Normal Newborn Study Guide Pt. 1 (terms, labs, APGAR, & reflexes)

define acrocyanosis

cyanosis of the extremities.

define caput succedaneum

swelling of edema occurring in or under the fetal scalp during labor; crosses suture lines.

define cephalohematoma

subcutaneous swelling containing blood found on the head of an infant 2-3 days after birth; does not cross suture lines; it usually disappears within 2 weeks to 3 months.

define cradel cap

• (infantile or neonatal seborrheic dermatitis, also known as crusta lactea, milk crust, and honeycomb disease) is a yellowish, patchy, greasy, scaly and crusty skin rash that occurs on the scalp of recently born babies.

• It is usually not itchy, and does not bother the baby.

• most commonly begins sometime in the first 3 months.

define Epstein’s pearls

small, white blebs found along the gum margins and at the junction of the hard and soft palates; commonly seen in the newborn as a normal manifestation

define erythema toxicum

• (also called “newborn rash”) innocuous pink papular rash of unknown cause with superimposed pustules;

• it appears within 24 to 48 hours after birth and resolves spontaneously within a few days.

define lanugo

• fine, downy hair found on all body parts of the fetus, with the exception of the palms of the hands and the soles of the feet, after 20 weeks gestation.

• Most abundant on the back.

• The greatest amount is seen between 28 and 30 weeks.

define meconium

thick, tarry, dark green or black material present in the large intestine of a full-term infant; the first stools passed by the newborn composed of amniotic fluids, intestinal secretions and shed mucosal cells.

define milia

tiny white papules appearing on the face of a newborn as a result of unopened sebaceous glands; they disappear spontaneously within a few weeks.

define mongolian spots

• macular areas of bluish black or gray-blue pigmentation found on the dorsal area and the buttocks of newborns.

• More common in dark-skinned newborns, but also seen in 1% to 9% of Caucasians.

• They may appear as bruises, so should be documented on the chart.

define neonatal period

from birth through 28 days of life. Used in epidemiology to describe neonatal mortality rate (number of births per 1000 births).

define nevus flammeus (port wine stain)

a capillary angioma directly below the epidermis. Nonelevated, sharply demarcated, red to purple, does not blanch. Commonly appears on the face, varies in size and shape, does not change in size or fade with time.

define nevus vasculosus (strawberry mark)

a very common type of birthmark made of blood vessels. Most hemangiomas are not visible at birth, but appear as a small bruise, scratch or a tiny red bump. They grow and change greatly during the first months of life. They may occur anywhere on the skin surface but are most common on the scalp, face and neck.

what are “hemangiomas”

nevus vasculosus (strawberry mark)

define superficial hemangioma

located in the outer layers of the skin

define deep hemangioma

under the skin in the fat

what are the characteristics of hemangiomas that are on the surface of the skin vs ones that are deep?

typically bright red to purple in color, while deep hemangiomas may be blue, purple, or even normal skin color if they are located deep under the skin surface

what are the size ranges of hemangiomas?

varies from very small (1 mm), to very large (20 cm or larger).

define petechiae in newborns

pinpoint bruising typically cause by pressure of birth.

define phenylketonuria (PKU)

a common metabolic disease caused by an inborn error in the metabolism of the amino acid phenylalanine. Part of the newborn screening panel.                  

define telangiectatic nevi (stork bites)

pale pink or red spots found on eyelids, nose, lower occipital bone, and nape of the neck. Common in light-skinned newborns and more noticeable when crying. No clinical significance; fade in a couple of years.

define thrush

fungal infection of the oral mucous membranes caused by Candida albicans (often acquired from the birth canal), characterized by white plaques in the mouth. Newborn typically treated with oral nystatin. If breastfeeding, mother must be treated also (usually with Diflucan).

define vernix caseosa

protective, cheese like, whitish substance made up of sebum and desquamated epithelial cells that are present on the fetal skin. Appears by 24 weeks gestation and disappears by term.

CCHD

critical congenital heart disease

FAS

fetal alcohol syndrome

define IUGR

intrauterine growth retardation

LBW

low birth weight

LGA

large for gestational age

PKU

phenylketonuria (part of the state screen)

SIDS

sudden infant death syndrome

SGA

small for gestational age

TCB

transcutaneous bilirubin        

normal birth weight for a newborn (MENTAL)

2500 – 4000 g; 5 lb 8 oz – 8 lb 13 oz

normal length for a newborn (MENTAL)

45 – 55 cm; 17.7 – 21.7 in

normal chest circumference (CC) for a newborn (MENTAL)

30 – 33 cm; 11.8 – 13 in

normal head circumference (HC) for a newborn (MENTAL)

32 – 36.8 cm; 12.6 – 14.5 in

normal HR for a newborn (MENTAL)

110-160

normal RR for a newborn (MENTAL)

30-60

normal temp for a newborn (MENTAL)

97.7F - 99.5F

normal BP for a newborn (MENTAL)

SBP = 60 – 80 mm Hg; DBP = 40 – 50 mm Hg (60-80/40-50)

what’s the purpose of the APGAR scoring system?

to evaluate the physical condition of the newborn at birth. WITH 5 criteria on which the system is based, and how each is scored.

what are the different portions of the PAGAR scoring system?

