn

Answer 28

breast tissue hypertrophy common (both male and female babies), due to maternal hormone - “witches milk” - can last several days to weeks, spacing - supernumerary nipples

Question 29

lungs newborn

Answer 29

observe rate, rhythm, efforts, auscultate

Question 30

cardiovascular new born exam

Answer 30

PMI at LLSB (RV is dominant), heave, thrill, Murmurs: most newborns have transient/benign murmurs

Question 31

PDA murmur newborn

Answer 31

continuous, harsh, and loudest under left clavicle/LLSB Usually closes within several hours to couple days after birth may take up to 2 weeks

Question 32

Pulmonary branch stenosis, or peripheral pulmonic stenosis (PPS) newborn

Answer 32

Systolic murmur heard everywhere equally, no other symptoms, common in babies/self limited (couple months), if heard after 6 months age, refer to ped cards

Question 33

abdomen newborn

Answer 33

Appearance: distention abnormal, scaphoid abnormal, diastasis rectu, gastroschisis or omphalocele Palpation: liver edge 1-3 cm below costal margin, occasionally spleen tip palpable, Any other palpable masses require further investigation Umbilical cord: look for signs infection, single umbilical artery associated with congenital and renal abnormalities

Question 34

female genitalia newborn

Answer 34

asses size/location of labia, clit, meatus, and vaginal opening, milk white, sometimes blood tinged vaginal discharge normal: withdrawal from maternal hormones

Question 35

Male newborn

Answer 35

presence of testes (undescended testicle 2-5%, 30% preterm) should descend from by 6 mo, penis size, scrotum: rugated and pigments (hydrocele, hernia, testicular torsion), foreskin: tight adhere, easy retraction not possible sometimes for several months to years

Question 36

why does anus need to be assessed

Answer 36

for patency - if not stool cant pass

Question 37

what do you check for trunk and spine for new born

Answer 37

Palpate spine: neural tube defects, soft tissue masses: lipoma, myelomeningocele Hair tufts, hemangioma, discoloration in area of sacrum/coccyx can indicate underlying vertebral or spinal cord anomaly Sacral dimple: visible intact base and .5 cm: benign: no further investigation, Deep, large, fall within superior portion/above gluteal crease, or other cutaneous signs (discoloration)> screen with spinal US

Question 37

extremites newborn

Answer 37

hands/feet: syndactyly, polydactyly, palmar crease Extremities movement: equal, spontaneous (r/o injury) Brachial plexus injury: cervical orr rarely upper thoracic nerve roots stretched during deliver Look for abnormal positioning, weakness, paralysis of arm

Question 38

hips newborn

Answer 38

primary rule out developmental dysplasia of hip (DDH) Risk factors: female, breech, fhx Ortolani (click) Barlow (clunk) Ultrasound screening at 6 weeks age

Question 39

normal tone exam newborns

Answer 39

in supine position - strong flexion of all four extremities Smooth, spontaneous movement of all extremities equally Some momentary migratory myoclonus facial twitches, irregular respiratory rate while asleep is normal; some tremulousness can occur in normal awake infants in first few days of life Hypotonia: in supine position: froglink position, abduction of hips, limbs extended, head lag Hypertonia: increased resistance to movement throughout range of motion of joints, persistent arching of the neck and trunk (opisthotonos), scissoring of legs

Question 40

how do you treat bilirubin

Answer 40

phototherapy, exchange transfusion

Question 41

what are major jaundice risk factors

Answer 41

bili in high risk zone, blood group incompatibility, know hemolytic dx, gestation age 35-36 weeks, previous sib with phototherapy, significant bruising, exclusive breastfeeding, east asian race

Question 42

what are minor jaundice risk factors

Answer 42

bili in high intermediate risk zone, gestational age 37-38 weeks, previous sib with jaundice, macrosomic infant of mom with diabetes, maternal age > 25 year, male gender

Question 43

what are some causes of indirect bilirubin in newborns

Answer 43

increased lysis or RBCs, decreased hepatic uptake and conjucation of bilirubin, increased enteroheaptic reabsorption

Question 44

what are some causes of direct bilirubin in newborns

Answer 44

hepatocelullar disease, biliary tree abnormalities

Question 45

what is important to distinguish for cyanosis in newborns

Answer 45

central vs peripheral

Question 46

what is peripheral cyanosis

Answer 46

usu have normal systemic O2 saturation, mucus membranes pink, often have peripheral vasoconstriction, can be benign or associated with central causes

Question 47

what are some causes of peripheral cyanosis in newborn

Answer 47

cold exposure, acrocyanosis, shock, sepsis, neonatal polycthemia

Question 48

what is central cyanosis and what causes it

Answer 48

decreased O2 saturation, Hypoventilation disorders Pulmonary disorders Cardiac causes Hematologic causes

Question 49

what is initial management for cyanosis

Answer 49

IV + O2 + Monitor

Question 50

what is respiratory distress for newborns

Answer 50

Increased rr, nasal flaring, grunting, retrations, cyanosis

Question 51

what do you need to consider for respirtoray distress in newborns

Answer 51

bacterial sepsis (GBS)

Question 52

What is transient tachypnea of newborn

Answer 52

Inadequate clearance of fluid in lungs at birth, usually self limited (about 24 hours) Occurs in late preterm (34-37 weeks ) full term infants - precipitous delivery/c section, diabetic mother

Question 53

How does transient tachypnea of newborn present

Answer 53

tachypnea is most prominent (Rate > 60/min), other signs of resp distress are mild, cyanosis easily corrected with 30-40% O2

Question 54

what is PE for TTN

Answer 54

lungs usu clear, CBC normal, ABG: respiratory acido, mild hypercapnia, mild hypoxemia, CXR: increase lung vols, flat diaphragm, prominent central vascular marking, fluid in the fissures, and possible small pleura effusion DO NOT see air bronchogrmas

Question 55

what is tx for TTN

Answer 55

supportive, O2, neutral thermal environment, nutrition, resolves 24-72 hours

Question 56

what is meconium aspiration syndrome

Answer 56

Meconium staining of amniotic fluid (MSAF): about 15% of all deliveries Sign of fetal distress

Question 57

who is most common to have meconium aspiration syndrome

Answer 57

post term infants

Question 58

how does meconium aspiration syndrome present

Answer 58

develop distress almost immediately after birth, marked respiratory distress: tachypnea, cyanosis, retraction, grunting and abdominal breathing Lung: rales, rhonchi Can be hard to distinguish from bacterial pneumonia Can lead to persistent pulm htn of the newborn

Question 59

how do you dx muconium aspiration

Answer 59

chest xray, ABG< CBC< blood culture, echo

Question 60

how do you mang meconium

Answer 60

maintain ox and ventilation, surfactant, inhaled nitric oxide, ecmo, broad spectrum abx Mortality about 1% Ecmo: extracorporeal membrane oxygenation

Question 61

what is persistent pulm HTN

Answer 61

Pulmonary vascular resistance remains abnormally high after birth, leading to R to L shunting of blood through foramen ovale and ductus arteriosus (persistent fetal circulation)

Question 62

what causes persistent pulmonary htn in newborns

Answer 62

MAS, sepsis, pneumonia, RDS, congenital diaphragmatic hernia, pulmonary hypoplasia

Question 63

how do you dx persistent pulm htn

Answer 63

usually presents 1st day of life, signs of resp distress and cyanosis diagnostic = echo