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FNP exam > Perinatal/ newborn health screening > Flashcards

Perinatal/ newborn health screening Flashcards

1
Q

When detailed assessment of the pre/peri/ postantal course should be included in the history

A

newborn to age 3 years

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2
Q

Low birth weight

A

Low birth weight (LBW) < 2,500 g
Very low birth weight (VLBW) < 1,500 g
Extremely low birth weight (ELBW) < 1,000 g

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3
Q

Assessment of weight for gestational age

A
  • Appropriate for gestational age (AGA): btw 10 - 90%
  • Large for gestational age (LGA): weight > 90%, associated with maternal diabetes
  • Small for gestational age (SGA): weight < 10%, symmetric (> chronic) vs assymetric (> acute assault)
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4
Q

APGAR score

A

Five areas of assessment for a total of 10 points: appearance, pulse, grimace, activity, respirations

  • Max score at 1 & 5 minutes = 10, 3 points possible for each area: 0, 1, 2
  • Appearance (skin color): normal color all over, normal color but hands and feet are bluish, bluish-gray or pale all over
  • Pulse: Normal (>100), below 100, absent
  • Grimace (responsiveness or “reflex irritability”: Pulls away, sneezes, or coughs with stimulation; facial movement only (grimace) with stimulation; absent
  • Activity (muscle tone): Active, spontaneous movement; Arms & legs flexed with little movement; No movement, “floppy” tone
  • Respirations: Normal rate & effort, good cry; Slow or irregular breathing, weak cry; Absent
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5
Q

Newborn assessment: weight, length, head circumference

A

Average:
weight: 7 lbs
length: 20-21 inches
HC: 13 - 14

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6
Q

Newborn assessment: gestational age

A
  • Infants born at gestational periods 37 - 41 weeks have the best health outcomes
  • Those born prior to 37 weeks of gestation are premature and those born after 41 weeks of gestation are post-term
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7
Q

Newborn assessment: intrauterine growth retardation (IUGR) - symmetric IUGR

A

SGA: symmetric IUGR (33% of SGA infants): HC, weight, and length are all < 10%. Usually suggests long term compromise to the fetus or the presence of an intrinsic problem:

  • Genetic: congenital or chromosomal abnormalities
  • Intrauterine infection: viral, bacterial, protozoal, spirochete
  • Inborn errors of metabolism
  • Environmental: drugs, nicotine, x-ray exposure
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8
Q

Newborn assessment: intrauterine growth retardation (IUGR) - assymetric IUGR

A

Assymetric IUGR (55% of SGA infants):

  • HC & length within normal limits, weight < 10%
  • May be due to acute extra fetal compromise (usually occurs > 24 weeks gestation): chronic hypertension, pre-eclampsia, renal disease, cyanotic heart disease, hemoglobinopathies, abruption placentae, multiple gestation, altitude
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9
Q

Newborn assessment: large for gestation age (weight >90%)

A
  • Maternal diabetes
  • Beckwith-Wiedemann syndrome: congenital growth disorder; hemihyperthrophy, large organs and other symptoms
  • Hydrops fetalis: Fatal condition defined as an abnormal accumulation of fluid in two or more fetal compartments
  • Large mothers
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10
Q

Newborn assessment: Dubowitz/ Ballard exam

A
  • Physical maturity assessment, performed within 2 hours of birth
  • Points -2 to +5 given for six criteria:
  • Skin texture: sticky, smooth, peeling
  • Lanugo: soft downy hair on baby’s body is absent in immature infants, present with maturity, and disappears with post maturity
  • Plantar creases: On solfe of feet ranges from absent to covering the entire feet
  • Breast: thickness and size of breast tissue
  • Eyes/ ears: Eyes fused or open, amount of ear cartilage present, and the amount of elastic recoil of cartilage
  • Genitals: Male: presence of testes and appearance of scrotum from smooth to wrinkled; Female: appearance and size of clitoris and labia
  • Neuromascular maturity assessment: assessed within 24 hours
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11
Q

Newborn assessment: vital signs

A
  • Temperature: > 100.4 F (38C) consider fever
  • Pulse: 120 - 170 bpm
  • Respiration: 30 to as high as 80
  • BP: < 112/74
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12
Q

Newborn assessment: milia

A

Pinpoint white papules on face, prominent on cheeks, nose, chin, forehead

  • spontaneously disappear within 3 to 4 weeks of life
  • if persist or wide spread distribution, may indicate a genetic syndrome
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13
Q

Newborn assessment: miliaria

A

Obstructed sweat (eccrine gland) ducts, sometimes referred to as “prickly heat”

