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95 Cards in this Set
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The standardized system for assessing gestational age
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Dubowitz Clinical Assessment
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The standardized system for assessing gestational age
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Dubowitz Clinical Assessment
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A total score of 46 to 60 is associated with a gestational age of 37 to 41 weeks
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Dubowitz Clinical Assessment. This is based on 10 neurologic signs and 11 external signs such as skin texture, breast size, and genital development.
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A total score of 46 to 60 is associated with a gestational age of 37 to 41 weeks
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Dubowitz Clinical Assessment. This is based on 10 neurologic signs and 11 external signs such as skin texture, breast size, and genital development.
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the infant is appropriate for gestational age (AGA)
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If the birth weight is from the 10th to the 90th percentile
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the infant is appropriate for gestational age (AGA)
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If the birth weight is from the 10th to the 90th percentile
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term is defined as a gestational age from
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38 to 42 weeks
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term is defined as a gestational age from
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38 to 42 weeks
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any infants who are LGA are infants of a diabetic mother. Infants of a diabetic mother are at risk for a number of complications, both in the immediate neonatal period and later in life. These infants must be carefully monitored for hypoglycemia and polycythemia; they are more likely to have
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hyperbilirubinemia in the first 3 days of life, and they are three to five times more likely to possess a congenital malformation than are infants in the general population.
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any infants who are LGA are infants of a diabetic mother. Infants of a diabetic mother are at risk for a number of complications, both in the immediate neonatal period and later in life. These infants must be carefully monitored for hypoglycemia and polycythemia; they are more likely to have
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hyperbilirubinemia in the first 3 days of life, and they are three to five times more likely to possess a congenital malformation than are infants in the general population.
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The respiratory rate of a newborn usually averages from
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30 to 50 breaths per minute.
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The respiratory rate of a newborn usually averages from
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30 to 50 breaths per minute.
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The average heart rate of a newborn ranges from
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120 to 140 beats
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The average heart rate of a newborn ranges from
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120 to 140 beats
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The infant's length is measured from the top of the head to the bottom of the feet; the length is usually between
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47 - 52
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The infant's length is measured from the top of the head to the bottom of the feet; the length is usually between
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47 - 52
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The head is measured at its greatest circumference around the occipitofrontal area. In general, three measurements are taken, the largest of which is recorded. The head circumference is usually
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34 - 37
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The head is measured at its greatest circumference around the occipitofrontal area. In general, three measurements are taken, the largest of which is recorded. The head circumference is usually
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34 - 37
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The chest circumference is normally smaller than the head circumference by 2 to 3 cm. The chest measurement is taken at the level of the nipples midway between inspiration and expiration. By the time the child is 1 year of age, the chest circumference will exceed the head circumference. These, and all other measurements performed during the physical examination, should be plotted on appropriate growth curves, correcting for the gestational age.
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The chest circumference is normally smaller than the head circumference by 2 to 3 cm. The chest measurement is taken at the level of the nipples midway between inspiration and expiration. By the time the child is 1 year of age, the chest circumference will exceed the head circumference. These, and all other measurements performed during the physical examination, should be plotted on appropriate growth curves, correcting for the gestational age.
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The chest circumference is normally smaller than the head circumference by 2 to 3 cm. The chest measurement is taken at the level of the nipples midway between inspiration and expiration. By the time the child is 1 year of age, the chest circumference will exceed the head circumference. These, and all other measurements performed during the physical examination, should be plotted on appropriate growth curves, correcting for the gestational age.
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The chest circumference is normally smaller than the head circumference by 2 to 3 cm. The chest measurement is taken at the level of the nipples midway between inspiration and expiration. By the time the child is 1 year of age, the chest circumference will exceed the head circumference. These, and all other measurements performed during the physical examination, should be plotted on appropriate growth curves, correcting for the gestational age.
