The Newborn Period

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Terms in this set (273)
heart rate respiratory rate muscle tone reflex irritability colorwhat are the *5 sections* of the *APGAR* score?cord blood_____ _____ is collected for blood typing, Coombs test, bilirubin if indicated -comes from the side *closest to the baby*driedbaby needs to be _____, swaddles, and placed under radiant heat source to maintain body temperature -babies have more body surface area to weight than we do so it is difficult for them to regulate their tempidentification_____ must be placed on the infant in the delivery room; footprints taken alsoadmit official vital signs erythromycin in eyes vitamin Konce the baby is born what are the 4 "in nursery" steps?official vital signs_____ _____ _____ includes the babies height, weight, head circumference, temperature, pulse, respiratory rateerythromycin_____ *eye ointment*; usually within *1 hour of birth*; protects against *chlamydia and gonorrhea*Vitamin K_____ 1mg *IM*; usually within *4hrs for birth to prevent hemorrhagic disease of the newborn* -injected into the anterior lateral thighrapid glucose testing_____ _____ _____ may be a standing order or done only for those at *high risk for HYPOglycemia* (diabetic mother, preterm, SGA, LGA, stressed infant)hourRapid Glucose Testing usually done at admission and every _____ if high risk3Rapid Glucose Testing usually *stabilizes* between 50-80 at hour _____Sx of hypoglycemiaif <40-45 mg/dL, confirm with serum glucose <40 mg/dL in forst 1-4hrs <45 mg/dL in hours 4-24 _____ _____ _____ include *lethargy, poor feeding, jitteriness, apnea, seizures*oral or IV glucose*treatment* for *hypoglycemia* includes _____ or _____ _____ per established protocolstoe prick to check the sugarhow do we do a Rapid Glucose Test on a baby? how is the blood drawn?3-6hrs*hematocrit* is done at _____-_____ hours of age if symptomatic or high risk for polycythemia or anemiaanemia_____ is a condition in which the body lacks enough health RBCs to properly oxygenate the bodypolycythemia_____ is an abnormally *increased concentration of hemoglobin* in the bloodSx of polycythemia_____ _____ _____ include *cyanosis, mild respiratory distress with tachypnea, and increased oxygen need, hypoglycemia, poor feeding, emesis, lethargy*Type *O* or *Rh-*Hematocrit -cord blood tested for *typing*, Coombs test, and bilirubin if other is Type _____ or _____ _____triple dye_____ _____ is *applied to the umbilical cord* -alcohol used to be recommended to be applied by parents but it has not been shown to have benefit over just cleaning area with soap and waternewborn hearing screening_____ _____ _____ is done prior to discharge by brainstem evoked response or evoked auto acoustic emissions24hrs*hepatitis B vaccine* is given within _____ of birth if medically stable and >2,000 grams (4.4lbs)hospital discharge 1 month oldif <2,000 grams (4.4lbs), give *hepatitis B vaccine* at _____ _____ or _____ _____ _____, whichever is *sooner*12hrsif *mom* is *HBsAg positive*, give *HBV vaccine* and 0.5mL of *Hepatitis B Immune Globulin* within _____ of brith9-12monthsinfants should be *tested* for *HBsAg* and *anti-HBs* at _____-_____12hrsif *moms status of hep b is UNKNOWN* give *HIBV vaccine* within _____ of brith *regardless of weight*12hrsif *moms status of hep b is UNKNOWN* and the infants weighs <2,000 grams, give hepatitis B immune globulin within _____ of brith with vaccine7 daysif *moms status of hep b is UNKNOWN* and infant weigh *>2,000 grams*, test mom for HBsAg, if positive give immune globulin as soon as possible but not later than _____ *after brith(2-6hrsa newborn is generally Abel to *feed* _____-_____ after deliveryearliera newborn may begin breastfeeding _____ if alert, vigorous, normal hunger cry, soft abdomen, good bowel sounds, and good suckpronein the nursery, counsel family on feeding, BMs, car seat, *avoid _____ sleeping position* etc1-2 weeks*first office visit* at _____-_____ old1 weekfirst office visit should be *no longer than _____ if mom is breastfeeding* -want to make sure baby is eating enough, and that mom has a healthy supplySIDSwhy do you want to *avoid prone position* for sleeping babies?mandatory neonatal screening tests*mandatory _____ _____ _____* -*done by heel stick* -*best if done after 24-48hrs old( -*if early discharge (sample taken before 24hrs), repeat this in 1 week* -the actual tests vary from state to state; go