how many infants are born each year in US
4 million
how many newborns need resuscitation
10%
what are the major physiological events at birth
lung expansion/cry
umbilical cord clamping and sudden increase in BP
decrease in pulmonary vascular resistance
transition from fetal to adult ciruclaiton (FO close, DA close)
when are APGAR scores assessed
1, 5, 10 minutes of life
what is the a in apgar
appearance (color)
what is the p in apgar
pulse (heart rate)
what is the g in apgar
grimace (irritability)
what is tha a in apgar
activity (muscle tone)
what is the r in apgar
respirations
what is a 0 in a
blue/pale
what is a 1 in a
pink body, blue exterior
what is a 2 in a
completely pink
what is a 0 in pulse
absent
what is a 1 in pulse
slow (< 100/min)
what is a 2 in pulse
>100/min
what is a 0 in grmiace
no response
what is a 1 in grimace
grimace
what is a 2 in grimace
cough/sneeze
what is a 0 in activity
limp
what is a 1 in activity
some flexion
what is a 2 in activity
active movments
what is a 0 in respirations
absent
what is a 1 in respirations
slow, irregular
what is a 2 in respirations
good, crying
what types of situations could apgars be misleading in
preterm infants, meconium deliveries
what is a meconium delivery
...
what are the key things in the newborn physical exam
vital signs
"measurements"
genreal appearance
what are the vital signs
temp
resp
BP
HR
what is important about the "measurements" in newborns
head circumference
length
weight
gestational age
what is improtant about gneral appearance of newborns
activity
color
obvious abnormalities
what should you notice about the newborn's skin
color
rashes
nevi
what types of colors could be see on newborn skin
plethora
jaundice
pallor
cyanosis
bruising
mottling
what is a newborn's skin like if it is described as "plethora"
flushed
what would a baby's skin be like if it were jaundinced
yellow hue
what is a baby that has "pallor" in the skin like
pale
what is "mottling" in a baby'e skin like
marble like pattern when the baby gets cold
what is another name for nevi
birthmarks
what is erythema toxicum
blotchy red spots on the skin[4] with overlying white or yellow papules or pustules
disappear on their own
what type of rashes could be seen on newborn skin
milia
erythma toxicum
candida albicans
acne neonatorum
what types of nevi could be seen on newborn skin
macular hemangiomata
port wine stain
mongolian spot
what is of note in newborn heads
anteiror and posterior fontanelles
modling
caput succedaneum
increased IC pressure
craniosynostosis
what is improtant in newborn neck
clavicle intact
thyroglossal duct
hematomata
what is important in newborn face
symmetry (damage to facial nerve)
obvious dysmorphology
what is important in newborn ears
abnormal shape and/or position
what is important in newborn eyes
red reflex
scleral color
Brushfield's spots
conjunctivitis
what is important in newborn nose
assessment of patency of nares
what is important in newborn mouths
ranula
epstein's pearls
mucocele
natal teeth
macroglossia
copious saliva
thrus
what is important in newborn chest
breath sounds: asymmtery, quality, tachypnea
pectus excavatum
breast tissue
what is important in newborn heart
murmurs: ASD, VSD, PDA, TOF, coarctation
pulses and perfusion
what is improthatn in newborn abdomen
auscultaiton
palpation
anomalies (gastroschissi, omphalocele)
what is importnat in newborn umbilicus
3 vessel cord
what is important in newborn male genitalia
hypospadias, epispadias, chordee, testicles, herna
what is important in newborn female genitalia
muscoal tag, vaginal bleeding, clitoromegaly
what is important in newborn anus and rectum
patency and position
what is improtant in newborn extremities
syndactyly
polydactyly
simian crease
clubfoot
what is important in newborn spine
sacral dimple
abnormal pigmentation
what is important in newborn hips
dislocation
what is important in newborn nervous system
muscle tone
reflexes
crenial nerves
movemetnt
what is "preterm"
earlier than 38 weeks
what is "term"
38-41+6
what is "post term"
over 42
whatis small for gestational age
less than 2 SD below mean or <10%
what is large for gestational age
greater than 2 SD above mean or >90%
what is new ballard score best performed at for infants less than 26 week gestation
<12 hrs of life
what i the new ballard score best performed at for more mature infants
<96 hrs of life
within how many weeks of gestational age is the new ballard score activate
2 weeks
what are the criteria of new ballard score
6 neuromusclar
6 phsyical
what is routine newborn care in terms of monitoring
monitoring temp, HR, resp rate, feeding vol/freq/tolerance, urine output, meconium, daily weights, initial blood glucose and hematocirt
what types of things should you watch for newborn eye care
prophylaxis for gonococcal ophthalmia neonatorum
what would you treat gonococal ophthalmia neonatorum with
AgNO3 or erythromycin within an hour of delivery
what does vitamin K prevent
hemorrhagic disease of newborn within 1 hour of birth
what are some general things to pay attention to with the newborn
cord care
circumcision
hep B vaccine
hearing screeing
newborn screening
discharge planning
what things are included in the newborn screen
phenylketoniuria
galactosemia
hypothyroidism
homocystinuria
maple syrup urine disaes
sickle cell disaese/hemoglobinopathies
cystic fibrosis
what are the things to set up with discharge planning
newborn screen
return visit
back to sleep
carseat safety
from lecture
...
