Newborn Care

What % of newborns are healthy & “normal”

97%

When do we resuscitate?

if there is poor respiratory effort OR HR <100 bpm

What is the single most reliable indicator of the need for resuscitation?

depressed HR

When is APGAR scoring recorded?

1 minute, then 5 minutes

What score indicates severe CP/CNS depression, and what does that require?

0-4 at 1 minute on APGAR; immediate resuscitation needed

What is done if the APGAR score is <7 at 5 mins?

Score every 5 minutes again until there’s a score of > 7 OR reach 20 minutes of life

Why is patentcy of nares assesed?

for choanal atresia

What is skin color a big indicator of?

cardiac output

What are the # of vessels of the umbilical stump

2 arteries, 1 vein

What are potential neuromuscular/skeletal birth injuries?

• clavicular fractures

• nerve palsies - facial and erb’s

What patients do we do a H/H for?

those at risk for anemia/polcythemia

When is the complete nursery exam performed?

within 24 hours of birth

What is considered hyperthermia/fever?

> 38 C (100.4 F)

What do we screen for on DOL #2, in relation to O2 saturation?

critical congenital heart disease

What BP is considered HTN in the newborn?

> 90/60 mmHg

What is considered SGA?

<10th percentile

What is considered LGA?

>90th percentile

What does the Ballard scoring look at?

neuromuscular and physical maturity for GA

What is macrosomia?

growth beyond a specifc threshold (weight of 4000g; 8lbs 13 oz), but doesn’t take in to account GA

What can persistent pallor/cyanosis suggest?

inadequate cardiac output

When is jaundice NEVER normal?

within the 1st 24hrs

What is the most common rash in newborn nursery?

erythema toxicum

When does erythema toxicum usually present?

24-48 hrs after birth, resolves around 1 week

When does transient neonatal pustular melanosis present?

at birth

What is another term for congenital dermal melanocytosis?

mongolian spots

Where is congenital dermal melanocytosis (Mongolian spots) most common?

the sacrum, but can be anywhere

When are cafe au lait macules indicative of neurofibromatosis?

presence of 6 or more that are >1.5 cm in adults or >0.5 cm in prepubertal children

What can a port wine stain on the face indicate?

sturge-weber syndrome (SWS)

What is sturge-weber syndrome (SWS)?

congenital d/o with a triad of facial port wine stains, ocular involvement, and leptomeningeal capillary-venous malformation

What can a port wine stain on the back/extremities indicate?

klippel-trenaunay syndrome (KTS)

What is klippel-trenaunay syndrome (KTS)?

congenital d/o with a triad of capillary malformation, venous malformation, and limb overgrowth

What is fusion of the suture lines (shouldn’t happen)?

craniosynostosis

What differentiates caput succedaneum and cephalohematoma?

caput succedaneum: crosses suture lines

cephalohematoma: doesn’t corss suture lines

What syndrome is often associated with micrognathia?

pierre-robin syndrome

What is webbing of the neck and widely spaced nipples most often indicative of?

turner syndrome

What is the normal RRs in a newborn?

30-60/min

What is common on auscultation of the breath sounds in the newborn?

rales/crackles

What is done if there are any suspicious/concerning findings of the chest and lungs?

CXR

What is the normal HR of the newborn?

120-160bpm

What is the most common innocent murmur in the neonate?

peripheral pulmonary stenosis (PPS)

What is a fairly common presentation of infants with CHD at birth?

asymptomatic at birth

What are the 2 fairly obvious presentations of CHD?

1. cyanosis (central)

2. CHF with abnormal pulses/perfusion

When is screening for CCHD done?

DOL #2

If there is anything suspicious during the exam of the heart, what is done?

echo

What is the #1 cause of abdominal masses in infants/kids

renal causes

What is a schaphoid abdomen potentially?

possible congenital diaphragmatic hernia (CDH)

What is prune belly syndrome associated with?

significant uro-renal tract abnormalities

What is one of the biggest causes of ambiguous genitalia?

congenital adrenal hyperplasia (CAH)

What happens in hypospadias?

the urethral meatus is inferior/ventral to distal tip

What happens in epispadias?

urethral meatus is superior/dorsal to distal tip

What are 2 CIs to circumcision?

hypospadias and epispadis

What is cryptorchidism?

undescended or absent testis(es)

What population is at an increased risk of cryptorchidism?

preterm infants

What is the possible associations mnemonic of an imperforate anus?

V - vertebral anomalies

A - anal atresia

C - CV anomalies

TE - TE fistula

R - renal anomalies

L - limb anomalies

What is a simian crease, and what does it often indicate?

single (1) transverse crease, can indicate trisomy 21 (down syndrome)

Why may erb’s palsy occur?

brachial plexus injury due to shoulder dystocia

What is close spinal dysraphism known as?

incomplete fusion - aka spina bifida occulta

How long are infants obligate nasal breathers?

2-6 months

What are the biggest concerns associated with ear abnormalities?

• hearing loss

• renal anomalies - do U/S

What is used to assess ankyloglossia?

Hazelbaker assessment tool for lingual frenulum function

What is leukocoria, and what does it require?

absent/white reflex; requires opthalmology consult

What does Galeazzi’s sign assess, and what age can it be used until?

assesses for shortening of the femur, which may indicate dislocation, especially when the knee is lower on the affected side; done until 3 months

How is the ortalni test performed?

• during ABduction, attempt to “lift” the trochanter forward

• “relocation” of the subluxed/dislocated hip

How is the barlow test performed?

during ADuction, attempt to displace the femoral head posteriorly by placing downward pressure on the leg

True or False: babinski’s sign is negative in newborns?

false; normal here; the big toe should bend up and back toward the top of the foot, and the other toes fan out upon stimulation of the sole

What is the standard formula size?

20 kcal/oz

How long after birth should urination occur?

within 24 hours

How long after birth should defecation occur?

within 48hrs

When do most normal-term newborns pass meconium?

94% pass meconium within the first 24 hours of life

What is standard for the Hep B vaccine?

standard for ALL newborns to recieve before they leave the hospital

What is done if the mother is HBsAg+?

infant gets Hep B vaccine AND HBIg within 12 hours of life

What is done if the maternal HBsAg status is unknown?

infant is given Hep B vaccine within 12 hours of life, and if it’s discovered the mother is +, baby should be given HBIg within 7 days

What is the concern if treatment is delayed in congenital hypothyroidism?

permanent nuerologic damage (intellecutal disability) can occur if treatment is delayed

Who should be considered for congenital hypothyroidism?

any critically ill infant or infant with neurological, metabolic, liver, or developmental disease

When does d/c usually occur?

DOL #3

When does the 1st peds/PCP office visit occur?

1-2 weeks of life