2165 - Newborn Assessment Definitions

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Lacerations

A wound or irregular tear of the flesh

Plethora

Congestion causing distention of the blood vessels. In the newborn often caused by exessive RBC's; skin color very red,ruddy.

Cyanosis

A blue, gray, slate or dark purple discoloration of the skin or mucous membranes caused by deoxygenated or reduced hemoglobin in the blood. Cyanosis if found most often in hypoxemic patients and rarely in patients with methemoglobinemias. Occasionally, a bluish skin tint that superficially resembles cyanosis results from exposure to the cold. In the very young patient, cyanosis may point to a congential heart defect.

Jaundice

A condition marked by yellow staining of body tissues and fluids, as a result of excessive levels of bilirubin in the bloodtsream. Jaundice is not usually visible until the total bilirubin level rises above 3mg/dl.

Physiological Jaundice of the Newborn

Nonpatho jaundice affecting newborns. It manifests 48 to 72 hr after birth, last only a few days, and does not require therapy.

Pathological Jaundice of the Newborn

Jaundice manifests in first 24 hours. Always investigate cause(s) and notify MD.

Erthroblastosis Fetails

A hemolytic disease of the newborn marked by anemia, jaundice, enlargment of the liver and spleen, and generalized edema.

Impetigo

A bacterical infection of the skin, caused by streptococci, and marked by yellow to red, weeping and crusted or pustular lesions, especially around the nose, mouth, and cheeks or on the extremities. The disease is common in children and adults may develop after trauma or irritation to the skin.

Lanugo

Fine, soft hair covering the fetus

Mottling

Lacy red pattern from dilated blood vessels under the skin.

Vernix Caseosa

Thick, white substance that coats and protects the skin of the fetus; decreases at term

Hemangioma

A benign tumor of dilated blood vessels.

Strawberry Hemoangioma

A dull red benign lesion, usually present at birth or appearing within 2-3 months thereafter. This type of birthmark is usually found on the face or neck and is well demarcated from the surrounding skin. It grows rapidly and then regresses. It is caused by a proliferation of immature capillary vessels in active stroma.

Erythema Toxicum Neonatorum

A benign, self-limiting rash marked by firm,yellow-white papules or pustules from 1 to 2 mm in size present in about 50% of full-term infants. The cause is unknown, and the lesions disappear without the need for treatment.

Mongolian Spots

One of the blue or mulberry-colored spots usually located in the sacral region. It may be present at birth in Asian, American Indian, black, and Southern European infants, and usually disappears during childhood.

Prematurity

The state of an infant born any time prior to the completion of the 37th week of gestation. The normal gestation period for the human being is 40 weeks.

Hydrocephalus

An accumulation of excessive amounts or cerebrospinal fluid within the ventricles of the brain, resulting from blockage or destruction of the normal channels for CSF drainage. Sometimes the accumulated fluid leads to increased intracranial pressures. In congenital hydrocephalus, the faulty drainage of CSF from the ventricles of the brain often results in malformation of the skull and abnormal development of pyschomotor and cognitive or language skills. **May note increased head circumference size.

Microcephaly

Abnormal smallness of the head (below 1350cc capacity) often seen in mental retardation (microcephalic, microcephalous). Notable decrease in head circumference size.

Congenital Dwarfism

Congenital : Present at birth. Dwarfism: the condition of being abnormally small. It may be hereditary or result of endocrine dysfunction, nutritional deficiency, renal insufficiency, diease of the skeleton, or other causes. Notable decrease in length.

Tetany

A neurological disorder marked by intermittent tonic spasms that are usually paroxysmal and involve the extremities. It may occur in infants, especially newborns in ICUs. High-risk infants include premature newborns of diabetic mothers and those who have had perinatal asphyxia.

Lethargic

Sleepiness, drowsiness, somnolence, or mental sluggishness.

Seizures

A convulsion or other clinical detectable event caused by a sudden discharge of electrical activity in the brain.

Caput Succedaneum

Area of edema over the presenting part of the fetus/newborn; occurs between scalp and periosteum, crosses suture lines.

Cephalohematoma

A collection of blood under the scalp (specifically between the periosteum and the cranium, therefore a cephalohematoma does not cross suture lines) of a newborn usually located over the parietal bone. Risk factors include large neonatal birth weight, forceps delivery and mother's first pregnancy.

Craniosynostosis

Premature fusion of 1 or more cranial sutures resulting in an abnormal head shape.

Anencephaly

Neural tube defect whereby the end of the neural tube fails to close resulting in the absence of a major portion of the brain, skull and scalp. There is no cure or treatment for this defect.

Encephalocele

Failure of the anterior neural tube to close due to genetic, toxic or infectious reasons. The brainis actually outside the skull in a skin covered sack. Surgery can be performed to put the protruding sack back into the skull.

Facial Paralysis

Drooping mouth, diminished movement of the tongue and difficulty with closing eyes are signs of paralysis. Especially note asymmetrical facial movement.