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results from injury to the seventh and eighth cervical nerves, producing paralysis of the hand and forearm
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The grasp reflex is usually preserved. Klumpke's paralysis results from injury to the seventh and eighth cervical nerves, producing paralysis of the hand and forearm. The grasp reflex is absent. Involvement of the first thoracic nerve with Klumpke's paralysis may also result in ipsilateral ptosis and miosis
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results from injury to the seventh and eighth cervical nerves, producing paralysis of the hand and forearm
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The grasp reflex is usually preserved. Klumpke's paralysis results from injury to the seventh and eighth cervical nerves, producing paralysis of the hand and forearm. The grasp reflex is absent. Involvement of the first thoracic nerve with Klumpke's paralysis may also result in ipsilateral ptosis and miosis
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Is plethora present? Plethora is
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a condition marked by vascular turgescence, excess of blood, and a marked redness to the complexion. Plethora in the newborn usually indicates high levels of hemoglobin.
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Is plethora present? Plethora is
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a condition marked by vascular turgescence, excess of blood, and a marked redness to the complexion. Plethora in the newborn usually indicates high levels of hemoglobin.
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the skin is free from
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any acrocyanosis, plethora, pallor, or birth trauma
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the skin is free from
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any acrocyanosis, plethora, pallor, or birth trauma
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Although most neonatal jaundice is benign, icterus appearing before the third day may indicate a pathologic condition. Disorders that must be considered are
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hemolytic anemia caused by blood group incompatibility or other causes, and galactosemia, an inborn error of galactose metabolism.
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Although most neonatal jaundice is benign, icterus appearing before the third day may indicate a pathologic condition. Disorders that must be considered are
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hemolytic anemia caused by blood group incompatibility or other causes, and galactosemia, an inborn error of galactose metabolism.
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Visible jaundice in newborns does not appear until the serum bilirubin is
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5 mg/dL. When the level exceeds this threshold, the jaundice spreads in a well-circumscribed, orderly fashion, from the top of the head to the soles of the feet. When the soles become yellow, the serum bilirubin level has reached 12 mg/dL.
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Visible jaundice in newborns does not appear until the serum bilirubin is
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5 mg/dL. When the level exceeds this threshold, the jaundice spreads in a well-circumscribed, orderly fashion, from the top of the head to the soles of the feet. When the soles become yellow, the serum bilirubin level has reached 12 mg/dL.
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A newborn's skin may be covered with fine, soft, immature hair, known as
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lanugo hair. Lanugo hair frequently covers the scalp and brow in premature infants but is usually absent in term infants
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The anterior fontanelle is located at
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the junction of the sagittal and coronal sutures, is usually 4 to 6 cm in diameter, and appears diamond shaped
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The anterior fontanelle is located at
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the junction of the sagittal and coronal sutures, is usually 4 to 6 cm in diameter, and appears diamond shaped
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The triangular posterior fontanelle is located at
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sagittal and lambdoid sutures and measures 1 to 2 cm in diameter. Normally, the fontanelles are flat. A bulging fontanelle may indicate increased intracranial pressure; a depressed fontanelle may be seen in dehydration.
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fontanelle closure
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. The anterior fontanelle normally closes by 18 months, but there is a wide range of normality; the posterior fontanelle should be closed by 2 months of age.
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fontanelle closure
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. The anterior fontanelle normally closes by 18 months, but there is a wide range of normality; the posterior fontanelle should be closed by 2 months of age.
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edema of the soft tissues over the vertex of the skull that is related to the birth process
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Caput succedaneum
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edema of the soft tissues over the vertex of the skull that is related to the birth process
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Caput succedaneum
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malformation caused by sutural closure at an unusually early age
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Craniosynostosis
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Microcornea may result from
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congenital rubella
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Medial epicanthal folds, flaps of skin covering the inner canthus of the eye, are seen frequently in individuals with midface hypoplasia. This condition occurs in a number of disorders, including
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trisomy 21 and fetal alcohol syndrome,
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Medial epicanthal folds, flaps of skin covering the inner canthus of the eye, are seen frequently in individuals with midface hypoplasia. This condition occurs in a number of disorders, including
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trisomy 21 and fetal alcohol syndrome,
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Persistence of blue color of the sclera after 6 months of age is suggestive of the presence of a connective tissue disorder, such as
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osteogenesis imperfecta or Ehlers-Danlos syndrome
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To test for visual acuity in the newborn, the examiner must rely on indirect methods such as the response to a bright light, known as the
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the optical blink reflex. This reflex is normally observed when a bright light is shined on each eye: the newborn blinks and dorsiflexes the head. Although never actually tested, the visual acuity of newborns has been estimated to be approximately 20/100 to 20/150, based on their ability to fixate on and imitate the adult face.
