Newborn Exam Flashcards
(153 cards)
1
Q
Components of a prenatal visit
A
- Courtesy of pediatric office without charge
- Chance to meet provider and see office/ask questions
- Chance to discuss feeding options and what happens in hospital after birth ie circumcision, immunizations, hearing screen, etc
2
Q
3 components to a complete newborn history
A
- Maternal and paternal medical history
- Maternal past obstetric history
- Current antepartum and intrapartum history
3
Q
Maternal and paternal history review
A
- Chronic medical issues in family
- Dietary habits
- Smoking or substance abuse
- Occupational history
- Social history - abuse or neglect
- Family illnesses and congenital anomalies
4
Q
Maternal OB history
A
- Maternal age
- How many times pregnant
- How many times given birth
- Pregnancy outcomes
- Maternal blood type
5
Q
Occuring right prior to delivery
A
Antepartum
6
Q
Occuring during labor or delivery
A
Intrapartum
7
Q
Time after delivery up to 6 weeks
A
Post partum
8
Q
Review of antepartum and intrapartum hx
A
- Mom’s history: US, amnio, screening labs
- Tests that determine fetal well being: NST, dopplers of blood flow and BPP
- Mom prenatal issues ie gestational DM, UTIs, HTN, preeclampsia, preterm labor
- Significant issues like maternal fevers, difficult delivery, meconium stained fluid, vaginal vs C/s, forceps, resuscitation
9
Q
Newborn hep B history
A
- Maternal hep B status: newborn given hep B vaccine within 1st 12 hrs
- Babies born to Hep B mom who do not get vaccine - 40% get hep b and 25% die from chronic liver disease
- HBsAG and HBeAg vertical transmission 90%
10
Q
What does the baby need to receive after birth if the mom has HBsAg
A
- HBIG and Hep B vaccine ASAP after birth on opposite legs then Hep B again at 1 and 6 months
- If HBsAg not tested and mom high risk, give hep B vaccine ASAP and do labs. If HBsAg +, give HBIG up to 48 hours after
no hep c vaccine yet and no prevention for newborns :(
11
Q
What should you do if mom is HIV +
A
- Babies receive antiretrovirals within 6-12 hours
- Breastfeeding not recommended
12
Q
What is APGAR?
A
- Helps determine condition at birth
- Recorded at 1 and 5 minutes after birth
- Serial score shows progression/improvement
- Scale 1-10 and want at least a 7
13
Q
What does APGAR stand for?
A
- Appearance
- Pulse
- Grimace
- Activity
- Respiration
14
Q
What is a 0, 1, and 2 on Appearance APGAR score?
A
- 0: cyanotic
- 1: some cyanosis (extremities)
- 2: all pink
15
Q
What is 0,1,2 on pulse APGAR score?
A
- 0: absent
- 1: <100
- 2: >100
16
Q
What is 0,1,2 grimace on APGAR score?
A
- 0: none
- 1: “some” some flexion of extremities
- 2: cries in response
17
Q
What is 0,1,2 on activity APGAR score?
A
0: none
1: some flexion of extremities
2: active movement
18
Q
What is 0,1,2 on respirations APGAR score
A
0 none
1 some - slow irregular
2 spontaneous cry
19
Q
Dubowitz/Ballard Exam and scoring
A
- Evaluates both physical characteristics and neurological characteristics of a newborn
- 6 physical and 6 neurological signs of maturity scored
- total score estimates gestational age
20
Q
What are gestational age predictors?
A
- LMP
- Fetal US
- Physical and neurologic development
21
Q
What is a square window?
A
Wrist flexion, term baby wrist can bend all the way down
22
Q
What is scarf sign?
A
How far arm will extend across body
23
Q
Ballard postnatal assessment
A
- Best performed at 30-42 hours of age
- Takes about 3-4 minutes to complete even on sick infants
- New ballard can test infants from 20-44 weeks
24
Q
What can be accomplished with a prenatal visit?
A
Meet each other, see office
25
What vaccine is given to a newborn within 12 hours of birth?