according to state law -many facilities use supplemental neonatal screening programsPKU Congenital Hypothyroidism Sickle Cell and other Hemoglobin Diseases MSUD Galactosemia Congenital Adrenal HyperplasiaPA state law mandates testing for 6 diseases, what are they?22in 2009, PA law requires all screening labs in PA to report an *additional _____ diseases* and state provides f/u for thesePhenylketonuria (PKU)-autosomal recessive disorder -pt *lack enzyme to convert phenylalanine to tyrosine* -Sx: hyperactivity, seizures, light complexion, eczema -leads to *severe intellectual disability* (ID) if not treated all of these are characteristics of?Phenylketonuria (PKU)Treatment -strict *restriction of phenylalanine* to only what is necessary for normal growth and development -*tyrosine supplements* -prognosis is best if diet is initiated within the first month of life -diet restrictions should be lifelong to prevent changes in intellect and behavior and neurologic damage that can occur after stopping diet all of these are characteristics of?congenital hypothyroidism-will lead to *ID if not treated* as maternal thyroid hormone disappears: -slow to feed -constipation -lethargy -hoarse cry -cool skin hypotonic with slow reflexes -low thyroid function all of these are characteristics of?congenital hypothyroidism-*goiter* present in 5-10% other long term sequelae: -ataxia (movement issues) -gross and fine motor incoordination -spastiticty -speech disorders -problems with attention span -stabismus -10% will have *sensorineural hearing loss* all of these are characteristics of?congenital hypothyroidism-treatment is *levothyroxine* -begin levothyroxine no later than *1 month old* -loss of IQ is proportionate to the age when treatment is initiated -important to get *therapeutic dose as quickly as possible* and then to maintain the TSH in the appropriate range all of these are characteristics of?maple syrup urine disease (MSUD)-*autosomal recessive disease* -pt *lacks enzyme that breaks down leucine, isoleucine, and valine* symptoms: progress over 1-4 weeks -poor feeding, vomiting -tachypnea -altering hypotonia and hypertonia --> muscle mass tone -seizures coma all of these are characteristics of?maple syrup urine disease (MSUD)-*disease is fatal within 1 month if untreated* Treatment: -*restriction of branched chained amino acids* to amounts required for good nutrition -best prognosis if initiated in *first 10 days of life* -serum levels of branched chain amino acids must be monitored frequently in first few months to adjust for changing protein requirements -very high leucine levels require *hemodialysis* -*liver tranplant is curative* all of these are characteristics of?galactosemia-*autosomal recessive* -*lacks enzyme to break down galactose* Sx-begin after initiation of milk feeding -vomiting -jaundice -hepatomegaly -*rapid onset* of *hepatic insufficiency*- *hepatic* *cirrhosis* is *progressive* -mild cases may go undiagnosed by lead to ID all of these are characteristics of?galactosemia-*without treatment, death can occur within 1 month* -often from *E;.Coli sepsis* Treatment: -prompt initiation of *galactose free diet* -pt is still at risk for *speech and language deficits* and *ovarian failure* -diet is life long -*calcium supplementations* all of these are characteristics of?congenital adrenal hyperplasia-*autosomal recessive, mutation of CYP21 gene* -*increased ACTH* (adrenocorticotropic hormone) secretion with subsequent adrenal hyperplasia and various increased adrenal hormones -widely varying degrees of severity all of these are characteristics of?congenital adrenal hyperplasiain FEMALES -*external genitalia can show clitoral enlargement to complete fusion of the labioscrotal folds to form a scrotum, penile urethra, and penile shaft* -*hyperpigmentation* of labia major and nipples -pts become muscular -*precocious puberty* -excessive acne -deep voice -excessive pigmentation -signs of *salt loss* may present in first few days of life or much later in mild disease -severe disease may present with adrenal crisis in newborn with severe hypovolemic/hyponatremic shock all of these are characteristics of?congenital adrenal hyperplasiain MALES -salt losing crisis may begin in first 2-4 weeks -*enlargement of the penis* -hyperpigmentation -other symptoms similar to those in female all of these are characteristics of?congenital adrenal hyperplasiaTreatment: -*glucocorticoid (hydrocortisone)* in just