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To test for visual acuity in the newborn, the examiner must rely on indirect methods such as the response to a bright light, known as the
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the optical blink reflex. This reflex is normally observed when a bright light is shined on each eye: the newborn blinks and dorsiflexes the head. Although never actually tested, the visual acuity of newborns has been estimated to be approximately 20/100 to 20/150, based on their ability to fixate on and imitate the adult face.
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In all newborns, the presence of the red reflex bilaterally suggests grossly normal eyes and the absence of
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glaucoma, cataract, or intraocular disorders.
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In all newborns, the presence of the red reflex bilaterally suggests grossly normal eyes and the absence of
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glaucoma, cataract, or intraocular disorders.
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the eyes are
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symetrical open spontaneously, with good acuity, and normal red reflex
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the eyes are
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symetrical open spontaneously, with good acuity, and normal red reflex
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Inspect the external ear. An imaginary line drawn from the inner and outer canthus of the eye toward the vertex should be at or below the level of the superior attachment of the ear. Low-set ears are often associated with congenital kidney defects or chromosomal disorders
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Inspect the external ear. An imaginary line drawn from the inner and outer canthus of the eye toward the vertex should be at or below the level of the superior attachment of the ear. Low-set ears are often associated with congenital kidney defects or chromosomal disorders
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Inspect the external ear. An imaginary line drawn from the inner and outer canthus of the eye toward the vertex should be at or below the level of the superior attachment of the ear. Low-set ears are often associated with congenital kidney defects or chromosomal disorders
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Inspect the external ear. An imaginary line drawn from the inner and outer canthus of the eye toward the vertex should be at or below the level of the superior attachment of the ear. Low-set ears are often associated with congenital kidney defects or chromosomal disorders
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microtia, is often associated with a condition called
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hemifacial microsomia or Goldenhar's syndrome
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microtia, is often associated with a condition called
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hemifacial microsomia or Goldenhar's syndrome
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Are any skin tags present? A skin tag or cleft in front of the tragus often represents a remnant of the
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first branchial cleft and may represent an isolated anomaly or be part of a more widespread group of malformation, such as Treacher Collins syndrome, or the aforementioned hemifacial microsomia.
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Are any skin tags present? A skin tag or cleft in front of the tragus often represents a remnant of the
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first branchial cleft and may represent an isolated anomaly or be part of a more widespread group of malformation, such as Treacher Collins syndrome, or the aforementioned hemifacial microsomia.
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Hearing in newborns may be tested by using the primitive acoustic blink reflex
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Blinking the eyes in response to snapping of the fingers or a loud noise indicates that the newborn can hear. This is a crude test with low sensitivity. A negative response should be further tested with a specific pure-tone screening device
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Hearing in newborns may be tested by using the primitive acoustic blink reflex
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Blinking the eyes in response to snapping of the fingers or a loud noise indicates that the newborn can hear. This is a crude test with low sensitivity. A negative response should be further tested with a specific pure-tone screening device
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the patients ears are symmetrical in size,
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symmetrical in size, without skin tags, the primitive acoustic blink reflex is intact, and the external canal is visualized with vernix caseosa present
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Inspect for a congenitally deviated septum.
If this has not already been done in the delivery room, patency of the nasopharynx is determined by passing a soft, sterile, 6-French catheter through each external naris and advancing it into the posterior nasopharynx. This test rules out the presence of unilateral or bilateral |
choanal atresia, which is a cause of severe respiratory distress in newborns.
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Test the sucking reflex by
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Put on a glove, and insert your index finger into the newborn's mouth. A strong sucking reflex should be present. The sucking reflex is strong at 34 weeks' gestation and disappears at 9 to 12 months of age. Feel for any clefts in the palate.
