3016: CHAPTER 26 INFANT FINAL

CHAPTER 26 INFANT

What is normal newborn weight range? (Growth patterns for Healthy Newborn)

2.5–3.3 kg (5 lb 8 oz – 8 lb 13 oz)

How does infant weight change in first year?
(Growth patterns for Healthy Newborn)

• Doubles by 4–6 months

• Triples by 1 year

Growth pattern progression?
(Growth patterns for Healthy Newborn)

• Cephalocaudal (gains head control → before walking)

• Proximodistal (rolls over before grasping a toy)

How to assess genetics vs a new diagnosis in a newborn child

What suggests a genetic condition?

• Dysmorphic features

• Family history

• Multiple abnormalities

Example of genetic disorder signs?

• Down syndrome (low ears, flat face, upslant eyes)

• Single palmar crease

What are the state mandatory screening for metabolic/genetic disorders?

• Congenital Hypothyroidism

• Galactosemia

• Phenylketonuria (PKU)

When is Apgar Score assessed? What does it measure?

• Assessed at 1 + 5 minutes

• Measures HR, Respiratory Effort, Muscle Tone, Reflex Irritability, + Color

• Scores (0,1,2)

Normal and Abnormal findings for Apgar Score?

Normal: 7–10.

Abnormal: <7 (requires intervention/resuscitation)

NOT used to guide resuscitation, BUT if needed, resuscitation before 1 MINUTE APGAR SCORE

What interventions to take if 5-minute Apgar score is <7? (Abnormals for newborn)

• Continue to score every 5 minutes up to 20 minutes until score is above 7

• Newborn is then intubated or transferred to a nursery

Apgar score of 4-6 indicates what? (Abnormals for newborn)

Moderately depressed newborn

Apgar score of 0-3 indicates what? (Abnormals for newborn)

Severe respiratory depression + requires observation/care in NICU

What date is Gestational Age (Ballard Score) calculated? At what hour is it most accurate?

• From date of last menstrual period

• Between 10 and 36 hours of age

Gestational Age (Ballard Score) evaluates which type of maturity?

Neuromuscular + physical maturity (skin texture, lanugo, breast bud)

Normal newborn vital signs? (Newborn normal assessment)

• HR: 110–160 bpm

• RR: 30–60/min

• Temp: 36.5–37°C

Normal newborn findings?

• Acrocyanosis (hands/feet blue)

• Soft fontanelles

• Irregular breathing pattern

What is abnormal cyanosis? (Newborn abnormal findings)

Central cyanosis (lips/tongue) → EMERGENCY

What do sunken fontanelles indicate? (Newborn abnormal findings)

Dehydration

What do bulging fontanelles indicate? (Newborn abnormal findings)

Increased intracranial pressure

Signs of respiratory distress in newborn?

• Tachypnea (>60)

• Nasal flaring

• Grunting

• Retractions

• Cyanosis

What indicates abnormal cardiac issue? (Cardiac system)

• Central cyanosis (blue tongue)

• Tachycardia/Bradycardia

• Weak thready pulses → low cardiac output

• Abnormal murmur

What should you measure and compare in cardiovascular system? What does it suggest?

Disparate BP readings between upper and lower extremities (suggests coarctation of the aorta)

Signs of neurological defects in newborn? (Neuro system)

• High-pitched cry

• Lethargy

• Bulging or sunken fontanelles (at rest)

• Late newborn reflexes

Opisthotonos appearance? What is it the result of? (Abnormal Neuro system)

• Stiff neck/arched back

• Meningitis irritation

Failure to blink when bright light is shone in eyes indicates what? (Abnormal Neuro system)

• Sign of blindness

Absence of blink when theres loud noise indicates what? (Abnormal Neuro system)

Deafness

Important newborn reflexes? (Neuro system)

• Moro (startle)

• Rooting

• Suck

• Babinski

What is abnormal neuro finding?

Absent or asymmetrical reflexes!!!!

Moro (startle) reflex?

• Arms extend then flex

• Disappears 4–6 months

REFLEXES HERE

What indicates infection in newborn? (Immune System)

• Fever >38°C (100.4°F)

• Hypothermia (newborns)

• Poor feeding

• Unusual odors

• Vomiting/diarrhea

Safe sleep guidelines? (Education for New Moms)

• Back to sleep on firm mattress in separate crib!!!

• No toys/blankets → prevent SIDS

Feeding education? (Education for New Moms)

• Breast milk (6-12 months)

• NEVER microwave bottles → HOT SPOTS (burning)

• Vitamin D supplement

• No honey!! → risk for botulism!! (toxic to neurological system)

Why shouldn’t caregivers feed infants cow milk before 1 years old? (Education for New Moms)

Cow milk → water intoxication, malnutrition, anemia

What alternative formula is used for infants with caregivers who cannot breastfeed? (Education for New Moms)

Iron-fortified formula (liquid concrete + powder)

Key home safety changes? (Common changes that must be made to a home with a new baby)

• Remove choking hazards “get on ground”

• Rear-facing car seat until age 2

• Secure chemicals/meds

• Never leave baby unattended

Common infant complaints?

• Crying/irritability

• Fever

• Respiratory issues

• GI problems

SIDS stands for? (Important Terms)

Sudden unexplained infant death during sleep (under 1 year)

How to prevent SIDS? (Important Terms)

Back sleeping + soft bedding!!

Signs for anemia in infant? (Important Terms)

• Low hemoglobin

• Pale skin, fatigue

How do newborns maintain thermoregulation? (Important Terms)

Newborns cannot shiver and rely on "brown fat”

Exam Look: Cool skin, cyanotic nail beds, and axillary temp <36.5°C

Why are newborns at risk for heat loss? (Important Terms)

Cannot shiver + large surface area

Where does Mongolian Spots originate from? What ethnic groups is it common with? (Important Terms)

Congenital Dermal Melanocytosis

Asian, African, or Hispanic descent

Mongolian spots? (Important Terms)

Bluish “bruise spots” pigmentation on lower back/buttocks (normal)

Clinical Judgment Case: Keri Meadows

• Initial Findings: 1-month-old, healthy, mother concerned about milk supply.

• Change at 3.5 Months: Keri has lost 5% of her weight, has sunken fontanelles, dry mucous membranes, and dark urine.

• Analysis: Keri is experiencing dehydration due to ineffective breastfeeding after the mother returned to work.

• Intervention: Refer to a lactation specialist, encourage mother's fluid intake, and teach pumping techniques