Hep B
26
What is a perfect APGAR score?
10
27
What time after birth are APGARs done?
1 and 5 minutes
28
Is there a hepatitis C vaccine?
No
29
Unexplained death of a healthy baby younger than one, usually during sleep
SIDS
30
What causes SIDS?
True cause unknown
Thought to be related to area in brain that controls breathing and waking from sleep
31
Risk factors for SIDS
* Certain types of brain defects (brain area that controls breathing underdeveloped)
* Low birth weight
* Respiratory infections - many who die recently had a cold
* Sleeping on their stomach or side
* Sleeping on a soft surface (fluffy blanket, soft mattress, waterbed)
* Sharing a bed - with parents, siblings, or pets
* Overheating - being too warm can increase risk
* Males > females
* Age 2-4 months
* Race - more likely in black, native american, and alaskan native
* Family history of SIDS
* Second hand smoke
* Premature birth and low birth weight
32
How do we reduce the risk of SIDS?
* Place baby on back to sleep, never side or stomach
* Keep crib bare with firm/flat mattress
* No pillows, blankets, or stuffed animals
* Don't overheat baby and never cover baby's head
* Baby should sleep in parents room for first 6 months
* Breast feed if possible
* Do not rely on commercial devices that predict SIDS. They do not prevent
* Offer pacifier
* Get vaccines on time
33
What is normal cry of newborn? Abnormal?
Strong
* High pitched abnormal
* Low, hoarse cry sign of hypothyroidism
* Weak, poor cry can be sick infant
34
What is the average size of a full term baby in America?
* 7 lbs
* 19-20 inches long
* Head circumference of 13-14 inches
35
Any jaundice within the first ---- is abnormal
24
36
Bluish discoloration of infants hands and feet
Acrocyanosis
37
Is acrocyanosis normal or abnormal? What causes this?
Normal
Vasomotor changes that result in peripheral vasoconstriction and is benign
## Footnote
central blueness is not normal
38
skin has mottled look like cobblestone street
cutis marmorata
39
When is cutis marmorata more common? What causes this?
Skin is cold
Superficial blood vessels dilate and give red color then constrict and give blue color, rewarming helps color return
40
Cutis marmorata is a common skin finding in what condition
Down syndrome
41
Waxy or cheesy like appearance after birth due to substance made of water, lipids, and proteins
Vernix Caseosa
42
What is vernix caseosa and what is its function?
Biofilm that covers fetus during last trimester
* Protects newborn skin and provides barrier against infection
* Delayed bathing common- delaying over 12 hours may help thermoregulation, hypoglycemia, and rates of breast feeding
43
Light, fine hair that covers the newborn baby
Lanugo
44
What is the relationship between lanugo and age of baby? What is purpose of lanugo?
* Younger baby, more hair
* Thought to insulate baby and help vernix stick, disappears over time
45
Are males or females more likely to have SIDS?
Males
46
Does a family history matter with SIDS?
Yes
47
Does a pacifier increase or decrease the risk of SIDS?
Decrease
48
Is jaundice normal in the first 24 hours?
NO
49
Is it okay for a baby to have blue hands and feet? What is this called
Yes, acrocyanosis
50
What is faint thin baby hair called on a preemie?
Lanugo
51
Skin rashes in newborns
* erythema toxicum
* Newborn acne
* Milia
* Sebaceous gland hyperplasia
52
Red base, papular - vesicular rash that is common in newborns
Erythema toxicum
53
# Re
What causes erythema toxicum? How long does it last?
Eosinophils in tiny vesicles
Appears 2-5 days after birth and resolves in weeks
54
What is the appearance and cause of acne neonatorium (newborn acne)?
* Closed comedones - red and inflamed, looks like real acne on cheeks, forehead, and sometimes chest and back and resolves on own
* Thought to be due to maternal hormones
55
Tiny, white epidermal cysts filled with keratin
Milia
56
What are locations of milia?
Usually on face, resolves in 2-4 weeks
If in roof of mouth, called Epstein's pearl
57
What is a hemangioma?