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test the sucking reflex by
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Put on a glove, and insert your index finger into the newborn's mouth. A strong sucking reflex should be present. The sucking reflex is strong at 34 weeks' gestation and disappears at 9 to 12 months of age. Feel for any clefts in the palate.
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Because the production of saliva is limited in the first few months of life, the presence of excessive saliva in the mouth is suggestive of
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esophageal atresia.
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Epstein's pearls
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These are mucous retention cysts and disappear within the first few weeks of life. Similar cysts may be present on the gingivae. Inspect for neonatal teeth.
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A low-pitched, hoarse cry that is infrequent and low in intensity is often associated with
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hypothyroidism, hypocalcemic tetany, or Williams' syndrome
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A low-pitched, hoarse cry that is infrequent and low in intensity is often associated with
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hypothyroidism, hypocalcemic tetany, or Williams' syndrome
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A sound that resembles a cat mewing suggests a condition known as cri du chat, caused by
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deletion of the short arm of chromosome 5 (del 5p).
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A sound that resembles a cat mewing suggests a condition known as cri du chat, caused by
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deletion of the short arm of chromosome 5 (del 5p).
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the neck is
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symmetrical with normal rotation/tone, the clavlicles are without crepitus, the neck is free of any masses
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Palpate for masses. A midline mass may be a
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thyroglossal cyst or thyromegaly. A lateral mass may be a cystic hygroma or branchial cleft cyst.
Is webbing of the neck present? Webbing is a feature of Turner's syndrome and other congenital abnormalities. |
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Palpate for masses. A midline mass may be a
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thyroglossal cyst or thyromegaly. A lateral mass may be a cystic hygroma or branchial cleft cyst.
Is webbing of the neck present? Webbing is a feature of Turner's syndrome and other congenital abnormalities. |
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Observe the respiratory rate while the infant is undisturbed. At several hours of age, the rate may vary from 20 to 80 breaths per minute, with an average of
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30 to 40
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Observe the respiratory rate while the infant is undisturbed. At several hours of age, the rate may vary from 20 to 80 breaths per minute, with an average of
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30 to 40
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Inspect for evidence of congestive heart failure. In newborns, the most important signs of heart failure are
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poor feeding, persistent tachycardia of 200 beats per minute, tachypnea, and an enlarged liver. Crackles are not sensitive indicators of heart failure in newborns. Heart failure during the first few days of life is frequently caused by hypoplastic left heart syndrome
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Inspect for evidence of congestive heart failure. In newborns, the most important signs of heart failure are
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poor feeding, persistent tachycardia of 200 beats per minute, tachypnea, and an enlarged liver. Crackles are not sensitive indicators of heart failure in newborns. Heart failure during the first few days of life is frequently caused by hypoplastic left heart syndrome
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Palpate for the point of maximum impulse. In newborns less than 48 hours old, the point of maximum impulse is often in
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in the xiphoid region
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The continuous machinery murmur of a patent ductus arteriosus is commonly heard at birth but disappears by the
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second or third day of life as the ductus spontaneously closes. This condition is frequently associated with a hyperdynamic precordium. If any murmurs are present, they should be noted and described as indicated
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The continuous machinery murmur of a patent ductus arteriosus is commonly heard at birth but disappears by the
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second or third day of life as the ductus spontaneously closes. This condition is frequently associated with a hyperdynamic precordium. If any murmurs are present, they should be noted and described as indicated
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Palpate the femoral pulses, at the midpoint of the inguinal ligament. Spend enough time to be sure you are feeling the arterial pulsations and not the movement of the abdominal wall with respiration. Weak femoral pulses should raise the suspicion of
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coarctation of the aorta. In hypoplastic left heart syndrome or preductal coarctation of the aorta, the femoral pulses may be present for the first 24 to 48 hours, and disappear as the ductus closes.