HR

respiratory effort

muscle tone

reflex irritability

color

what would give you a score of 2 in HR in the apgar?

greater than or equal to 100

what would give you a score of 1 in HR in the apgar?

slow, or less than 100

what would give you a score of 2 in respiratory effort in the apgar?

good crying

what would give you a score of 1 in respiratory effort in the apgar?

slow, irregular  

what would give you a score of 2 in muscle tone in the apgar?

active motion

what would give you a score of 1 in muscle tone in the apgar?

some flexion of extremities

what would give you a score of 2 in reflex irritability in the apgar?

vigorous cry

what would give you a score of 1 in reflex irritability in the apgar?

grimace

what would give you a score of 2 in color in the apgar?

completely pink

what would give you a score of 1 in color in the apgar?

body pink, extremities blue

what would qualify for a 0 in the apgar for the different portions?

absent, muscle tone=absent, and their color- pale, blue

what are the different periods of reactivity of a newborn?

(first and second periods) observed in the newborn during the first few hours following birth.

what’s the first period of reactivity?

• first 30 minutes after birth; newborn awake and alert, feeding cues present and has a strong sucking reflex, optimum period for breastfeeding and bonding.

• Following the first period of reactivity, newborn falls into a deep sleep, which may last 2 to 4 hours.

what’s the second period of reactivity?

• when baby becomes awake and alert again, heart and respiratory rates increase, but may have apneic periods; production of respiratory and gastric mucus increases which may lead to gagging, choking and regurgitating;

• may pass first meconium stool and first void; shows feeding cues.

• Lasts 4-6 hours.

what are the “six states of arousal” for a newborn?

Behavior and neurologic responses of newborn. includes:

• Deep or quiet sleep

• Light sleep

• Drowsy or semidozing

• Quiet alert

• Active alert

• Crying

what’s the “deep or quiet sleep“ state of arousal?

closed eyes; no eye movement; regular, even breathing; startles at regular intervals; responds slowly to stimuli and not likely to come out of state.

what’s the “light sleep“ state of arousal?

irregular respirations, eyes closed with REM, irregular sucking motions, minimal activity, stimuli will cause startle and change of state.

what’s the “drowsy or semidozing“ state of arousal?

fluttering eyelids; slow regular movements of extremities; mild startles; stimuli may cause a change of state.

what’s the “quiet alert“ state of arousal?

alert and focused on objects, faces or sounds; still; responds slowly to stimuli.

what’s the “active alert“ state of arousal?

eyes open; intense motor activity; stimuli increases startles or motor activity.

what’s the “crying“ state of arousal?

intense crying, jerky movements; discharges energy and allows for reorganization of behavior; elicits response from parents

how do you evoke the Babinski reflex & what’s the normal response?

• Gently stroke sole of foot

• Toes fan and extend

how do you evoke the moro reflex & what’s the normal response?

• With infant lying held horizontally, lower quickly

• Arms extend, head back, fingers spread, and then arms come back to center and hands clench. Disappears by 6 months

how do you evoke the palmar grasp reflex & what’s the normal response?

• Place finger or object in newborn’s palm

• Grasps object

how do you evoke the plantar reflex & what’s the normal response?

• Apply pressure with the finger against ball of feet

• Plantar flexion of all toes. Disappears by the end of first year

how do you evoke the rooting reflex & what’s the normal response?

• Lightly touch cheek

• Head rotates toward stimulation, mouth opens, attempts to suck. Disappears by 4 months.

how do you evoke the stepping reflex & what’s the normal response?

• Support infant in upright position with feet lightly touching a flat surface

• Rhythmic stepping motions. Disappears by 4 to 8 weeks.

how do you evoke the suck/swallow reflex & what’s the normal response?

• Place finger or nipple in mouth

• Rhythmic sucking. If liquid moves into mouth, newborn swallows.

how do you evoke the tonic neck (“fencing pose”) reflex & what’s the normal response?

• Turn head to one side

• Arm and leg extend on side infant faces. Opposing extremities flex

how do you evoke the trunk incurvation reflex & what’s the normal response?

• Stroke spine while newborn prone

• Pelvis turns to stimulated side