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