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Flashcards in Newborn Infant Deck (74)
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1

Gestational Age

Gestational age is the common term used during pregnancy to describe how far along the pregnancy is. It is measured in weeks, from the first day of the woman's last menstrual cycle to the current date.

2

Why is Gestational Age Important?

Gestational age can predict problems, morbidity, mortality, and can help you keep alert for certain problems

3

Gestational Age Assessment

Date estimation, Calculated from 1st day of last menstrual period.

4

Gestational Age Assessment Accuracy

Early OB ultrasound is best and is accurate within approximately 3 days. A later OB ultrasound can be accurate within approximately 2 weeks.

The Ballard Gestational Age Assessment is accurate within about +/- 2 weeks.

5

Ballard Exam

Estimates Physical Maturity as well as Neuromuscular Maturity by evaluating: Posture, Square window, Arm recoil, Popliteal angle, Scarf sign, Heel-to-ear.

6

Using a Ballard Exam

Add scores together and compare with estimated gestational age by OB (dates and/or ultrasound)

7

Significance of a Newborn Exam

A child’s first exam should be one of the most thorough the child ever receives. The newborn assessment is different from an adult exam!!!

8

Preforming a Newborn Exam

If you start at the head and plan to go to toes, a quiet child may no longer be quiet! Look, listen, feel; Listen to heart, lungs, and abdomen while the infant is quiet, then attempt to work “head to toe”. You may have to continuously adjust your exam and examine what becomes available.

9

Observation in the Cardiopulmonary Exam

1. Look at the chest for color, symmetry, work of breathing, and respiratory rate.
2. Observe for retractions, nasal flaring, malformations, abnormal pulsations, and parasternal heave.

10

Cardiopulmonary Exam: Heart Exam

Heart examination: Rate, rhythm, murmurs, gallops, clicks, loudest on right side or left side, location and strength of PMI (point of maximal impulse). Check femoral pulses and compare with brachial pulses

11

Cardiopulmonary Exam: Lung Exam

Listen to the lungs: Bilateral breath sounds, crackles, wheezes, or rhonchi

12

Abdominal Exam

1. Inspect first
2. Auscultate: Listen for bowel sounds: Present or absent
3. Palpate: Feel the tummy!, One hand is generally fine. Palpate for liver, spleen, kidneys, and presence of masses. Make sure to palpate the umbilical cord and area.

13

Omphalocele

Abdominal contents pushed out in a sheath with the umbilicus.

14

Gastochisis

Abdominal contents are pushed out with out a sheet; Not indicative of gentic disorder.

15

Male Genitourinary Exam

1. Penis: Phimosis is normal!!! Do not retract the foreskin! Look for epi- or hypospadias.
2. Testes: Feel both testes, look for hydroceles, hernias, or other abnormalities.
3. Anus: Check for patency and placement

16

Hypospadias

A condition in which the opening of the urethra is on the underside of the penis, instead of at the tip.

17

Normal neonatal phimosis

The inability to retract the distal foreskin over the glans penis.

18

Female Genitourinary Exam

1. Labia: Large labia majora is common (maternal hormones). Examine for fusion and clitoral hypertrophy.
2. Vagina: Vaginal discharge is common; white & mucoid to pseudo menses. May have hymenal tags
3. Anus: check for patency and placement

19

Imperforate anus

A defect that is present from birth (congenital). The opening to the anus is missing or blocked. The anus is the opening to the rectum through which stools leave the body.

20

Ambiguous genitalia

If the process that causes this fetal tissue to become "male" or "female" is disrupted, ambiguous genitalia can develop. 'Ambiguous genitalia' or atypical genitalia is a birth defect of the sex organs that makes it unclear whether an affected newborn is a girl or boy. Causes include genetic abnormalities and hormonal problems.

21

Extremities Exam

1. Digits: number and abnormalities (Examples: polydactyly, syndactyly, clinodactyly, single palmar creases (genetic problems-trisomy 21))

2. Arms/Legs: Examine range of motion, tone, asymmetry

3. Clavicles: Feel for fractures!!!

4. Hips: Barlow and Ortaloni exam. Clicks are common and benign (estrogenic effect). Clunks are indicative of hip dislocation/relocation (developmental dysplasia of the hips).

22

Polydactyly

A condition in which a person has more than five fingers per hand or five toes per foot.

23

Congenital Talipes Equinovarus

Commonly known as club foot, is a foot deformity in which the foot is twisted inward with the toes pointing down.

24

Syndactyly

The most common congenital malformation of the limbs. Webbing of the fingers and toes is called syndactyly. It refers to the connection of two or more fingers or toes.

25

Spine Exam

Flip infant onto your forearm and look at entire spine. Feel the vertebral column for bony defects. Examine sacral area closely looking for clefts, hairy tufts, change in pigmentation
as well as for gross defects such as meningomyelocele, teratomas, sinus tracts.

26

Sacral Sinus and Dimple

A congenital dermal sinus is a scaly, multi-layered channel of tissue found along the body’s midline anywhere between the nasal bridge and the tailbone. The tract may end just below the skin surface or may extend to portions of the spinal cord, skull base or nasal cavity.

27

Hair tuft

A tuft of hair on the skin of the back is a common sign of Spina Bifida Occulta

28

Meningomyelocele

Meningomyelocele is a type of spina bifida, a kind of birth defect in which the spinal canal and the backbone don't close before birth.

29

Meningocele

A protrusion of the meninges through an opening in the skull or spinal column, forming a bulge or sac filled with cerebrospinal fluid.

30

Skin Exam

Look at the skin during the entire exam. Look for Jaundice,
Mongolian spots (Important to document!!!), Rashes, HSV lesions, Milia, Transient pustular melanosis , Cradle cap, Neonatal Acne, Stork bites and Erythema toxicum neonatorum.