Very common vascular birth mark located on face, scalp, or thorax, but can be anywhere consisting of small, densely packed blood vessels
Cause unknown
58
What is the progression of hemangiomas?
* Start several months after birth
* Grow rapidly, then remain fixed, then start to resolve
* Most gone by age of 9
59
When would a hemangioma require immediate treatment?
* Visual, hearing, rectal, vaginal, nasal obstruction
* Airway obstruction
* Huge hemangiomas may cause cardiac decompensation
60
"Stork bite" light red macules found over nape of neck, upper eyelids, and between eyebrows
Nevus simplex
61
Dark red macules anywhere on body consisting of thick, dilated blood vessels
Nevus flammeus/port wine stain
62
If port wine stain is seen on the face along the opthalmic branch of trigeminal nerve, about 25% will have -----
sturge weber syndrome
63
What can port wine stains be associated with?
* Vision problems
* Angiomas that grow in brain and cause seizures and develomental disabilities
64
Darkish blue birthmark over lower back and butt that is more common in darker skinned babies and lasts for years
Congenital dermal melanocytosis
## Footnote
Also known as "Mongolian spot"
65
Light brown oddly shaped flat macules that can be anywhere
Cafe au lait spots
66
How long do cafe au lait spots persist?
For life and may increase in number
67
If there are more than 6 macules over half a cm of cafe au lait spots, what does that mean?
Major diagnostic criteria for neurofibromatosis 1
68
What is normal for vaginal birth head appearance? Breech? C- section?
C-section: pretty head
Vaginal: elongated
Breech: narrow face and head
69
What causes hydrocephalus?
Can be present at birth due to slowly increasing ICP causing ventricles to enlarge --> head grows in circumference
* Obstruction of flow (blocked 4th ventricle, dandy walker malformation or arnold chiari malformation)
* Overproduction of CSF (choroid plexus papilloma)
70
What are findings in hydrocephalus?
Sunsetting eyes due to increased pressure
Increasing serial head measurements
71
Treatment of hydrocephalus
VP shunt to shunt fluid from brain into abdominal cavity
72
What fontanelles are present at birth? How do these change over time?
* Anterior and posterior
* Anterior closes from 9-24 months
* Posterior closes around 2-3 months
73
What does a bulging fontanelle indicate? A depressed fontanelle?
* Bulging: increased intracranial pressure
* Depressed: dehydration
74
Defect caused by swelling of scalp due to pressure on the head during vaginal birth, decreased blood flow --> edema
Caput succedaneum
75
Presentation of caput succadaneum
* Can extend across suture lines
* Localized soft tissue edema with poorly defined borders
* Resolves after 2-3 days
76
What is a cephalohematoma
* Subperiosteal hemorrhage
* Feels soft like cyst and usually occurs after difficult delivery or instrument associated delivery
* Well defined outline and does not cross suture lines
* Takes weeks to resolve
77
Abnormal thinning of parietal bones in premature babies that gives sensation of ping pong ball on pressure
Craniotabes
78
Where is craniotabes usually located?
Along parietal bones, sometimes occipital, running along lambdoid suture lines
79
How long does craniotabes last? What happens if not?
* Usually disappears in a few weeks
* If not, think rickets, osteogenesis imperfecta or hydrocephalus
80
What is subgaleal hematoma/hemorrhage?
* Serious but rare complication of vacuum assisted delivery
* Caused by rupture of emissary veins, which are connections between dural sinuses and scalp veins
* Blood accumulates between epicranial aponeurosis of scalp and periosteum
* Can accomodate up to one half of blood volume of neonate
* Need to monitor BP, hematocrit, bilirubin, signs of hypovolemia
81
Life threatening congenital anomaly with short jaw, cleft palate, and airway obstruction
Pierre Robin syndrome
82
What causes pierre robin syndrome?
* Failure of mandible to grow
* Tongue blocks fusion of palate so cleft forms
* Tongue obstructs airway
83
Treatment of Pierre Robin syndrome
* Fixing lower jaw and supporting child with feeding and breathing in meantime
84
What is the presentation of facial nerve palsy at birth?