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14
Q

Newborn assessment: erythema toxicum

A

Most commone newborn rash; usually appears btw days 2 to 5 after birth; characterized by blotchy red spots on the skin with overlying white or yellow papulses or pustules; resolves by the 14th day

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15
Q

Newborn assessment: Cafe au lait spots

A

Typically a subtle shade discoloration located on either flank; may not be present at birth but likely to increase in size with age: suspect neurofibromatosis if there are many large spots or if more than 6 spots in a child older than 5 yo

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16
Q

Newborn assessment: junctional nevi

A

If present in large numbers, suspect tuberous sclerosis, xeroderma pigmentosus, or generalized neurofibromatosis

17
Q

Newborn assessment: mongolian spots

A

Benign, flat, congenital birthmark with wavy borders and irregular shape; common color is blue; may last up to 3 to 5 years after birth, almost always disappear by puberty

18
Q

Newborn assessment: Port wine stain

A

Vascular birthmark (malformation) consisting of superficial and deep dilated capillaries in the skin; produce a reddish to purplis discoloration of the skin; permanent. Associated with neuro (seizures) - ocular (glaucoma) characteristics

19
Q

Newborn assessment: strawberry mark (hemangiomas):

A

Raised, soft red lumps on the skin, more common in premature babies; hypo/hyper-pigmented; after 6 months of age, the strawberry marks usually begin to shrink and fade

20
Q

Newborn assessment: normal posture

A

Hips should be abducted and partially flexed with knees flexed, arms adducted, elbows flexed, and fists clenched

21
Q

Newborn assessment: primitive reflexes - present at birth

A

Pacing/ stepping: disappears 1-2 months
Rooting: disappears 3-4 months
Sucking: disappears 3-4 months
Moro: disappears 3-4 months
Grasp (Palmar, plantar): disappears to to 6 months, plantar - 4 months
Tonic neck: disappears 3 months
Babinski: disappears 12 months or when walking

22
Q

Newborn assessment: white forelocks

A

White forelocks with other anomalies are sometimes associated with deafness and retardation (Waardenburg syndrome)

23
Q

Newborn assessment: common causes of wide fontanels

A 
Prematurity
IUGR
Hydrocephalus
Down syndrome
Hypothyroidism
24
Q

Newborn assessment: red reflex

A
  • Red reflex replaced by a black spot means there is no clear pathway from the lens to the retina
  • Red reflex replaced by a whitish color, may suggest retinoblastsoma or congenital cataracts
  • the sclera is normally white and may appear bluish in premies; if the sclera is deep blue, osteogenesis imperfecta should be ruled out
25
Q

Newborn assessment: choanal atresia

A

narrowing or blockage of the nasal airway by tissue, present at birth

26
Q

Newborn assessment: microstomia

A

Small mouth, observed in trisomy 18 and 21

27
Q

Newborn assessment: macrostomia

A

Large mouth, present in mucopolysaccharidoses; fish mouth is seen in fetal alcohol syndrome

28
Q

Newborn assessment: macroglassia

A

Large tongue, seen in hypothyroidism and mucopolysaccharidoses

29
Q

Newborn assessment: umbilical cord

A

Two arteries and one vein

30
Q

Newborn assessment: testes

A

97% of full term males have descended tested at birth

31
Q

Newborn assessment: developmental dysplasia of the hip

A

With hips flexed at 90 degrees and knees together, begin by abducting, then adduct while the examiner’s fingers are over the greater trochanters

  • Ortolani’s click: a click is heard or felt as dislocation is reduced
  • Barlow’s maneuver: feeling for a slip as the femoral head slips away from the acetabulum causing the dislocation
32
Q

Newborn assessment: mandatory screening program

A

All states require PKU, galactosemia, sickle cell disease, congenital hypothyroidism

  • a re-screen is mandatory for newborns tested at < 24 hours of age
  • rescreen infants that appear symptomatic
33
Q

Newborn assessment: PKU

A

Phenylketonuria

  • Developmental delay
  • severe retardation
  • seizures
  • aggression
  • autism
  • hyperactivity
34
Q

Newborn assessment: galactosemia

A

Liver dysfunction, coagulopatheis
25% of unrecognized infants develop sepsis
Maple sugar urine odor

35
Q

Newborn assessment: hemoglobinopathies

A

Sickle cell disease, thalassemia

  • 1:400 African Americans
  • anemia
  • Sepsis
36
Q

Newborn assessment: hypothyroidism

A
  • Measurement of T4 and TSH in newborn

- Mental retardation, neurologic abnormalities, metabolic abnormalities

FNP exam (6 decks)

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