Newborn infant and clinical exam Flashcards
(77 cards)
1
Q
Visit Priorities of a prenatal interview
A
- Maternal/Paternal medical & genetic hx:
- Social circumstances
- Health of mother & father
- including allergies or meds
- Genetic problems in the family
- Alcohol & smoking habits
- Past maternal obstetric history
2
Q
Newborn exam step 1
A
Review Delivery Record
3
Q
Delivery record data
A
- Length
- Membrane rupture timing
- Delivery type & reasoning
- Medications used
4
Q
If membrane rupture >24 hours =
A
↑ risk of infection
* Subtle S/S of infection in newborn
warrant greater attention
* Consider sepsis workup on the baby,
EVEN IF APPEARING WELL!
5
Q
Significant peripartum events
A
- Fetal distress
- Meconium-stained amniotic fluid
- Anesthesia & analgesia used
- Infant status at birth
- Maternal fever (T.O.R.C.H. infections)
6
Q
Review Delivery Record: Condition of infant
A
- APGAR Score = Resuscitation needed
- Weight & length (absolute & %)
- Vital Signs
- Blood type, & Rh factor of infant
- Gestational age
- Fetal Distress
7
Q
Future (mostly counseling) priorities during prenatal interview:
A
- Feeding plan: Breast feeding vs. bottle feeding
- Safety & general care concerns
- Car seat usage
- Exposure to cigarette smoke
- Crib safety
- Work plans/childcare plans
- Social Support
8
Q
If baby suspected to be born + for HIV
A
- PCR testing for infant
- Initiation of antiviral HIV treatment within 8-12
hours following birth - Consult pediatric HIV specialist
9
Q
Normal infant pulse =
A
100-160 bpm
10
Q
Normal infant respiratory rate =
A
40-60 rpm
11
Q
Newborn transition problems
A
- Respiratory distress
- Cyanosis
- Hypoglycemia
- Poor feeding
- Temperature instability
- Jittery or lethargic
- Risk of withdrawal from maternal substance use
12
Q
No meconium by 24 hours OR (+) abdominal distention = Workup for
A
Anal patency, Hirschsprung disease
* Other causes of intestinal obstruction:
* Cystic fibrosis, electrolyte abnormalities, hypothyroidism, & neuromuscular
disease
13
Q
Color of baby meanings
A
- Normal Hgb = 16-17g/dl: Ruddy appearance (healthy & red)
- Plethoric (excessively red) in polycythemia, suspect maternal diabetes
- Pallor (pale): with anemia or poor perfusion
- Cyanosis (blue): typically manifests in the
extremities when the newborn is cold, ALWAYS requires immediately evaluation
14
Q
What do you call the baby on the right’s color?
A
Plethoric
15
Q
What do you call the color of the baby on the left?
A
Anemic, abnormally pallid
16
Q
Jaundice in the newborn
A
- Yellow staining of the body tissues & fluids
- Excessive levels of bilirubin in the bloodstream
- Timing
- > 24 hours
- Physiologic jaundice of the newborn = Normal
- < 24 hours
Pathologic jaundice = Abnormal
17
Q
Acute Bilirubin Encephalopathy
A
Neurological dysfunction in first postnatal weeks from bilirubin toxicity
18
Q
Acute Bilirubin Encephalopathy clinical phases
A
- Early (1-2 days) - Poor feeding, high-pitched cry, stupor, hypotonia
- Middle (1st postnatal week)
* Hypertonia of extensor muscles
* Opisthotonos (severe arching of the neck & spine)
* Retrocollis (tightening of the muscle of the neck & shoulder girdle) - Late (after 1st postnatal week) - generalized hypotonia
19
Q
Chronic bilirubin encephalopathy (Kernicterus)
A
Slower evolution of S/S over the first years of life
1. (1st year) - hypotonia, hyperreflexia, & delayed
motor development
2. (>1 year)
* Extrapyramidal dysfunction
* Dental enamel hypoplasia
* Visual
* Auditory
* Minor intellectual deficits possible
20
Q
Kernicterus Risk Factors: Think J.A.U.N.D.I.C.E.