enough doses to *suppress adrenal function* -mineralocorticoid (fludrocortisone) to maintain electrolyte balance -females may require genital reconstructive surgery all of these are characteristics of?circumcisiondebate over benefit- may decrease the following: -phimosis (unable to retract) -paraphimosis (unable to reduce) -CA (penile and cervical) -UTI -STI Asks (complication rates <1%) -bleed -infection -urethral injury all of these are characteristics of?contraindications_____ for circumcision -genital abnormalities such as hypospadias -bleeding disorder; coagulation screen done prior to procedure if FH of bleeding d/o counseling: -parents will apply Vaseline until healed -signs of infection should be explained -no bath until healedGomco Circumcision Clamp Mogan Circumcision Clampwhat are the 2 types of circumcision *clamps*?Mogan Circumcision Clampwhich circ clamp is "more dangerous" due to the fact that you *cannot see uretheral opening*Plastibela break in adhesion and then use a *plastic ring* to cut off the blood flow supply and the tissue will eventually fall off within a week; what type of circ is this?gestational age_____ _____ may be important to predict normal behaviors and to identify potential medical problemslast menstrual cycle*gestational age* is usually determines by the *date* of the mothers _____ _____ _____(Naegele's Rule); then confirmed by the U/Sneuromuscular developmentgestational age may also be estimated by the assessment of physical characteristics and _____ _____ -these vary according to fetal age and maturity -the newborn is assessed on the first day of lifeBallard Score Methoda *cumulative score* from 2 charts can estimate the gestational age by the _____ _____ _____; usually accurate within 2 weeksappropriate for gestational age (AGA) small for gestational age (SGA) large for gestational age (LGA)*weight* is plotted on a standardized chart foe gestational age and pt is classified into 3 different groups; what re they?appropriate generational age (AGA)_____ _____ _____ means the *weight is between the 10th and 90th percentile*small for gestational age (SGA)_____ _____ _____ is also called *intrauterine growth restriction* (IUGR); *weight is <10%* (some curves <5%) -pts are at risk for fetal distress during L&D, polycythemia, hypoglycemiasmall for gestational age (SGA)which pts are at *risk for fetal distress during L&D, polycythemia, hypoglycemia*?large for gestation age (LGA)_____ _____ _____ means the *weight >90%*; often associated with infant of *diabetic mother* and post maturity -pts are at risk for birth injuries, hypoglycemia, polycythemia, congenital abnormalities, cardiomyopathylarge for gestation age (LGA)which pots are at *risk for birth injuries, hypoglycemia, polycythemia, congenital abnormalities, cardiomyopathy*?symmetrical growth restriction asymmetrical growth restrictionssmall for gestational age (*SGA*) has 2 categories; what are they?symmetrical growth restriction_____ _____ _____ shows *weight, height, and head circumference all < 10%* -suggests an event/issue *early in pregnancy* such as chromosomal abnormalities, maternal drug/alcohol abuse, congenital viral infectionasymmetrical growth restriction_____ _____ _____ shows *only weight is < 10%* -suggests a problem late in pregnancy such as pregnancy induced hypertension or placental insufficiency -has a better prognosisnewborn history3 main components: -maternal and paternal medical and genetic history -maternal past obstetric history -current antepartum and intrapartum obstetric historydemography social history-age -race -STI, hepatitis, HIV -tobacco, drug, alcohol use -immune status-syphilis, rubella, varicella, hepatitis B, blood group -occupational exposure what type of history?past medical history-chronic HTN -heart disease -DM -thyroid disease -hematologic/cancers -collagen vascular disease -genetic history: inborn errors of metabolism, chromosomal abnormalities, bleeding, jaundice what type of history?maternal last obstetric history-abortion; especially spontaneous -congenital malformation -incompetent cervix -brith weight -prematurity -twins -blood group sensitization/ Neonatal Jaundice -hydrops -infertility what type of history?pregnancycurrent antepartum and intrapartum obstetric history : _____ -current gestational age (method used) -U/S results -amniotic fluid analysis -vaginal bleeding -preterm labor -premature rupture of membranes -preeclampsia -UTI -colonization status: herpes simplex, group B strep (neonatal sepsis) -medications/drugs -medical illness during _____labor and deliverycurrent antepartum and intrapartum obstetric history: _____ and _____ -duration of _____ -presentation -vaginal vs Cesarean Section -spontaneous vs induced -forceps delivery -presence of meconium stained fluid -maternal fever/amionitis -fetal heart rate patterns -apgar score/methods of resuscitation -gestational age assessment -growth status: AGA, SGA, LGAdistress well*first exam* may be while a newborn is in _____ or may be on a _____ childpositionnewborns and infants are examined in the *supine _____*warm and quietexam areas should be _____ and _____120-160vitals: newborn heart rate?30-60vitals: newborn respirations?98.6 *take 1st temp. carefully to make sure there is no imperforate anus*vitals: newborn temperature?20" (18-21.5 is 5-95%)newborn average height?30 inchesaverage height at 1 y/o?36 inchesaverage height at 3 y/o?40 inchesaverage height at 4 y/o?7.5 lbs (5.5-9.5lbs 5-95%)newborn exam: weight -average newborn weight is _____lose (a) few ouncesalthough the newborn weight average is 7.5lbs, they may _____ _____ _____ in the hospital after birth5-10%*term newborns* can lose _____-_____% of body weight in 1st week15-20%*preterm newborns* can lose _____-_____% of body weight in 1st week*1 lb ever 2 weeks* until up to 14 lbsaverage weight gain of _____lbs ever _____ up to 14lbsdouble_____ weight by 5 months; triple by 1 year old; quadruple by 2 years old13.5 inches or 35cmnewborn average hear circumference?2 years oldthe head circumference is measured every visit until _____ _____ _____circumferenceplace the measuring tape *around the occiput and the supraorbital prominence* to get the largest _____molding_____ is a slight *cone shaped* head -allows passage through the brith canal -usually resolves in 2-3daysoccipital nodes_____ _____ may be present at the "hair line" on the back of the head; usually *pea sized* and firmskull fracture_____ _____ are possible from birth; usually linear and require Tx; depressed _____ _____ may be associated with intoracrnaill injuryanterior fontanellethe _____ fontanelle is: *1-4cm* in any direction usually *closes 9-18months* (average 14)posterior fontanellethe _____ fontanelle is: *1cm* or less *closes by 2-4months*large fontanelles_____ _____ may be associated with *hydrocephalus, rickets, hypothyroidism*microcephaly_____ has a *<5%* of head circumference; one cause is *craniosynostosis*carniosynostosis_____ is the *premature closure* of the sutures which causes microcephaly, cerebral atrophy, and iDmacrocephaly_____ has a *>95%* for head circumference and *large fontanelles*; may indicate *hydrocephaly*hydrocephaly_____ is an *increased accumulation of CSF* in ventricles; may require shunt of lead to ID or deathcephalhematoma caput succedaneumthere are *2 types of head swelling*, what are they?cephalhematoma-*subperiosteal hemorrhage* -swelling does *not cross suture line* -rarely associated with skull fx -*reabsorbs in 2-3 months* -no Tx usually necessary; very rarely *phototherapy for hyperbilrubinema*caput succedaneum-*swelling of the soft tissue* of the scalp; usually over the presenting portion of the head -*swelling can cross suture lines* -scalp may also be *ecchymotic* -*resolves in 2-4 days*; rarely phototherapy for hyperbilirubinemiaopportunityexamine the *eyes* at any _____ during the examsuck on somethingclinical pearl--to open the eyes of a newborn to examine- have the baby _____ _____ _____ which may help to *relax* the facial muscles; gently open eyes with thumb and index fingerswelling / ecchymosis (bruising) of the eyelids subconjunctival hemorrhagewhat are (3) common things that may be present around/in the newborns eyes?immobile lensvisual acuity is approximately 20/400 at birth due to an _____ _____l this improves over the 1st 6 monthsfixation and tracking_____ and _____ become *well developed by 2 months* of agehorizontalcheck for Mongolian vs anti-Mongolian slant: draw an imaginary line between the medial canthi of each eye and extend line out last the outer canthi; this line should be _____Mongolian slantif the *outer canthi* are *above* the *line* a _____ _____ is *present*Down's Syndromeis a *Mongolian slant is present* what may it be associated with?anti-Mongolian slantif the *outer canthi* is *below* the horizontal line then an _____ _____ is presentclearthe newborn *cornea* should be _____cloudya _____ cornea