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Palpate the femoral pulses, at the midpoint of the inguinal ligament. Spend enough time to be sure you are feeling the arterial pulsations and not the movement of the abdominal wall with respiration. Weak femoral pulses should raise the suspicion of
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coarctation of the aorta. In hypoplastic left heart syndrome or preductal coarctation of the aorta, the femoral pulses may be present for the first 24 to 48 hours, and disappear as the ductus closes.
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In hypoplastic left heart syndrome or
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preductal coarctation of the aorta, the femoral pulses may be present for the first 24 to 48 hours, and disappear as the ductus closes.
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In hypoplastic left heart syndrome or
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preductal coarctation of the aorta, the femoral pulses may be present for the first 24 to 48 hours, and disappear as the ductus closes.
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spect the abdomen. The abdomen of a newborn is
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protuberant as a result of the poor development of the abdominal musculature. If the abdomen is scaphoid, there should be a high index of suspicion that a diaphragmatic hernia is present and that the abdominal organs may be located in the chest.
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spect the abdomen. The abdomen of a newborn is
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protuberant as a result of the poor development of the abdominal musculature. If the abdomen is scaphoid, there should be a high index of suspicion that a diaphragmatic hernia is present and that the abdominal organs may be located in the chest.
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Umbilical hernias are common in African-American infants. An umbilical hernia in a non-African-American child may be an indication of
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hypothyroidism.
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Umbilical hernias are common in African-American infants. An umbilical hernia in a non-African-American child may be an indication of
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hypothyroidism.
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Although uncommon, two major defects in the abdominal wall are known to occur. Omphaloceles are
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severe umbilical hernias in which some of the abdominal contents are located outside the body. Omphaloceles, which always involve the umbilicus and, as such, are always in the midline, may be isolated anomalies or may be associated with additional anomalies, such as in the case of the Beckwith-Wiedemann syndrome.
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Although uncommon, two major defects in the abdominal wall are known to occur. Omphaloceles are
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severe umbilical hernias in which some of the abdominal contents are located outside the body. Omphaloceles, which always involve the umbilicus and, as such, are always in the midline, may be isolated anomalies or may be associated with additional anomalies, such as in the case of the Beckwith-Wiedemann syndrome.
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Gastroschisis, which results from an
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embryonic vascular deficiency, is similar to omphalocele in that abdominal contents are located outside of the abdominal cavity. However, gastroschises are never midline, never covered with a membrane, and usually are located in the right upper quadrant. Gastroschisis may be associated with intestinal atresias, a condition known as apple peel bowel.
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Gastroschisis, which results from an
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embryonic vascular deficiency, is similar to omphalocele in that abdominal contents are located outside of the abdominal cavity. However, gastroschises are never midline, never covered with a membrane, and usually are located in the right upper quadrant. Gastroschisis may be associated with intestinal atresias, a condition known as apple peel bowel.
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Inspect the umbilical cord stump. Is there evidence of yellow staining by meconium as a result of fetal distress? The normal umbilical cord contains two thick-walled arteries and one thin-walled vein. This examination needs to be done in the delivery room, before the cord is treated with triple dye for antisepsis. Newborns with a single artery often have congenital abnormalities of the
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the kidneys and spine.
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. Drainage of a clear discharge from the umbilicus suggests the presence of a
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patent urachus* or possibly an omphalomesenteric duct.
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Auscultate the abdomen. The abdomen of a newborn infant is
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ympanitic, with metallic tinkling sounds being heard every 15 to 20 seconds.
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Auscultate the abdomen. The abdomen of a newborn infant is
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ympanitic, with metallic tinkling sounds being heard every 15 to 20 seconds.
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ympanitic, with metallic tinkling sounds being heard every 15 to 20 seconds.
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ympanitic, with metallic tinkling sounds being heard every 15 to 20 seconds.
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There should be a fingertip space between the vagina and the anus. If not,
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the possibility of sexual ambiguity exists. A whitish, serosanguineous vaginal discharge is common during the first few days of life and is due to the estrogen effect. The examiner should inspect the urethral meatus and vaginal orifice by placing a gloved thumb and index finger on the child's perineum while pressing downward and laterally on the buttocks
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