A
Jaundice within first 24 hours
A sibling who was jaundiced as a neonate
Unrecognized hemolysis such as ABO blood type
incompatibility or Rh incompatibility
Nonoptimal sucking/nursing
Deficiency in glucose-6-phosphate dehydrogenase
Infection
Cephalohematomas/bruising
East Asian or Mediterranean descent
21
Q
Vernix Caseosa
A
(varnish cheesy)
* White, lipid-rich, moisturizer
* Fetal sebum, lanugo, & corneocytes
* Found in creases & flexor surfaces
* Lysosomes & lactoferrin are
antibacterial/fungal
* Helps retain heat
* Facilitates stratum corneum growth
22
Q
Vernix retention after birth leads to
A
↑ skin hydration & ↓ skin surface
pH 24 hours after birth
* WHO recommends
23
Q
Lanugo
A
- Downy hair covering the body
- More common with prematurity
24
Q
Sebaceous gland hyperplasia
A
- Small, yellow papules over nose & cheek
- Disappear spontaneously
25
Acne Neonatorum
* Acne appearance
* Maternal hormonal influence
* Spontaneous resolution in 2-3 months
26
What is this?
Cutis Marmorata
* Newborn’s skin is thin & blood vessels can be seen
* Bluish, mottled, lacey, reticular appearance
* Disappears with rewarming (if not consider sepsis, esp in an ill-appearing infant)
27
What is this?
Erythema Toxicum
* Benign, common rash (50%)
* Erythematous papules & pustules (eosinophils)
* Predominates on face & chest
* 1 - 2 days after birth
* Resolves within 5 - 7 days
28
What is this?
Transient Neonatal Pustular Melanosis
* Idiopathic pustular eruption of the newborn
* Resolves with hyperpigmented macules
* Less common than erythema toxicum
* More prevalent with darkly pigmented skin
* Present at birth, may appear up to 3 weeks after
29
What is this?
Dermal melanocytosis (Mongolian spots) - essentially a birth mark that goes away
* Bluish/black macular lesions
* Usually over lumbosacral area
* Native American, Asian infants (99-100%)
* Ectopic melanocytes, incomplete migration from
the neural crest to the epidermis
* Tend to disappear within one year
* Always document! (NOT a bruise!)
30
What are birthmarks called & when do they present?
Congenital Melanocytic Nevi
* Present at birth or appear in the first few months
* Tend to grow with children (esp puberty)
* ↑ risk of melanoma
* 2+ medium lesions → ↑ risk for neurocutaneous melanocytosis
31
What is this?
Cafe au lait spots
* Light-brown, oval macule
* dark brown on brown/black skin, possible
halos
* Found anywhere on the body
* 1.5 cm or larger
32
One of the MAJOR diagnostic criterion for
Neurofibromatosis Type 1
Café Au Lait
33
What is this?
Nevus Flammeus
(Nevus Simplex, Macular Hemangiomas, Vascular Nevi)
* “Stork bites” → back of neck
* “Crow’s nests” → above the eyes
* Benign, flat, red skin patches
* May disappear within 1st year
* Can persist & darken
34
What is this?
Port-Wine Stain
* Nevus flammeus family
* Permanent skin discoloration
* May be associated with other
arteriovenous malformations
35
What is this?
Strawberry or capillary hemangioma
* Elevated collections of capillaries
* Variable appearance
* Grow for 3-7 months, stabilize, then involute ~1
year old → resolved by 5 yo
* Usually, no scar or blemish
* Observation only, unless on the eyelid - Ophthalmology consult required
36
What is this?
Cavernous Hemangioma
* Less common than strawberry hemangiomas
* Less predictable course
* Collection of larger blood vessels
* Larger than strawberry hemangiomas & bluer in color
* May be associated with thrombocytopenia
* Often, they mature & then disappear
* May treat with steroids or radiation
37
What is this?
Milia
* Subepidermal keratin cysts
* Pilosebaceous units or
eccrine sweat ducts
* Disappear spontaneously
38
Craniotabies
Thin, soft skull bones
* Caused by rickets or syphilis
* Common in babies born prematurely
39
Caput Succedānēum
Cone-head
* Common
* Boggy swelling of subcutaneous
tissues of the presenting part
* Crosses suture lines*
* Head compression against cervix
impedes venous return
* Reabsorbs in 1–3 days
40
What is Cephalohematoma?
* Blood pooling subperiosteum
* Confined to a single bone
* CANNOT cross suture lines**
* Apparent 2 hrs – 2 days after birth
* Almost always parietal bone
* From fracture*
* Lasts >4 weeks
41
What is this head shape called?
Caput succedānēum
42
What is this head shape called?
Cephalohematoma
43
Fontanelles
* Anterior fontanelle (junction of two frontal & two parietal bones)
* Larger
* Closes ~18-24 months
* Posterior fontanelle (junction of parietal & occipital bones)
* Smaller
* < 1 cm
* Closes ~6 weeks
44
Craniosynostosis
* Abnormal, premature closure of skull sutures
* Most common = Sagittal suture - Anterior/posterior lengthening of the head
* Fusion of coronal sutures - Lateral widening of the head
* Palpate sutures: Should move up & down independently
45
Normal Head circumference of neonate, what would micro and macrocephaly be?