may be a sign of *corneal gear* or *glaucoma* and should be referredpupils_____ should be *round, equal, and reactive*anisocoria<10% of newborns may have *congenital* _____ which is an *unequal size of the pupil*coloboma (piece missing) Brushfiled spots (speckling)the *iris* should be inspected for _____ *"piece missing"* or _____ _____ *speckling* -both should be referreduncoordinated*extra ocular eye movements should be intact* but may be _____ at timesstrabismus_____- *abnormal alignment* of the eyes; may be diagnosed with corneal light reflexpseudostrabismus_____- pupils *falsely* look like they aren't aligned; may be due to a *flat nasal bridge*redcheck for _____ *light reflex*leukocria_____ is a *white reflex* and may indicate: -glaucoma -congenital cataract -infections such as Rubella, CMV, Toxoplasmosis, Syphilis -rentinoblastoma (a malignant glioma of the retina) -chorioretinitis -retinopathy of prematurity -*must be referred to ophthalmology*retinoblastoma_____ is a malignant glioma of the retinaobservationa *nose* exam is mostly _____patenteesmay *block one nostril* to check _____ of opposite nostrilobligate nosebabies are _____ _____ breathers until *1 month or older*respirator distressany *nose obstruction* may cause _____ _____purulent nasal discharge_____ _____ _____ may indicate *congenital syphilis or chlamydia*lip cheektechnique: put tongue bald between _____ and down side of one _____---this will often stimulate newborns to open their mouthpink and moistlook at inside of cheek, across inside of lips, to opposite side of cheek; *oral mucosa* should be _____ and _____lastlook at back of *oral cavity* _____! -may be slightly darker in color than anterior of mouth -if tongue is in the way, advance the tongue blade further on the tongue; often stimulates "gag reflex" which allows quick visualizationadvancing the tongue blade further on the tongue; stimulates gage reflexwhat allows for a *quick visualization of the back of the oral cavity*?r/o cleft lip and palatein a newborn mouth exam, what do you want to r/o?submucosal clefta _____ _____ may be present if the *palatal arch is high or bifid uvula* -may need to stick your gloved finger in mouth to palpate the palatenatal teeth_____ _____ are present at birth; some *recommend removal to prevent aspiration*, especially if hyper mobile; usually cause nom problems but these *uncalcified teeth* may "wear down" and turn colorEpstein's pearlls_____ _____ area los called *epithelial pearls*; small, round, *white accumulations of epithelial cells on gum* margins or palate; no treatment necessary; resolves in a few weeks -pimple like in the mouthankyloglossia_____ is caused by a short *lingual frenulum* which attaches to the *distal 1/3* of the tongue instead of the middle 1/3; may be *snipped* but not always necessary -referred to as "tongue tied*macroglossia_____ is an *abnormally large tongue* may be associated with congenital abnormalities such as -*Down's syndrome* -*Beckwith-Wiedemann Syndrome* -*Congential Hypothyroidism*auricles_____ should be well formed, flexible, and have immediate recoil after bending slightlypreauricular pits and tags_____ _____ and _____ are minor variants but occasionally are associated with *hearing loss*; often removed via suture tieocciputcheck ear position: should be above a line drawn between the _____ and the corner of the eyekidneys; renal abnormalities!!*ears develop* at same position in amniotic development as the _____; if *deformities or low in position* think _____ _____ !!hold infant'sfor an *otoscope exam*: _____ _____ head on its side against table; use the flat part of your hand or fingers; a parent may need to hold the infants hands at its sidesvernix caseosaTMs should be visualized; canals may still have _____ _____ which is a *white cheese or flaking material*TMs_____ may be dull, gray, and *opaque* for the first *1-4weeks8galactosemiawhich of the following diseases form the mandatory neonatal screening tests in PA will lead to *vomiting, jaundice, hepatomegaly, liver insufficiency and eventually liver cirrhosis*?congenital adrenal hyperplasiawhich of the diseases from the mandatory neonatal screening tests in PA may cause a pt to be born with *ambiguous genitalia*?-symmetrical SGA -congenital abnormalities -occurred early in pregnancyyour newborn pt is <% for heigh, weight, and head circumference what is your Dx? what may have caused this? when during the pregnancy was it likely ot occur?