* Damage during delivery, can be due to difficult/forcep assisted delivery
* Involves lower part of facial nerve that controls mouth
* Asymmetric crying face
* Eyelid may not close on affected size
* No movement on affected side
85
Treatment for facial nerve palsy
Observation
86
Collection of blood beneath conjunctiva due to trauma
Subconjunctival hemorrhage
87
What is prognosis of subconjunctival hemorrhage?
* Likely due to birth process and goes away on its own without treatment
88
How is neonatal conjunctivitis treated?
Erythromycin ointment in eyes to prevent chlamydia
all newborns given after birth
## Footnote
leading cause of blindness in developing countries!
89
What can congenital cataracts indicate?
Metabolic disease, congenital infection, or problem with thyroid
90
What is presentation of glaucoma?
tearing
tight eyelids
terrified of light
91
What happens if glaucoma is left untreated
damage to optic nerve can lead to blindness
92
what can an absent, blunted, or white red reflex mean?
* glaucoma
* Congenital cataract
* retinoblastoma
93
Treatment for white reflex
immediate referral to opthalmology
94
Rapidly developing eye tumor from immature cells in the retina
retinoblastoma
## Footnote
best cure rate of childhood cancers if caught early
95
presentation and treatment of retinoblastoma
* white pupillary response or leukocoria
* Immediate referral (emergency!)
96
Blocked tear duct at birth that is most common cause of tearing and sicharge from eye
Dacryostenosis
97
Presentation of dacryostenosis
* Tearing
* Discharge
* Heavy matting and debris on lashes
* Redness of conjunctiva not normal
* Spontaneous resolution in 90% of babies by 6 months
98
Treatment of dacryostenosis if not resolved
referral for probing
99
Infected tear duct
Acute dacryocytitis
100
Presentation of acute dacryocystitis
* Redness
* Warmth
* Swelling
* Rare complication of stenosis
* Staph aureus MC bacteria
* Can lead to orbital cellulitis
101
Treatment of acute dacryocystitis
* Consult opthalmology
* Probe to open area
* Systemic antibiotics
102
What extracranial bleed crosses suture lines?
Caput
103
Which extracranial bleed does not cross suture lines?
Cephalohematoma
104
What is the primary reason for newborn acne?
Maternal hormones
105
What are the tiny, white keratin filled lesions called?
Milia
106
When is a hemangioma a medical issue?
Obstructs orifice
107
What facial birthmark can have other associated medical issues?
Port Wine Stain
108
A cloudy eye at birth could mean what?
Congenital cataract
109
What is a blocked tear duct called?
Dacryostenosis
110
Caues of septal deviation?
Can be due to trauma at birth, will have respiratory distress if not addressed (newborns obligate nose breathers)
111
Treatment for septal deviation?
Surgery as child gets older
112
Congenital disorder where back of nose blocked due to abnormal bony tissue
Choanal atresia --> can cause feeding and breathing issues
113
Treatment of choanal atresia
Surgery to open area
114
Natal teeth
* Teeth present at birth
* Do not have strong roots and can be easy to aspirate
* Usually removed and can be associated with several syndromes
115
Oral thrush
White, thick coating inside the mouth and inside the cheeks. Cannot be scraped off, causes bleeding
* Painful for baby and cause trouble earing
* Yeast
116
Treatment for oral thrush
* Antifungal applied inside mouth (nystatin)
* If mom breast feeding, clean breast and apply same medication
* Boil all bottle nipples and pacifiers during treatment
117
How is a normal location of ears determines?
Drawing line from inner canthus of the eye perpendicular to verticular axis of the head
If top part of ear beneath this line associated with syndromes
118
Preauricular pits of ears
* Small indentions in front of ear of newborn
* Common, but can be associated with congenital anomalies
* Should have formal hearing test
* Risk of permanent hearing loss with ear pits or tags is fix times that of normal population
* Rare that needs fixed
119
If a patient has a ear pit/tag and any other craniofacial developmental issue, what should be performed?