Milia

White cysts, 1-2 mm in size, caused by distended sebaceous glands, spontaneously resolve by 2 months.

Subconjunctivial Hemorrhage

Area or areas of collection of blood seen in the sclera of the eye, due to pressure during the birth causing rupture of capillaries.

Strabismus

A turning inward or outward of the eyes (crossing)

Opthalmia Neonatorum

Purulent destructive eye disease (conjunctivitis) that is usually given from mother to newborn. The mircrobial agents can be neisseria gonorrhoeae, or Chlamydia. Defined as conjuctivitis occurring in the first month of life.

Chemical Conjunctivitis

Results from an aseptic nature and usually occurs with the induction of silver nitrate which is used prophylactic in the newborn for infectious conjunctivitis.

Congenital Cataract

Opacification (cloudiness) of the newborn's lens.

Congenital Glaucoma

Abnormal development of the anterior chamber before birth leading to improper aqueous outflow system. Causes intraocular pressure resulting in vision loss.

Epstein's Pearls

Small, white, hard inclusion cysts (an accumulation of epithelial cells) found on the hard palate and gums; spontaneously resolve.

Thrush

A fungal infection present in the mouth characterized by white, cheesy, thick coating on buccal mucoa, tongue.

Cleft Lip/ Palate

A separation in the oral-facial region involving 1 or all of the following: the lip,hard palate, and soft tissue in the back of the mouth, causing an immediate problem with feeding after birth. Surgery has been very successful.

Esophageal Atresia

Abnormality in which the middle portion of the esophagus is absent, therefore the superior esophagus ends in a blind pouch. Infant may show excessive drooling and may cough and choke during feedings.

Tracheo-Esophageal Fistula

Abnormal communication between the trachea and esophagus. When infant strains, coughs or cries air enters stomach via the fistula causing the stomach to dilate, diaphragm to elevate impeding respirations. ** When infant eats, liquid may enter trachea causing aspiration, cyanosis.

Micrognathia

Underbite-receding chin, small size of lower jaw. May interfere with feeding.

Microstomia

A congenital defect in which the mouth is unusually small.

Choanal Atresia

A congenital anomaly of the anterior skull based characterized by closure of one or both nasal cavities. Since newborns are primarily nose breathers, this could cause significant respiratory distress.

Nasal Flaring

Reflex widening of nostrils when infant is receiving insufficient oxygen. Helps to increase amount of air entering lungs and decrease airway resistance. Intermittent flaring may occur during first hour after birth, continued flaring indicates serious respiratory problems.

Shrill

Intense, screaming cry. May indicate neurologic, metabolic abnormalities or drug withdrawal.

Webbing

A skin fold that runs along the sides of the neck down to the shoulders.

Torticollis

(wryneck) Limited neck motion in which infant will hold head to one side with chin pointing to the opposite side.

Hematoma of the Sternocleodomastoid Muscle

A firm, non-tender mass in the midportion of the muscle. Usually seen with Torticollis. Important to pick-up on this early because the mass could become fibrotic and shorten the muscle.

Sepsis

Infection, Contamination. Often presents in newborns with symptoms of respiratory distress and/or hypothermia.

Respiratory Distress

S/S tachycardia (RR>60), retractions, nasal flaring, cyanosis, grunting, seesawing, apneic periods and asymmetry of chest movements.

Tachypnea

Most common sign of respiratory distress, not unusual during the first hour after birth and during the second period of reactivity, considered abnormal if it continues.

Retractions

When soft tissue around bones of chest are drawn in with the effort of pulling air into the lungs. ( Xiphoid- substernal, ribs- intercostals, clavicle - supraclavicular). Occasional mild retractions common immediately after birth,should not continue after first hour.

Grunting

Noise made on expiration when pressure increased within the alveoli to help keep them open. Can be mild (heard only with stethoscope) or loud enough to head unaided in infant having severer respiratory difficulty. Persistent grunting is a common sign of respiratory distress syndrome.

Seesaw Respirations

The chest falls when the abdomen rises and chest rises when the abdomen falls. Sign of severe respiratory difficulty. (normally chest and abdomen rise and fall together during respiration)

Asymmetry

Unequal chest expansion with respiration. Abnormal - assess for pneumothorax.

Fractured Clavicle

Break in long bone of shoulder girdle. May palpate crepitus.

Diaphragmatic Hernia

Diaphragm fails to fuse and a large or small part of abdominal contents moves into the chest cavity.

Dextrocardia

Location of the heart in the right hemothorax, either as a result of displacement by disease or as congenital defect.

Supernumerary Nipples

an excessive number of nipples, which are usually not associated with underlying glandular tissue. They may vary in size from small pink dots to that of normal nipples.

Pneumothorax

Collapse of lung, identified through asymmetry of decreased movement on one side of chest during respirations, or respiratory distress; also may note muffled heart sounds.