what will the OB do in terms of taking care of the child
provide respiration support, that's it
what should the newborn's HR be
over 100
if you don't have a newborn HR over 60 what will be provided
chest compressions and then if it continues they will get epinephrine
what is given to reverse the effects on the baby of the mom's pain meds
narcan (sometimes)
can a baby's temperature be both too high and too low
yep
what can be an underlying cause if the heart rate is too slow
coarctation of aorta, etc other things
what should you do first after checking the general appearance of the child
heart and lungs
what could make a baby large for gestational age
maternal diabetes
what could make a baby small for gestational age
bad placental connection
CMV or other TORCH viruses
what will a mottling baby look like
irregular and splotchy in color
do you fix cavernous hemangiomas if you see them
no they resolve themselves
where would a stork bite mark be
on the back of the neck
what would be a serum jaundice level to watch
over 20 mg/dL
what would you do for a serum jaundice over 20 mg/dL
observation
bili blanket
phototherapy
what will the bili blanket do
provide light that helps convert wavelength of light to a more excretable form
do all babies get jaundice
yes
where does jaundice start and where does it go
starts in face and moves down body
what ia newborn jauncie due to
baby's liver not being good enough to get rid of bilirubin well yet
what should the baby's diet be like if he/she has jaundice
a lot so it can poop a lot to get it out
what is milia
keratin filled cyst on skin or roof of mouth
what is this
milia
what is this
erythema toxicum
what is erythema toxicum
blotchy red spots on skin with overlying white or yellow papules or pustules, benign
what is a macular hemangioma
vascular malformation, benign for most part but not if in wrong place
what is a port wine stain associated with
telangiectasic symptoms
is a port wine stain permanent
yes
what is this
macular hemangioma
what is this
mongolian spot
what is acrocyanosis
blue hands or feet
is acrocyanosis normal
yep
is the forceps mark something to worry about
no, actually much better than vaccuum bruise actually
what is molding from
big baby head going through small space
resolves in a couple of days
what happens to cephalohematoma
gets absrobed like a bruise
is there an underlying skull fracture in cepahlohematoma
no
what does cephalohematoma put baby at risk for
baseline jaundice persistence
is it common to have damage to clavicles with difficult delivery
yes very, can be felt with crepidice
are hematomas usually ok in newborns
yes but watch for respirations
what should be watched for in the face
extra ear attachments
preauricular skin tags could indicate hyperplasia or some tissues around this
what should the newborn's eyes be checked for
retinoblastoma or cataracts
why do baby's eyes appear to be crossing
nose is so wide
is red reflex in newborn's eye normal
yes
is pseudostrabismus normal in newborn
yes
what should be checked for in the mouth of newborns
extra teeth or palate abnormalities
do epsteins pearls go away
yes
do mucoceles go away
yes
what is this
mucocele
what is a labial/lingual frena
tongue tie
if the tongue tie is narrow, what happens to it
clipped in nursery
if tongue tie is deep, what happens to it
sent to dentist
what is important for lingual frena
makes the mother very sore from breastfeeding
why are natal teeth important
can be aspirated, dangerous
what does thrush look like
adherent white plaques on tongue
can yeast get into the breast
yes from thrush and it hurts the baby
whats a main thing for people to worry about in newborn's chest
pneumothorax
why is it hard to hear heart abnormalities in newborn
because HR so high
if a baby's abdomen is flat what could be underlying issue
diaphragmatic hernia
is gastroschisis or omphalocele associated with midline abnormality
omphalocele
what are the vessels in the umbilicus
2 umb arteries
1 vein
where do newborns get IV
right from umbilicus
why are no babies with penile abnormalities circumcised
might need the skin for repair
what is a very important thing to recognize in babies sexual organs
any abnormalities
what is chordee
penis is tethered at the body
what do you do for an undescended testicle
brought down after a few weeks because of the increased incidence of cancer
is it pretty normal for there to be vaginal bleeding
yes
if baby doesnt poop for 24 hours what could they have
meconium plug
patent anus
do babies with polydactyly get plastic surgery pretty young
yes because this is bony tissue
what is simian crease associated with
trisomy 21
is bowing of the legs normal in newborns
yes
what are the feet like in newborn and preterm babies
term: normal
preterm: slick
what happens to babies with clubfoot
serial casting for many weeks after born and repaired after they straighten out
what can sacral dimple be a sign of
underlying spina bifida
do most babies with sacral dimple have spina bifida
no
what will happen if you can dislocate the baby's hip easily
orthopedic surgery right away to fix; big lawsuit thing if you miss this
what is the device for correcting an easily dislocateable baby hip
puts head of femur in anterior part of acetabulum
what are some good indications that the baby may have easily dislocatable hips
asymmetric gluteal folds and dysplasia
what will baby feel like if it does not have great muscle tone
floppy
what will the flexibility and folding of tissues be like in a more preterm baby
more flexible
more pronounced rugae in scrotum in a normal baby
how much weight can baby lose in first week
10%
why are babies given vitamink K
turns on clotting factors in baby so they dont bleed during circumcision and stuff
how is the newborn hearing screening done
measures brainstem response to what they are hearing
what are some important things to remember in discharge in the carseat
watch the airways!