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DU PA Newb & infant

Duke PA Newborn and Infant

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