-macrocephaly is a large head -could be due to hydrocephaly --> extra CSF in the ventricleswhat is the definition of macrocephaly? what is one cause of macrocephaly?-microcephaly is a small head -premature closer of the fontanelleswhat is the definition of microcephaly? what is one cause of microcephaly?lymph nodes_____ _____ may be visualized or palpable; usually *pea sided and firm*ROM (range of motion)turn the neck from side to side to check _____torticollis_____ or *wry neck*; *head is turned toward and face turned away* from the affected side; most often from muscular birth injury -AP and lateral x ray to r/o cervical spin lesion and Arnold-Chiari malformationsmassescheck for other neck _____ (besides the lymph nodes)brachial cleft cysta *mass anterior SCM* is often a _____ _____ _____; opening between the embryonic brachial arches -becomes functional gill slits in fish -on the side of the beckthyroglossal duct cyst*midline (neck) mass)* may be a _____ _____ _____; a duct in the embryo that connects the thyroid diverticulum to the tongue; usually disappears but may persist as an anomaly; usually filled with *mucus*; may become infectedU/Sconfirmation of a *thyroglossal duct cyst* can be made with _____; verify that the thyroid gland is in normal position; occasionally the thyroid gland fails to migrate to its normal position and may be located with the cystSistrunck proceduretthyroglossal duct cyst: ultimate treatment would be *surgical removal*- usually the _____ _____ which is the *removal of the duct and the mid portion of the hyoid bone* because of its close association with the duct remnantTurner's Syndrome*excess webbing of the neck* may indicate _____ _____ -45 chromosomes -X0clavicular fractures_____ _____ can occur during birth, especially with *shoulder dystocia* Sx: crepitus, bruising, tenderness, ack of movement of the extremity Tx: *pin sleeve of arm across the abdomen*; heals within a weeklaterally displaced nipples_____ _____ _____ may also indicate *Turner' syndrome* -seen on chest exampalpable_____ nodules under nipple are commonestrogenpalpable nodules are due to _____ *stimulation* of breast tissue; can be in m ale or female; may express milky dischargewitch's milkmilky discharge other name?headthe *chest circumference* is *LESS* than the _____ *circumference* until *1 year of age*supernumerary_____ nipples may be present; may be *found anywhere along the milk line*; may have associated breast tissue and may become enlarged with estrogen stimulation during adolescencepectus excavatum-*anterior depression* of the chest wall -usually causes *no functional problems* -there are surgical procedures to correctpectus carinatum-*bowing out of the sternum* -"pigeon breast" -usually causes *no functional problems* -there are surgical procedures for correctionralesin normal infants, _____ may be present at brith but should *clear by 1-2hrs* of life1-2hrshow long should it take for *rales* to clear from an infants lungs?30-40*respirations* usually _____-_____>60>_____ (*respirations*) may indicate *cardiac* or *pulmonary disease*diaphragmaticinfant breathing is usually _____- the *thorax draws in and out and abdomen protrudes with inspiration*disease (respiratory distress >60)*intercostal retractions, nasal flaring, and expiratory grunting* all indicate _____decreased_____ breathing sounds indicate *pneumothorax, space occupying lesions, or diaphragmatic hernia*newbornsrespirations: *30-80*1 year oldrespirations: *20-30*3 years oldrespirations: *20-30*6 years oldrespirations: *16-22*10 years oldrespirations: *16-20*17 years oldrespirations: *12-20*120-160newborn *heart rate*?irregularly irregularan _____ _____ heartbeat is common in the *first few days* of life and is usually to to *premature partial contractions*innocentfunctional murmur?innocentmost *murmurs* in the *first few days of life* are _____cyanosis congenital heart failuremost common *presentation* of *congenital heart disease* is _____ and _____ _____ _____hypoplastic heartpulse---absent throughout?coarctation of the aortapulse---absent or *diminished in lower extremities*?normally *round* or *pot belly*shape of newborn *abdomen*?scaphoidif the *abdomen* is _____ especially with *respiratory distress*, may be diaphragmatic *hernia*spleen nd liver_____ and _____ *palpable* in *25%* of normal newbornssitus inversus (reversal of all internal organs)a *LEFT sided liver* would suggest?renalkidneys may be