Congenital Heart Defect

Classified as either acyanotic or cyanotic.

Acyanotic Defect

Obstruction of blood flow from left side of heart or a defect that causes increased blood flow to the lungs. Increases workload of heart, congestion in lungs leading to pulmonary hypertension. Increased risk for respiratory infections, Slowed growth, easily fatigued.

Cyanotic Defect

decrease in blood flow to the lungs, mixing of venous and arterial (oxygenated) blood into circulation or both. Decreased oxygen carried to tissues.

Brachial Palsy

"Old" name for brachial plexus injury - This may occur from excessive stretching of this plexus during delivery, note : asymmetrical shoulder, arm, hand, posture at rest and with movement.

Syndactyly

Fusion of fingers or toes.

Polydactyly

more than the normal number of fingers or toes.

Club Foot

Congenital deformity of the foot. (Talipes equinovarus, TEV) inversion deformity of heel: sole points medially, Forefoot in curving an ankle position of toes pointing down and heel pointing up.

Diastasis recti

Separation of the rectus abdominis muscle.

Distention

Swelling, a newborns abdomen often looks "big" distention is "markedly big" often feels tense.

Bleeding of the cord

Indicates loose clamp before blood vessels have had time to occlude.

Omphalocele

Congenital herniation of intraabdominal viscera through a defect in the abdominal wall around the umbilicus

Umbilical Hernia

A soft, skin covered protrusion of intestine and omentum through a weakness in the abdominal wall around the umbilicus.

Exstrophy of Bladder

Develpoment anomaly marked by absence of part of the lower abdominal wall and the anterior wall of the urinary bladder, with eversion of the posterior wall of the bladder through the defect as well as an open pubic arch and widely seperated ischia connected by a fibrous band.

Infection of the Cord (Omphalitis)

an inflammation of the umbilical stump marked by redness, swelling and purulent exudates in severe cases.

Pyloric Stenosis

Narrowing of the pyloric sphincter at the outlet of the stomach causing an obstruction that blocks the flow of food into the small intestine. Often presents at 3-4 weeks of age with nonbilious vomiting that becomes projective with time.

Visible Peristalsis

a sign of pyloric stenosis.

Hypospadias

The meatus should be at the tip of the glans penis. It may be abnormally located on the underside of the penis.

Epispadias

The meatus is located on the upper side of the glans penis or on the perineum.

Undescended Testes

The testes begin to descend through the inguinal canal at about 30 weeks and should be in the scrotal sac by 39 weeks. An empty sac or a sac with only one palpable teste.

Sexual Ambiguity

Sex of infant is difficult to ascertain by physical exam of genitals; penis is very small - or is the appendage an enlarged clitoris? Scrotum is questinable -- is the structure an edematous or enlarged fused labia majora? refer to MD

Hydrocele

Enlargement of one or both sides of the scrotum. This is a collection of fluid around the testes and makes it difficult to palpate them. Use a flashlight against the sac to outline the testes. Hydroceles is not painful and the fluid usually reabsorbs within 1 year.

Priapism

Abnormal, painful and continued erection of the penis caused by disease, occurring usually without sexual desire. May be caused by lesions of the cord above the lumbar region.

Variocele

Enlargement of the veins of the spermatic cord, commonly occurring above the left testicle. On exam the vessels on the affected side of the scrotum are full, feel like a bundle of worms and sometimes purple.

Spina Bifida Occulta

Failure of the vertebral arch to close. A palpable indentation on the vertebral column is a sign of spina bifida occulta. The defect is not obvious on visual inspection because it is covered by skin and sometimes a tuft of hair grows of the area.

Meningocele

a protrusion of meninges through the spina bifida, covered by skin or a thin membrane. The spinal cord is not involved so paralysis does not occur.

Myleomeningocele

A protrusion of meninges and spinal cord through the spina bifida. The degree of paralysis depends on the location. The infant may also have hydrocephalous, or it may develop after surgery.

Pilonidal Sinus

A small opening present at the base of the spine. This should be examined for depth and any hair.

Pilonidal Dimple

a dimple present at the base of the spine; also called sacral dimple.

Imperforate Anus

an anus without an opening.

Meconium Ileus

Obstruction of the small intestine in the newborn caused by impaction of thick, dry, tenacious meconium.

Congenital Hip Dysplasia

A condition where instability of the hip joint occurs and the femur can be moved in and out of the acetabulum. Ortolani and Barlow test methods are used to assess hip dysplasia

Ortolani maneuver

used to assess hip instability in the newborn period. Abduct the thighs and apply gentle pressure forward over the greater trochanter. A "clunking" sensation indicates a dislocated femoral head moving into the acetabulum; WNL hips will NOT produce this sensation.

Barlow Maneuver

Adduction of hips will produce a palpable "clunk" IF there is instability present; if hips WNL NO clunk will be felt.

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