Duke PA Newborn and Infant
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| What defines the newborn period | First 28 days of life
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| Term infants are those that are born between __ weeks | 38-42
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| What is the post natal period | 28th day to end of 1st year
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| To what nursery level do healthy infants go | Level 1
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| What is a level 3 nursery | Regional center for critical infants
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| When is the APGAR score normally done | 1 & 5 minutes, 10 minutes in depressed infants
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| Infant conjunctivitis is common or uncommon | Common
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| Most babies will lose __% of their birth wt in first 24 hours | 8-10
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| Most babies will regain their birth wt by __ | 2 weeks
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| Normal vital signs for newborns | HR-120-160, RR-30-60, BP 50-70 systolic; Record & plot Ht, Wt, HC
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| Hematoma contained in skull suture lines | Cephalohematoma
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| Hematoma that crosses skull suture lines | Caput succedaneum
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| When does the anterior fontanelle usually close | 4-24 months, average 1 year
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| When does the posterior fontanelle usually close | 2-4 months
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| What is the term for premature fusion of the sutures | Craniosynostosis
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| Intermittent strabismus is normal up to __ | 3-6 months
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| Cloudy cornea from cataracts or glaucoma | Leukocoria
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| Newborns are obligate __ breathers | Nose
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| Hearing is fully developed by __ | 1 month
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| Macroglossia is associated with __ | Trisomy 21, Beckwith-Wiedemann
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| Where is a branchial cleft cyst locate | Anterior to SCM
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| Where is a thyroglossal duct cyst located | Neck midline
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| Where is a cystic hygroma located | Posterior to SCM
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| Name some common neck masses | Branchial cleft cyst, thyroglossal duct cyst, cystic hygroma
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| What does APGAR stand for | Appearance, Pulse, Grimace, Activity, Respiration
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| What are the five components of the APGAR (not the mnemonic) | Skin color, pulse rate, reflex irritability, muscle tone, breathing
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| APGAR – blue all over gets a score of | 0
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| APGAR – blue at extremities body pink gets a score of | 1
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| APGAR – no cyanosis gets a score of | 2
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| APGAR – absent pulse gets a score of | 0
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| APGAR – pulse <100 gets a score of | 1
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| APGAR - pulse > 100 gets a score of | 2
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| APGAR – no response to stimulation gets a score of | 0
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| APGAR – grimace/feeble cry when stimulated gets a score of | 1
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| APGAR – sneeze/cough/pulls away when stimulated gets a score of | 2
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| APGAR – no muscle tone gets a score of | 0
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| APGAR – active movement gets a score of | 2
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| APGAR – some flexion gets a score of | 1
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| APGAR – no breathing gets a score of | 0
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| APGAR – weak or irregular breathing gets a score of | 1
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| APGAR – strong breathing gets a score of | 2
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| APGAR score of __ are considered critically low | 3 and below
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| APGAR scores of __ are considered fairly low | 4-6
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| APGAR scores of __ are considered normal | 7-10
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| APGAR scores are taken at __ and again at __ in depressed infants | 1 and 5 minutes, 10 minutes
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| Umbilical cord should have __ artery to vein ratio | 2:1
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| Eye prophylaxis to prevent GC | Erythromycin ointment within 1 hour of birth
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| What is given 1mg IM within 4 hours of birth to prevent hemorrhagic newborn disease | Vitamin K
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| What tests are done on the cord blood | Type, Coombs test, Newborn screening, Hct, glucose
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| Normal newborn HR | 120-160
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| Normal newborn RR | 30-60
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| Normal newborn BP | 50-70 systolic
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| Birth weight decreases by __% in the first 24 hours but is regain by 2 weeks | 8-10
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| What are the parts of the evaluation of the newborn in the nursery | Skin, auscultation of heart and lungs, palpate abdomen, HEENT, genitalia, hips, Neurologic (tone, reflexes, symmetry of movements)
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| What are the parts of the initial care of the newborn | Bulb suction oropharynx, support body temp, eye prophylaxis to prevent GC, hep B vaccine, glucose testing, state mandated newborn screen, hearing screen, cord blood eval, vitamin K, position (supine, or R side dependent arm extended)
