Peds E1 - Newborn Exam

Normal VS for a newborn

Temp: 97.7-99.5 F

RR: 35-60 bpm

HR: 120-160 bpm (lower in sleep)

Pulse Ox: 98%

BP: not obtained usually

How does weight change immediately following birth?

lose up to 10% of birthweight and gain it back by week 3 of life

What is acrocyanosis?

blue color to hands and feet; usually no clubbing

What is central cyanosis?

blue color to chest/torso; suggestive of CHD/pulm disease or sepsis

What is perioral cyanosis?

blue color around the oral orifice

What is a fontanelle?

“soft spot”; dense connective tissue between developing skull bones; allow for continued growth of brain and skull

What is a normal head circumference?

13-15 inches

What usually causes microcephaly?

familial etiology or genetic disorder

What usually causes macrocephaly?

hydrocephalus, subdural hematoma, brain tumor

What is Caput Succedaneum?

superficial edema/ecchymosis that crosses the suture line; reconfigure in ~1wk

What is Cephalohematoma?

blood collection occurs under the periosteum and does NOT cross the suture line; heals in several months

What is a Subgaleal hemorrhage?

occurs between scalp and skull; blood migrates to the dependent side

Which fontanelle closes first? (closed by 2-3 months)

posterior

What may cause a fontanelle to bulge?

inc ICP

What may cause a fontanelle to be sunken?

dehydration

What might large fontanelles (>3 cm) indicate?

hydrocephaly, hypothyroidism, vit D deficiency, achondroplasia, osteogenesis imperfecta

What might small fontanelles or delayed closure indicate?

chromosomal defects, congenital infections, fetal alcohol syndrome, craniosynostosis, normal genetic variation

What are head sutures? what are they for?

fibrous joints that separate floating bones, allows for bones to slide over each other during birth

What is Craniosynostosis?

premature closure of crania sutures due to abnormal skull or brain development

What can craniosynostosis cause?

compensatory skull growth perpendicular to the affected suture (abn head shape), inc ICP, learning/development problems

What is Positional Plagiocephaly?

d/t supine position → sutures are NOT closed, ear is displaced anteriorly on affect side

How do you tx Positional Plagiocephaly?

cranial molding orthosis (helmet) to help reshape

What is Posterior Craniosynostosis?

premature closure of lamboid suture resulting in ipsilateral occipitoparietal flattening → forehead bulging on the opposite side, ears may be displaced

What is Trigonocephaly?

fusion of the metopic suture (forehead) → prominent ridge running down the forehead & closely placed eyes

What is Scaphocephaly?

early fusion of the sagittal suture (midline) → long narrow skull “hull shaped”

What imaging is done for Cranosynostosis?

CT: asses extent of fusion and calculate intracranial volume

What is the tx for Craniosynostosis?

surgical repair to prevent intracranial HTN & skull deformities

What is a Lacunar skull?

dysplasia of the membranous skull vault characterized by groups of pits on the inner surface of the skull (seen on plain films or MRI)

What is a Doll’s eyes reflex?

infants eyes stay fixed and have a lag time before adjusting to where the head is now facing (birth-3/4 months)

What does an absent red light reflex indicate?

retinoblastoma, cataract, opacified cornea

What does a white/grey reflex indicate?

cataracts, hemorrhage, Peter’s anomaly

What is Peter’s anomaly?

centra defect in the corneal endothelium w/ adhesion of the iris and lens to the central cornea

What is CHARGE syndrome?

Coloboma, Heart anomalies, Atresia of choanae, Retardation of growth, GU abnormalities, Ear anomalies

How soon after birth does Gonorrheal conjunctivitis occur?

24-48 hours

What is the tx for Gonorrheal conjunctivitis?

Rocephin 25-50 mg/kg IV or IM

How soon after birth does Chlamydial conjunctivitis present?

7-14 days

What is the tx for Chlamydial conjunctivitis?

oral Azithro 20 mg/kg x 3 days

Alt: Erythromycin 50 g/kg/day QID x 2 weeks

What is the tx HSV conjunctivitis?

refer to ophthalmologist

How soon after birth is HSV conjunctivitis present?

2 weeks; associated w/ keratitis, cataracts, chorioretinitis, optic neuritis

What is Retinoblastoma?

rapidly developing cancer of the retina; NO red reflex present; typically unilateral

What is Retinopathy of Prematurity?

developmental vascular proliferative disorder that occurs in the retina of premature infants w/ incomplete retinal vascularization

What is Choanal atresia?

congenital disorder where the back of the nasal passage is block

What is a cleft lip?

unilateral/bilateral defect tin the lip that can extend all the way to the opening of the nose

What is a cleft palate?

unilateral or bilateral and involves the hard and soft palate

What is Ankyloglossia caused by? (tongue tied)

unusually shortened or distally inserted frenulum

What is the tx for ankyloglossia?

frenulotomy or frenectomy vs observation

What are natal teeth?

teeth present at birth

What are neonatal teeth?

teeth present during the neonatal period (before the first month)

What is the tx for oral candidiasis?

