The Newborn Infant

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What vaccinations should infants receive at birth?

Hepatitis B

When should an infant receive the Hep B vaccines

Birth, 1-2 months, 6-18 months

What is the neonatal period of an infant's life?

the first 28 days

What is the postneonatal period?

29days-1 year

When are newborns most responsive?

1-2 hours post feeding

When should you do an apgar score?

1 and 5 minutes after birth, Continue at 5 minute intervals until its greater than 7.

1 minute apgar score values

8-10 normal, 5-7 some nervous system depression, 0-4 severe depression requiring immediate resuscitation

5 minute apgar score values

8-10 normal, 0-7 high rish for CNS and other system damage

Gestational ages

<37 wks preterm, 37-42=term, >42 postterm

Birth weights

<1,000 extrememly low, <1,500 very low, <2,500 low >2,500 normal

SGA small for gestational age

<10th percentile

AGA appropriate gestational age

10-90th percentile

LGA large for gestational age

>90th percentile

Most normal, full-term newborns

lie in a symmetric position, with the limbs semiflexed and the legs partially abducted at the hip

By 1 year old, an infants weight should have

tripled and height increase by 50%

By 1 year, infants should be

walking, saying 1-3 words, and imitating activities

Normal heart rates for birth-1 year

0-2mo: 140, 90-190
0-6mo: 130, 80-180
6-12mo: 115, 75-155

Respiratory rates

Birth-2 months: <60, 2-12 months <50

miliaria rubria

scattered vesicles on an erythematous base, disappears spontaneously within weeks

erythema toxicum

pinpoint vesicles scatered diffusely, disappear within 1 week

milia

smooth, white raised areas on nose, chin and forehead, disappears on its own.

salmon patch (nevus simplex)

"stork bite" or "angel kiss", splotchy pink marks fade with age

cafe au lait spots

light-brown pigmented lesion, if more than 5 consider neurofibromatosis

mongolian spots

bluish-black on the buttocks

anterior fontanelle

4-6cm, closes between 4 and 26 months

posterior fontanelle

1-2cm, closes by 2 months

Female genitalia is often protuberant and has a milky white discharge from

materal estrogen

seborrhea

salmon, red scaly eruption

What is the most common cause of low birth weight in developing and developed countries?

IUGR, prematurity

What is given to prevent neonatal gonococcal and chlamydial eye disease?

Erythromycin drops

What is vitamin K prophylaxis for?

To prevent hemorrhagic disease of the newborn

Name the components of the apgar score:

Heart rate, respiration, muscle tone, reflex irritability, color of body

choanal atresia (stenosis)

Respiratory distress, apnea, unable to breath through nose

Tracheoesophageal Fistula manifestations

Unable to place NG tube in stomach, aspiration pneumonia, salivation

Acrocyanosis

May be noted in a healthy term infant a few days after birth.

Hair tufts over the LS spine

suggest a spine defect

Vernix caseosa

soft, white, creamy layer covering the skin in preterm infants

Epstein pearls

epidermal inclusion cysts on the hard palate, normal

The Moro reflex

Sudden, slight dropping of the supported head should cause opening of the hands and extension and abduction of the arms and a cry.

Rooting reflex

turning of the head toward light tactile stimulation of the periorbital area (by 32 weeks)

Omphalocele is more commonly associated with ______ while gastrochesis is more associated with ___?

other malformations; intestinal necrosis

caput succedaneum

a diffuse, edematous, often dark swelling of the soft tissue of the scalp that extends across the midline and suture lines

cephalhematoma

subperiosteal hemorrhage that does not cross the suture lines surrounding the respective bones.

IUGR

an adaptation to unfavorable uterine conditions that result in permanent alterations in metabolism, growth and development.

Hydrops fetalis

a fetal clinical condition of excessive fluid accumulation in the skin and one or more other body compartments.

What has reduced the incidence of hydrops fetalis?

Rho D Immunoglobulin

Bilirubin is produced by the

catabolism of hemoglobin in the reticuloendothelial system.

Jaundice on the first day of life

is always PATHOLOGIC.

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