Renal ultrasound
120
What can a delay or absence of pulse in lower extremities indicate?
Coarctation of aorta
121
What is a heart sign of congenital heart disease
Central cyanosis
122
Birth defect in which abnormal opening in diaphragm that allows abdominal content to move into chest cavity
Diaphragmatic hernia
123
How is diaphragmatic hernia managed
Diagnosed prenatally and surgery performed
124
Presentation of diaphragmatic hernia
* Tachypnea
* Tachycardia
* Cyanosis
* One side of chest larger than the other
* Concave abdomen
125
What is omphalitis
Cord area infection
126
Rectus abdominis does not close together completely over umbilical cord passage
Umbilical hernia
127
Which population more commonly gets umbilical hernia
African americans
128
Presentation of umbilical hernia
* Soft bulge at belly button
* More prominent when baby cries
* Easy to reduce
* Usually no medical issues
* Rarely complication of incarceration
* Usually resolves spontaneosly by 3-4 months
* If not resolved by about 3, can send to surgery for eval
129
What is umbilical granuloma
* Soft, pink, friable lesion of granulation tissue at belly button
* Forms in first few weeks of life from excess tisue that persists at base of cord
* Persistent drainage of serous fluid, sometimes green discharge or moisture around cord
130
Treatment of umbilical granuloma
* Silver nitrate to cauterize
* Can be treated several times with silver nitrate and may require surgery
131
Leukorrhea
Vaginal DC in newborn females with milky white or blood streaked vaginal discharge as a result of maternal hormone withdrawal
Labia can be swollen or even bruised after birth
132
Babies must ---- after circumcision to be considered for DC home
void
133
Fusion of digits
Syndactyly
134
Extra digits
Polydactyly
135
Congenital hip dysplasia
Head of femur does not fit in hip well due to socket of hip being too shallow
136
Where/who is congenital hip dysplasia more common
left hip
girls
firstborn children
multiples
CHD
breech babies
137
What is the risk of a missed congenital hip dysplasia?
life long limp and osteoarthritis of the hip
138
Most common fracture in newborn
Clavicular fracture
139
What are risk factors for clavicular fracture
* Difficult vaginal delivery
* Shoulder dysfocia
* Post term
* Induction
* Higher birth weight
140
Presentation of clavicular fracture
* Crepitus
* Swelling of area
* Abnormal bone contour
* Crying with movement
141
At what age does big toe bending up and backward while other 4 toes fan out in Babinski become abnormal?
2
142
What is a normal moro reflex?
* Arms abduct at shoulder and extend at elbow
* Adduction with flexion follows
143
Tonic neck reflex
* Turn infants head to one side and the same side leg and arm will extend and the opposite left will flex
* Appears like fencing position
* Gone by 8 months
144
Traction response
* Infant pulled from lying by it's hands to a sitting position
* First head lags
* then comes to midline
* Then flexes forward
145
What can cause a brachial plexus injury
* Difficult delivery
* Hard pull on neck as shoulder pass through
* Pulling on shoulders during head first delivery
* Pressure on raised arms during feet first delivery
* More common with large babies
* breech delivery
* Difficulty getting shoulder through
146
Treatment of brachial plexus injury
* Most babies recover by 3-6 months with observation
* Massage and ROM exercises can help
* Rarely -surgery needed if nerves ruptures or avulsed
147
Sacral dimple
* small hole or dimple near infants lower back in gluteal folds
* if large or has tufts of hair or a lump, needs studied
* Could be related to spina bifida occulta condition or tethered cord
* US or MRI can help with diagnosis
148
If nasal passages do not connect with the throat what is that called?
Choanal atresia
149
What is white coating on tongue that won't wipe off?
Thrush
150
What is rooting reflex?
rubbing side of cheek and will look for nipple
151
What does the big toe do in a + babinski in a newborn?
Up
152
What is the most common fracture in a newborn?
Clavicle
153
What increases the risk of congenital hip dysplasia?
Girls, firstborn children, multiples, family history of CHD
breech babies, multiples
