VanGarsse: Management and Exam of the Healthy Neonate Flashcards
(51 cards)
1
Q
Sx of hypoglycemia
A
- hypothermia
- jitteriness
- tremors
- hypotonia
- irritability
- lethargy
- stupor
- apnea
- poor feeding
- seizures
2
Q
Jaundice/hyperbilirubinemia
A
- values above 25mg/L
- can result in BIND (bilrubin induced neurologic desfunction and/or kernicterus
- risk factors include ABO incompatibility, excessive bruising, prematurity, sepsis, heart disease
3
Q
What is the first thing we look for in the new baby?
A
- is it breathing?
- watch for see-saw respirations
- belly goes up, chest goes down
- look for retractions and “singing”
4
Q
What are some pleural space problems that could happen?
A
- effusion
- pneumothorax- much more common than effusion
- most commonly spontaneous pneumo or from PPV during resuscitation
5
Q
What color is the color we want to see on our baby?
A
- pink is GOOD
- Blue is bad
6
Q
What is Acrocyanosis?
A
- blue discoloration of the perioral area, feet, and hands
- normal for first 24 hrs
- closely associated with cool surroundings
- perioral changes seen with sucking/feedings
7
Q
For how long after birth is central cyanosis normal?
A
- like 10 minutes
- if it continues, think cardiac stuff
8
Q
Do bruises blanch?
A
- no
- but cyanosis blanches… that is important
9
Q
Does jaundice in the first 24 hours concern us and deserve further evaluation?
A
-yes
10
Q
What does grayish hue mean?
A
- most often indicates severe acidosis in the newborn and often poor outcome
- gray is bad!
11
Q
How does a full term baby look with position at rest?
A
- flexed, with resistance noted when extremities moved
- flaccid full term/late preterm babies deserve attention/work up
12
Q
is a strong lusty cry reassuring?
A
-hell yes it is
13
Q
What does a high pitched cry mean?
A
-infant with CNS/head trauma and or substance withdrawal
14
Q
What are we looking for in the eyes?
A
- red reflex…. if not there, retinoblastoma
- in white it’s red
- in darker skinned, pearly gray, vessels still present
- white means pathology… URGENT REFERRAL
15
Q
what else do we look for in the eyes?
A
- size, placement, rotation shoud be noted
- palpebral fissure angle is from medial to the lateral canthus
16
Q
is subconjunctival hemorrhage worrying?
A
- no
- it looks scary as shit though
17
Q
when people say that a baby has low set ears, what do they really mean?
A
-the baby’s ears are just posteriorly rotated
18
Q
What else do we look for on the ears
A
- check for patency of EAC, tympanic membranes rarely viewed on the newborn exam
- significance of pre-auricular skin tags and “pits” are often debated
19
Q
What do we look for in the Nose?
A
- misshapen secondary to birthing or intrauterine positioning
- call ENT if you see this
- usually just swelling and it’s fine
20
Q
Causes of Nasal obstruction?
A
- mucus
- edema
- anatomical: tumor, encephalocele, Choanal atresia
21
Q
What are we looking for in the mouth?
A
- micrognathia: pierre robin sequence
- cleft lip and palate may also be associated with a syndrome
22
Q
Are epstein pearls a big deal?
A
-no
23
Q
What do we look for in the Neck?
A
- webbing like in turner’s syndrome
- excess skin at the base of the neck is common in trisomy-21 (down)
24
Q
What do we have to check for in clavicles?
A
- make sure they’re there
- see if they’re fractured
25
What is the goal of cardiac exam?
- ensure the absence of heart disease
| - determine if the heart is the source of the problem in the "ill" neonate
26
What is the normal heart rate for an infant?
-100-160 BPM
27
Which pulses should be examined simultaneously on an infant?
-femoral and brachial pulses
28
Does the absence of a murmur during auscultation of the chest does not ensure there are no pathological structural problems?
-hell no
29
Is a murmur a big deal in the newborn infant?
- no
| - most babies have murmurs in the newborn period .... most transient and innocent
30
Which murmurs deserve further evaluation?
-loud murmurs with harsh qualities, to and fro murmurs, or pansystolic murmurs which persist past the first few hours of life
31
what does the disappearance of a murmur in a clinically deteriorating infant indicative of?
-a "ductal dependent" lesion (coarctation of aorta, tricuspid atresia, pulmonary atresia)
32
What is the most important part of the respiratory system evaluation?
- observation of the newborn breathing
| - Stethoscope use is for evaluation of the quality, qunaitiy, and equality of air movement
33
What do we want to look for with the stethoscope in the chest?
- ensure the absence of bowel sounds in the chest and to localize abnormal sounds
- stridor, crepitance, crackles
34
what doe we look for on the chest?
- supernumery nipples
- more common in black ppl
- in white ppl, associated with renal anomalies
35
What abdomen things could we see?
- omphalocele
- gastroschisis
- obvious and require urgent surgical intervention
36
How many vessels will there be in an umbilical cord?
- 3
| - 2 arteries, 1 vein
37
Does a cephalohematoma cross the suture lines?
- No!
- weeks to months for resolution
- late can mimic a fracture on xray
38
What is caput succedaneum
- boggy area of edema and or bruising, crosses suture lines, gone in days, present at birth (generally does not enlarge)
- remember that the cap (baseball hat) goes across suture lines
- disappears without treatment
- no pathological significance
39
What is the least common but most dangerous extracranial injury?
- subgaleal hemorrhage
- lots of blood loss
- enlarges after birth
- crosses suture lines
- fluid wave
- can cover entire scalp and extend into the neck
40
What do we want to look for in the back?
- abnormal curves/position
- the number one reason for abnormal curves is an underlying defective fusion
- hair tuft
- dimples separate from gluteal crease
- skin tags or pits
41
What extremity do we need to pay attention to?
- the hip!
- developmental dysplasia of the hip is a thing
- re examin the hips before discharge!
42
What are we looking for in the genitalia?
- if it's ambiguous, urgent evaluation
| - endocrinologic emergency
43
What might we find on the female genitalia?
- muscous
- hymen has some openings
- labial mass in the groin
- hymenal tags very common
- it's all good in the clitoral hood
44
What might we see in the male genitalia?
- hypo or epispadias
| - white sebaceous cysts are relatively common on the distal foreskin and of no consequence
45
When do we need the surgeon evaluation if the testicles aren't down?
-by 9-12 months... if after that, get the surgeon
46
What could the absence of the anus mean?
- VATER
- Vertberal defects, ventricular septal defect
- anal atresia
- T-E fistula/esophageal atresia
- Radial dysplasia
47
What is Vernix?
-the white cheesy stuff that babies have all over..... goes away eventually
48
What are long nails, lack of vernix, peeling/dry skin signs of?
-post maturity
49
What is erythem toxicum neonatorum?
- benign rash of the newborn
- usually appears second to third day of life
- erythematous base with 1-2 mm pustules or papules
- spares palms, soles
- Pustule/vesicles contain debris and eosinophils
50
What are Milia
- appear on face and scalp
- 1-2 mm white, firm papules on the face and bridge of the nose
- resolve spontaneously by a few months
- appear at 36 weeks gestation
51
What are those things that can be found on the butt and kinda look like bruises?
- Slate grey spots (dermal melanosis)
- macular to patch size
- more common in darker skinned races, but affects all
- benign
- those on the lower back/buttocks tend to resolve over several years
- formerly "mongolian spots"
- make sure you document these things because they look like bruises.... police will probably ask ha ha