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| Cloudy cornea from cataracts or glaucoma | Leukocoria
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| Tachypnea in an infant is a rate >__ | 60
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| What are signs of respiratory distress in an infant | Tachypnea, retractions, grunting
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| Transient tachypnea of the newborn is from retained secretions, and usually resolves in __ | 24-36 hours
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| Murmurs heard at birth should be considered __ in etiology until proven otherwise | Valvular
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| Congenital heart disease is present in __% of infants | 0.8
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| __ due to PACs is not uncommon in the first few days of life | Irregular heart rate
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| Newborn has excessive drooling and choking with attempted feeding, diagnosis made with CXR after placement of nasogastric tube, surgical treatment is required | Tracheo-esophageal fistula
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| Abdominal wall defect to right of umbilicus. Intestines/stomach/bladder/liver are outside the peritoneal cavity | Gastroschisis
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| Liver and stomach covered by peritoneum at the umbilical orifice | Omphalocele
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| Umbilical hernias are found in up to __% of black infants | 40
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| Umbilical hernias <__cm usually close by age 5 | 1.5
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| What are signs that an umbilical hernia needs surgical repair | >1.5 cm at 2 years of age, or signs of incarceration
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| Congenital absence of intramural colonic ganglion cells in rectosigmoid. Inability of bowel complex to relax causes functional bowel obstruction. Presents in 1st 24-48 hours with failure to pass meconium, abdominal distention, and bilious vomiting | Hirschsprung disease; dx requires rectal bx
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| What nursery level will an infant >30 weeks and 1200 gm not requiring ventilation or circulatory support go to | Level 2
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| How is hypoglycemia defined in the infant | <35-40 mg/dL
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| By age 3 hours, glucose should be __mg/dL | 50-80
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| What are the symptoms of infant hypoglycemia | Lethargy, poor feeding, irritability, jitteriness, seizures
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| What is the treatment for infant hypoglycemia | IV glucose D10W @ 2ml/kg
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| Four criteria required before discharge of a newborn in 24-36 hours | Feeds and voids well, yellow stools, <10% wt loss, bili levels stable; ensure f/u in 48-72 hrs
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| Neonatal mortality: | from birth to 28th day
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| Perinatal mortality: | 20th week of gestation to 7th day after birth
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| LBW | <2500 g; 7% live births & 70% neonatal mortality
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| VLBW | <1500 g
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| Fetal scalp ABG of ____ indicates fetal hypoxic compromise | <7.20
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| Fetal scalp ABG of ____ is borderline & needs repeat test | 7.20 - 7.25
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| Soft creamy layer on skin in preterm infants = | vernix caseosa; also often see lanugo in preterm
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| transient blue/black macules on lower back/buttocks in 90% AA, Indian, Asian infants | Mongolian spots
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| Salmon patch = | Nevus simplex: pink macular hemangiomas; neck, eyelids, forehead
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| Portwine stain, aka _______, consider: | aka nevus flammeus; Sturge Weber
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| skin feature in post term infant | peeling skin
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| Neonatal vision | 20/200
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| white eye, cat eye: | retinoblastoma
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| Most common congenital anomaly of nose | choanal atresia (stenosis); poss resp distress/apnea at birth
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| micrognathia, cleft palate, airway obstruction | Pierre Robin syndrome
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| Persistence or aggravation of pulmonary vasoconstriction results in: | persistent pulmonary hypertension of the newborn (PPHN)
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| TTN | Failure to replace pulmonary alveolar fluid completely with air can lead to resp distress; retained secretions; usually resolves in 24-36 hrs
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| Periodic breathing | normal crescendo breathing followed by a brief apneic period
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| Capillary vs cavernous hemangiomas | capillary: raised, red lesions; cav: deep blue masses; Both enlarge after birth & resolve at 1-4 yo; may produce high-output heart failure or plt trapping/ hemorrhage
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| Erythema toxicum: | erythematous, papular-vesicular rash; common in neonates; involves eosinophils in the vesicular fluid
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| Pustular melanosis: | more common in AA; small, dry vesicle on a pigmented brown macular base
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| Bacterial infxn in newborn | sepsis, pneumonia, meningitis, UTIs, omphalitis
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| Perinatal viral infxn: | HSV, hepatitis B, C
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| congenital infxn in newborn | CMV, rubella, varicella, toxoplasmosis, syphilis, TB
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| Observe infants born to GPS-positive moms for: | 48 hrs
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| Severe cardiac defects & infection present in: | 6 hours
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