~34-35 cm
* Compare with normative data
* Microcephaly - ↓ head circumference
* <2 SDs of the mean for the gestational age
* Macrocephaly - ↑ head circumference
* > 2 SDs of the mean for the gestational age
* May indicate Hydrocephalus
46
Hydrocephalus
↑ volume of CSF
* Obstruction in the subarachnoid space
* Need pediatric neuro consult
* Treatment usually consists of
ventriculoperitoneal shunting
47
Clinical features of Hydrocephalus
* Macrocephaly
* ↑ rate of head growth
* Irritability
* Vomiting
* Voss of appetite
* Impaired extraocular movements, Esp. upward gaze
* Hypertonia
* Hyperreflexia
48
Facial appearance in neonates with downs syndrome
* Eyes slanting up
* sloping forehead
* low-set ears with small canals
* Glaucoma
* Eye(s) appear larger than normal
49
Facial appearance in neonates with fetal alcohol syndrome
* Eyes appear too small
* wide, flat nasal bridge
* Lacking a groove between lip &
nose (philtrum)
* Small jaw (micrognathia)
50
Facial appearance in neonates with Pierre Robin syndrome
* Small chin (micrognathia): May predispose infant to respiratory obstruction
51
Asymmetry of neonatal face while crying might be associated with
aortic valve abnormalities
* Also consider Facial nerve palsy
52
Eyesight at birth
Visual acuity is poor (20/400)
* Lens is immobile
* Acuity improves the first 6 months
* Able to fixate & track by 2 months
53
Nose exam on a neonate
* Asymmetry of nares
* Possible septal deviation
* Birth trauma
54
T/F Infants are obligate nose breathers
T
55
Choanal atresia
narrow or blocked nasal airway (tissue)
56
Torticollis
Head persistently turned to one side
57
T/F It is NOT significant to hear fluid
during the Newborn exam
T
58
2 MOST COMMON signs of heart disease in the newborn infant
1. Cyanosis
2. Diminished pulses
59
Diminished pulses pathologies
i. Hypoplastic left heart + critical aortic stenosis
* Diminished pulses at all sites
ii. Aortic coarctation + interrupted aortic arch
* Diminished pulses in the lower extremities
60
Polyhydramnios
excessive amniotic fluid
61
Umbilical cord
* 2 umbilical arteries & 1 umbilical vein
* Only 1 umbilical artery may be
associated with renal, CV, & MSK
malformations
62
Hypospadias
Urethral meatus displaced proximally on ventral penis
* Do NOT circumcise!
63
Unpalpable testes may indicate
_____
Cryptorchidism
64
Clinodactyly
In turning of a finger, usually 5th
* Trisomy 21 Feature
* Short broad hand, single palmar crease
65
Intrauterine crowding causes an increased
risk for _____
Developmental Dysplasia of Hip
66
Examine hips via these tests
* Barlow test (dislocating the hip)
* Ortolani (relocating the hip)
67
Talipēs Ēquīnōvārus
Clubfoot
1. Metatarsus adductus
2. Varus heel deformity
3. Shortening of the Achilles tendon
* Treatment should begin while newborn
is in the nursery
* Serial casting
68
Asymmetry with hemihypertrophy
May be associated with a Wilms tumor of the
kidney
69
Brachial plexus palsies (Erb’s palsy)
* One of the upper extremities flaccid
* 2° difficult delivery with brachial plexus injury
* Most common = C5, C6
* Absent Moro reflex on the affected side
* Consult pediatric neurology
* Good prognosis
70
Subdural Hematoma
* Related to birth trauma
* Tear(s) in the venous blood supply of the
subdural space
* Vomiting, irritability, lethargy, & seizures
within 2-3 days of birth
* May be asymptomatic
* Neurological consult
71
Most common neonatal intracranial hemorrhage
Primary Subarachnoid Hemorrhage
72
Babinski reflex
is “POSITIVE”
* Toes splay
* Normal in infants < 6 months of age
73
Moro (startle) reflex
* 28 weeks gest. to ~3 months
* Supporting head/neck, quickly lower baby down
* Symmetric abduction & extension
74
Rooting reflex
* 28 weeks gestation
* Stroking the cheek
* Infant turns head towards stimulus & opens mouth
75
Sucking reflex
* 14 weeks gestation
* Sucks in response to a nipple in the mouth
76
Palmar Grasp reflex
* 28 weeks gest. to ~ 4 months
* Placing index finger in palm of hand will elicit grasp
77
Tonic neck reflex
* Disappears by age 8 months
* Turn Infant's head to one side
* Ipsilateral arm & leg will extend
* Contralateral arm & leg will flex
* ”Fencing position"