palpable--most abdominal mass will be _____ (hydronephrosis, polycystic) -should be evaluated by U/Sprune belly syndrome (renal abnormalities)*absence of abdomen musculature* is called _____ _____ ______ and may be associated with *renal abnormalities* -belly may also be scaphoidumbilical_____ *hernias* are common; usually *resolve spontaneously* by school age; rarely cause strangulation2 weeks*cord remnant* will usually *remain* for _____ _____; keep area clean and ry, alcohol recommended in pastambiguouscheck for _____ genitalia; cannot determine if the newborn is male or female; must be followed with genetic testing*genetic testingwhat should you do if you can't physically tell what the genitalia are?non-purulentin females, normal genitalia may be prominent; can have a _____ discharge with our without bloodimperforate_____ *hymen* may be obvious; adhesions may be present between the labia; usually thin and difficult to separate the attachmentoften treated with *application of estrogen creams*how are *imperforate hymen* often *treated*?tight and adherentthe *foreskin* is usually _____ and _____2-3cm*non-erect penis* in newborn usually _____-_____cm; microphallus may indicate other organ abnormalitiescryptorchidism_____ is *undescended testicles*; surgical exploration will distinguish between absent or undescended; surgical correction should be done before 1 y/o1 year oldcryptorchidism *surgical correction* should be done when?hydrocelea _____ is a *collection of fluid* in *tunica vaginalis*; may distinguish from a hernia by palpation and *transillumination*; usually resolves *spontaneously* by 1 year of age; after 1 y/o likely needs surgical correction(male) inguinal_____ *hernias* are corrected (surgically) when foundpatency (opens)in a newborn anus exam, must verify _____; if necessary, probe anus with gloved and lubricated 5th finger/pinky if no meconium presentsmeconium_____ is the *first stool of newborns*; greenish black to dark brown in color; is passes within first 24hrs and persists for up to 3 daysis passed within the 1st 24hrs and persists for up to 3 dayshow long will *meconium* last for?spina bifida*tufts of hair, dimples, or masses* over the *sacral* area may represent a problem such as _____ _____, sinus tract, or tumorfractures or nerve (injuries)newborn exam of *extremities*: check for _____ or _____ injuriesbrachial plexus_____ _____ injuries due to *excessive traction* on the *neck*; may cause *paresis or complete paralysis of UEtibial torsion_____ _____ is common; *bowing of lower legs*single palmar creasea _____ _____ _____ (Siminan crease) may indicate *Down's syndrome*polymeans manydactylmeans fingersynmeans fusedclub foot-*plantar flexion* of the foot at the *ankle* -*forefoot varus* (turned in- walk on the *lateral portion* of the foot) -refer the pt while in the nursery; *will always go home with braces/serial cast* -achillies tendon is very right so they will sometimes do surgery to release the pressuremetatarsus adductus-*inward deviation of forefoot* -prominence at the base of the 5th metatarsal -may resolve spontaneously -may benefit from *serial casting* -ortho vs podiatry referral? -more commonsymmetrynewborn exam of the hips: observe for _____ of *skin folds*ROMnewborn exam of the hips: check for *smooth* _____ *without clicks*discrepancynewborn exam of the hips: check for leg length _____positive Allis signa _____ _____ _____ is done by checking the *height of the knees wile in the supine position with knees fixed and feet flat on table* -*indicates hip dislocation* or *shortened femur*ortolani test-this is a *reduction maneuver* -*hips flexed at 90 degrees* -abduct one hip and apply gentile pressure to reduce trochanter anteriorlyBarlow test-this is a *provocative maneuver* -hips flexed at *90 degrees* -slight downward pressure applied while hip is adducted to see if head moves posteriorlypetechiaenewborn exam for skin: scattered _____ on face and presenting parts commonblushing_____ especially on the face is commoncrackling and peeingdry skin with _____ and _____ is common, especially post term infantsjaundice_____ is *abnormal* in the *1st 24hrs of life*; may indicate *hemolytic process or congenital hepatitis*hemolytic process or congenital hepatitis*jaundice in the first 24hrs* of life can indicate what (2) things?acrocyanosis_____ is *peripheral cyanosis* and is *common*edema_____ may be present in preterm but may also suggest: -hydrops fetalis -sepsis -hypoalbuminemia -lymphatic disorderTurner's Syndromeif *edema is localized to DORSUM* of *feet* could be _____ _____cutis marmorata_____ _____ is *transient mottling* (flat, lacy pattern of skin color) when infant is exposed to *decreased temperature* -a manifestation of normal vasomotor instability in the newbornvasomotor instability*cutis marmorata* is a manifestation of *normal _____ _____* in the newborn; seen when the newborn is exposed to coldHarlequin color change_____ _____ _____ happens when the *newborn lies on his or her side*; lower hand of body is pink and upper half is pale; another manifestation of normal *vasomotor instability*lower half= PINK upper half= PALEin a *Harlequin color change*, what color is the *lower half* vs the *upper hand*cutis marmorata Harlequin color changewhat are *2 manifestations of vasomotor instability*in the newborn?vernix caseosa_____ _____ is the *white greasy material covering the body* that decreases as therm approacheslanugo_____ is a *fine hair covering pre-term infant*during times of *anorexia*when can the *fine hair covering called lanugo resurface*?mongolian spots_____ _____ are *blue to black pigmentation* of the *back and buttocks*; occurs in 90% of African American, Indian, and Asian infants -very similar to bruises thus they must be documented!!!Port Wine Stain (Nevus Flameus)-*macular*, *pink to purple, *circumscribed* areas more *common on face and neck* -often *unilateral* -may be associated with *Sturge-Weber Syndrome* (trigeminal angiomatosis, convulsions, ipsilateral intracrhail "trans line" calcifications---> causes behavioral changes -can be removed with laser surgeryhemangioma of infancy (formerly capillary hemangioma)-*bright red, protruding, compressible, well demarcated lesions* -may be present at brith but *more commonly appear in 1st 2 months* -60% resolve by age 5 -90% resolve by age 9 -many seen on face and hairline areadeep hemangioma (formally cavernous hemangioma)-*deeper, more diffuse, less defined lesion* -usually *cystic* -may be skin colored or with a bluish hue -*less likely to resolve spontaneously* -Tx: observe, may treat with intralesional sterile injection if impinging on another structuremilia*1-2mm pearly white epidermal inclusion cysts of pilosebacious follicles* mostly on the *nose*; may also be on the *cheeks* and *forehead*miliaria-*small papule (prickly heat)* caused by *obstructed sweat glands* of the face, scalp, and intertriginous areas -can be *vesicles, erythematous papule, or pustules*nevus simplex-*stork bite* or *salmon patch* -flat, deep pink hemangioma localized to the *back of the neck*rooting reflex-turns the head to side of facial stimulus, opens mouth -present at *28 weeks* -disappears by *4-6months old* -not conscious; reflex actionsucking reflex-in response to almost anything in the mouth -present at *14 weeks gestation* -*replaced by voluntary sucking*grasp reflex-placing an object in an infants *palm or sole* causes *flexion* of the *fingers* or *curling of the toes* -develops by 28 weeks -palmar grasp disappears around 3-4 months -plantar grasp disappears around 6-8 monthsmoro (startle) reflex-hold infant and support head; let head drop 1-2cm suddenly -baby will *abduct shoulder and move arms upward*, usually followed by adduction and flexion -*hands usually spread apart* -present by 28 weeks gestation -disappears 4-6 monthstonic neck (on guard) reflex-when pt is *supine* and *head is turned to the side* -arm and leg on that side extend while the arm and leg on opposite side flex -disappears by about 2 months -*must go away for pt to roll*step reflex-support the head and neck -*place baby feet on table and baby will lift foot*placing reflex-support head and neck -*rub top of baby foot on underside of table* -*baby will flex at knee to bring foot up*babinski reflex-*stroke the lateral portion* of the plantar surface of the *foot* -causes extension of the *great toe* -*fanning of the toes* -flexion at the knee and hip -disappears by about 6 months4at 5 minutes after delivery your newborn pt has a heart rate of 85 and has slow, irregular respirations, has some central cyanosis and minimal flexion of his extremities. in response to the catheter in his nostril he grimaces. what is his 5 minute APGAR score?hypothyroidismPA law mandates newborn screening for which of the following ?leukocoria (white flash)which of the following physical exam findings requires a referral in a newborn pt?