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PED Newborn Infant
The Newborn Infant
| Question | Answer |
|---|---|
| AGA | appropriate gestational age: plotting of birth weight and gestational age appropriate/match |
| SGA | small for gestational age: symmetrical vs. asymmetrical. Symmetric-overall small, Asymmetric - only weight is <10th percentile, all other features nl |
| LGA | large for gestational age; infants of diabetic mothers |
| Immunization for going to school given at age | within 4-6 year age. 4 days before 4th b-day or 4 days after 6th b-day. Too earlier or too late is not recordable b/c it is out of time frame |
| Usual cutoff of Fever temp to not give shots | 100.3 |
| perinatal mortality | 20 wk gestation to 7 days after birth |
| Neonatal Mortality | Infant death from birth until 28th day |
| Post Natal period mortality | 28th day to end of 1st yr |
| Infant Mortality rate | Neonatal + postnatal |
| APGAR tested at 1min and | @5 min. 10 min score in depressed infants. |
| Skeletal survey | obvious deformity; syndactyly, polydactyly, atresia, birth trauma, i.e. fx clavicle, Erb’s palsy |
| Umbilical Cord survey | 2 arteries / 1 vein1% have 2 vessel cord; carries slight risk of vascular abnormalities |
| APGAR Components (2 points each, 10 pts total) | HR, RR, Muscle Tone, Reflex irritability, Color |
| Evaluation of the newborn in the Nursery | Skin, Auscultation of lungs and heart, palpate abdomen, HEENT, Genitalia, Hips, Neurologic (tone, reflexes, symmetry of movements) |
| Conjunctivitis | not uncommon in newborns at all. At birth (gonorrhea), in first week (Chlamydia). Onset related to etiology. |
| Eye prophylaxis to prevent GC | erythromycin ointment within 1 hr of birth |
| Hep B | given to all newborns |
| Initial care of the newborn | glucose testing, heb p, hearing screen, eye prophylaxis, state mandated newborn screen |
| Many newborn tests utilized what sample source? | Cord blood |
| Vitamin K | 1 mg IM within 4 hr, prevent hemorrhagic newborn disease |
| Birth Weight decreases | 8-10% in 1st 24 hours. Regain BW by 2 weeks. |
| Lanugo | fine hair, often on back and shoulders. Seen more in pre-term babies |
| Mongolian spots | often seen in AA and Asians. Raised, colored |
| Macules with vesicles within them | Erythema toxicum. up to 50% of full-term infants develop this. Usually at 24-48 hrs of age, onset after 4-5 days post-birth is rare. May fade w/in 24-48 hrs or develop into wheals or pustules.Contain eosinophils, nothing on gram stain. Disappear 5-7 days. |
| Bleeding under the skull seen in | Cephalohematoma & caput succedaneum |
| Caput Succedaneum | crosses suture lines |
| cephalohematoma | usually seen when kids are delivered with forceps. contained in suture lines |
| closure of anterior fontanelle (2-4cm) | 2-24mo. avg is 1 year |
| closure of posterior fontanelle (1cm) | 2-4 months |
| Craniosyostosis | premature fusion of the sutures. Must be detected and corrected early. Once kids get 2 years old, it's too late |
| facial Nerve palsy | may only be able to see it when the baby cries. Usually self corrects. Early on can have some problems with feeding |
| New born eye sight range | 8-15" |
| Leukocoria (white instead of red reflex) | Cloudy cornea from cataracts or glaucoma, White eye, cat eye: retinoblastoma (most worrisome cause) |
| constant unilateral teary eye | nasolacrimal duct stenosis. Have parents massage the duct. |
| Strabismus | convergent gaze, normal in newborn, but if consistent for months, refer them out |
| check for nasal patency b/c | babies are obligate nose breathers for the first few months of life |
| Epstein's pearls | purplish raised areas along the gingiva |
| Thrush tx | nystatin. May be hard to tell if it is candida or residual milk on soft tissue. If baby refuses to feed, it is an indication for thrush b/c it is painful |
| Micrognathia is associated with | FAS, Pierre Robin Syndrome (uncommon ear, nose and throat syndrome) |
| Macroglossia is associated with | Trisomy 21, Beckwith-Wiedemann |
| Common masses in the newborn | brachial cleft cyst, thyroglossal duct cyst, cystic hygroma |
| Torticollis | Hematoma, or muscle mass in SCM |
| tachypnea in newborn is defined as | >60 |
| Periodic breathing | normal crescendo breathing followed by a brief apneic period. Count for a whole minute |
| Murmurs at birth | commonly heard in the first few days of life. murmurs heard at birth should be considered valvular in etiology until proven otherwise |
| Umbilical hernias | document. make sure it is easily reducible. Usually goes away by age 5 |
| Child not having a bowel movement? consider | hirschsprung disease |
| Female infants vaginal exam | blood may be present and is normal due to shifts in hormones, just make sure it stops in a few days |
| Talipes equinovarus | club foot |
| Metatarsus adductus | pigeon foot, sometimes corrects on its own. |
| Babinski | upgoing toes normal until age 2 years |
| Neonatal Jaundice | 65% develop in first week, most caused by unconjugated bilirubin. Starts at head and moves down. Elevated bilirubin can cause Neuro damage. If increased conjugated bilirubin: think biliary atresia |
| Jaundice in the 1st 24 hours | not normal; sepsis, hemolytic anemia. |
| Jaundice that appears on days 2-3 and disappears by day 5 is | physiologic; breast fed infants at increased risk |
| Unconjugated hyperbilirubinemia: pathologic | Increased production: results from increase in RBC destruction - antibody mediated hemolysis (coombs +) (ABO incompatibility fairly common), Non-immune hemolysis (Coombs -) |
| Tx for ABO incompatibility | Phototherapy |
| Unconjugated Hyperbilirubinemia: Pathologic | decreased rates of conjugation. RETURN TO |
| Unconjugated Hyperbilirubinemia: Physiologic | Unknown and or multiple causes. Risk for Physiologic jaundice: asian>white>AA. Prematurity, breast feeding, sibling with hyperbilirubinemia. Tx: phototherapy |
| Hypoglycemia | glu<35-40mg/dL. By age 3 hrs glucose should be 50-80mg/dL. Risks: IDM, IUGR, Infxn, Prematurity. Sx: lethargy, poor feeding, irritability, seizures. Tx: IV glucose D10W@2ml/kg |
| Infxns in the newborn | Routes of infxn: transplacental, ascending (after ROM), passage through infected birth canal. Bacterial infxns: sepsis, pneumonia, meningitis, UTIs, omphalitis. Congenital: CMV, rubella, varicella, toxo, syph., TB. Perinatal viral infxn:HSV, Hep B,C |
| When should parents expect the umbilical cord to fall off? | Within 1-3 weeks. Seek consultation with doctor if it has not fallen off by 8 weeks. Keep cord as clean and dry as possible (sponge baths advised). Umbilical granuloma (pink scar tissue) may form and need to be cauterized. |
Created by:
ltm12