Nystatin suspension

What are key signs of Turner’s syndrome?

wideset nipples, excessive nuchal skin, lymphedema

What is Poland’s syndrome?

unilateral absence or hypoplasia of the pectoralis major muscle

What is Pectus excavatum?

“funnel” chest

What is Pectus carinatum?

“pigeon” chest

What is considered tachycardia in neonates?

>160 bpm

What is considered bradycardia in neonates?

<100 bpm

How soon after birth do PDAs typically close?

24-72 hrs

What might weak LE pulses indicate?

coarctation of aorta/L ventricular tract obstruction

What does Scaphoid abdomen indicate?

diaphragmatic hernia

What is the tx for an Umbilical granuloma/

silver nitrate cauterization

What are Umbilical hernias caused by?

common d/t defect of the abdominal wall at the umbilicus

Do umbilical hernias require surgical repair?

no, 95% close by the age of 5

What is hypospadias?

urethra opens on the ventral surface of the penis

What is epispadias?

urethra opens on the dorsal surface of the penis

What is cryptotorchidism?

undescended testicle

What might an infants inability to pass stool indicate?

Hirschsprung’s disease (congenital megacolon)

What does a Meconium plug indicate?

CF, hypothyroidism, infant of diabetes mother

What is polydactyl?

supernumerary digits

What is syndactyl?

approximation/fusion of two or more digits

What is the tx for polydactyl & syndactyl?

surgery

What is the tx for Clubfoot (talipes equinovarus)?

splinting, taping, casting

Are gluteal cleft and sacral dimples normal in infants?

yes, unless accompanied by sinus tract or tuft of hair

What are RF for developmental hip dysplasia?

breech position in utero, FMH, Females

What is the Barlow maneuver?

*used for hip dysplasia

infant lying supine w/ knees flexed → grab thigh along great trochanter w/ thumb on inner thigh → ADDUCT and apply downward pressure to promote dislocation

What is the Ortolani maneuver?

*used for hip dysplasia

infant lying supine → grab hip along greater trochanter w/ thumb on inner thigh → ABDUCT and apply pressure anteriorly to brin the femur forward to reduce the joint

*clunk signifies movement into place = + test

What is Galeazzi’s sign?

*for hip dysplasia

infant lying supine → flex both knees → if one is higher than the other = + test

What testing is done to dx developmental hip dysplasia?

4-6 weeks old = U/S

4-6 mo old = XR

What is the tx for developmental hip dysplasia?

refer to pediatric ortho; Pavlik harness or Spica cast for several weeks

What is a Moro reflex?

sudden dropping of head → abduction & extension of arms/hands

What is Rooting reflex?

stroking cheek → head turns in that direction to prepare for sucking

What is the Grasp reflex?

place finger in palm of hand to elicit grasp

What is the Galant reflex?

place infant prone & stroke paravertebral region from thorax to lumbar → trunk and hips will move towards that side

What is the stepping reflex?

hold infant vertical w/ feet in contact w/ flat surface → feet move in slow alternating stepping action

What is the Asymmetric tone neck reflex?

turn head/neck to one side → extension of UE/LE on the side the head is facing w/ flexion of the C/L side (fencer position)

What is the Babinski reflex?

stroke lateral plantar surface w/ pointed object → extensor plantar

Is Spina bifida occulta open or closed?

closed

Is a myelomeningocele open or closed?

open

What is Cerebral Palsy?

motor dysfunction d/t damage of the motor control center of the developing brain in utero

What is Erb Duchenne Palsy?

upper brachial plexus injury: ADDuction and internal rotation of the should w/ elbow extension and pronation of forearm, flexion of wrist and intact grasp reflex

What condition is the “waiter’s tip” sign associated with?

Erb Duchenne Palsy

What is the MC cause of Erb Duchenne Pasly?

shoulder dystocia during a difficult birth

What is Klumpke’s Palsy?

lower branchia plexus injury: forearm is supinated and the wrist and fingers are flexed

What condition is “claw hand” associated with?

Klumpke’s palsy

What is lanugo?

fine hair all over the body (mainly shoulders/back)

What is White vernix caseosa?

“cheesy varnish” produced by sebaceous glands; less prominent the closer the infant is to term

What is Benign pustular melanosis?

non-erythematous milky vesicles on the hands/feet

What is a Congenital nevi?

brown/black discoloration that thickens w/ age

What is a Nevus simplex (macular stain)?

hyperpigmentation that lights with age

eyelid, glabellla, post neck

What is fat necrosis of the newborn?

discolored, nodular lesion d/t recent trauma (forceps)

What is the tx for serborrheic dermatitis?

scalp - mineral oil w/ soft brush; alt: ketoconazole

intertriginous - ketoconazole

What is the MC vascular tumor of infancy?

hemangioma