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83 Cards in this Set
- Front
- Back
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How many days classify newborn or neonate?
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Birth to 28 days
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What classifies an infant in terms of days/year?
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Child under age of 1
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What classifies a term gestation?
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37-42 weeks
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What classifies preterm infant/gestation?
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< 37 weeks
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What is ideal birthweight?
Low birthweight? Very low birthweight? |
> or = to 2500g (5lb 8oz)
Low birthweight = < 2500g Very low = < 1500g |
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What classifies the gestational age?
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The age of the fetus or newborn based upon the completed weeks from the date of the mothers LMP
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What classifies small for gestational age?
What classifies large for gestational age? |
Based on weight, length, or head circumference
Small: < or = 10%ile Large: > 90%ile |
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Does APGAR score have long term predicative value?
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No, no value of longterm outcome
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When is APGAR recorded?
What score is normal? |
1 minute and 5 minute
5 minute score of 7-10 = nml |
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What are the APGAR components?
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A = activity (muscle tone)
P = Pulse (>100-160) G = Grimace (reflex irritability) A = appearance (skin color) R = respiration (30-60 RR) |
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If the score is less than 7 after 5 minutes what should be done?
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Scores should be reassigned every 5 minutes until the baby has a score of 7 or greater
OR 20 minutes of life is reached |
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What would get a 2 on the APGAR?
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Active motion
Pulse > 100 bpm Grimace w/ cough or sneeze Appearance is completely pink Respiration that illicit a strong cry |
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What would get a 1 on the APGAR?
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Some flexion
Slow pulse (<100 bpm) Grimace, grunt Body pink; extremities blue Slow, irregular, weak cry |
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What would get a 0 on the APGAR?
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Limp
Absent pulse No grimace/response Blue/pale Absent respiration |
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What is circumcision?
Does the AAP support this? |
Removal of the foreskin from the penis
AAP says it is justified for families who choose it, but AAP does not recommend advantages or disadvantages |
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What are benefits of circumcision?
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Decreased rate of: UTI, foreskin abnormalities, STI, Penile Cancer
Improved hygiene |
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What is used to anesthetize the penis for circumcision?
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1% lidocaine WITHOUT epinephrine
(penile nerve block) |
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What is the risk of procedure and is it preformed on infants with genital abnormalities?
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Risk: local infection, bleeding, removing to much skin, urtethral injury
Abnormality = NO, contraindicated |
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When does the umbilical stump fall off?
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1-2 weeks
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What should be done for care of the umbilical stump?
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Sponge bath until stump falls off
AND Area around stump cleaned daily (soap and water) |
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What is an infection of the umbilical stump?
What are signs of the infection? |
Omphalitis
Foul-smelling Yellow discharge, redness around cord base |
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How many times should a baby be bathed?
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3 days per week for the 1st year (usually sufficient)
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What can be done after bathing to prevent dry skin or eczema?
What can be done after bathing to prevent yeast infections? |
Patting dry and applying hypoallergenic lotion
Cleaning and drying creases in: neck, chin, armpits, and genital area |
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What is considered appropriate loss of weight for a newborn?
Should the baby regain weight lost? When? |
5-7% for the first few days of life
Yes, within 2 weeks |
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What is appropriate weight gain for the first 6 months?
What is appropriate weight gain for the second 6 months? |
1 oz/day (1st 6 months)
.5 oz/day (2nd 6 months) |
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What is the general rule regarding infants and weight gain?
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Infants should triple their birth weight by their first birthday
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How many wet diapers do infants have after day 5?
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6-8 wet diapers every 24 hours
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How many stools do infants have after day 5?
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3-4 yellow stools every 24 hours
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When should happen with urine or stool output of a newborn in 24 hours?
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Pass Meconium: Should have one black green stool
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When are infants and mothers discharged from hospital?
What is AAP recommendation? |
24-36 hours of age appears safe for most newborn w/o contraindications
F/U visit within 48-72 hours for infants discharged less than 48 hours |
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What are contraindications to discharging an infant?
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Jaundice at or < 24 hours of age
High risk for infection Birth defects Narcotic withdrawl |
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What is a common neonatal problem? (65% of newborns develop this)
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Neonatal jaundice
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What is the bilirubin level for clinical neonatal jaundice?
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> 5 mg/dl during the first week of life
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Which bilirubin is altered by the liver?
Which bilirubin has not been altered by the liver? |
Conjugated bilirubin or direct bilirubin
Unconjugated bilirubin or indirect bilirubin |
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What is physiological jaundice?
What is physiological jaundice due to? |
Visible jaundice appearing after 24 hours of age
Cause: absent gut flora and slowed peristalsis causes conjugated bilirubin to be reabsorbed |
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What is the cause of jaundice before 24 hours of age?
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Pathologic origin
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When does peak bilirubin occur with physiologic jaundice? What is the maximal level?
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Peak = 3-5 days of age
Maximal level = 15 mg/dL |
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What pathological causes increase bilirubin production and have elevated reticulocyte count?
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Increased Hemolysis
Maternal antibodies against fetal cells (Coombs +) Abnormal RBC shape (spherocytosis) Abnormal RBC enzymes (G6PD, Pyruvate Kinase def) Nonhemolytic causes (Hemorrhage, Polycythemia) |
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What pathological cause would decrease the rate of conjugation and have normal reticulocyte count?
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Premature
G6PD def Inborn metabolism error (Galactosemia, Gilbert syndrome) |
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What is the primary cause of breast feeding associated jaundice?
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Decreased nutritional intake combined with increased enterohepatic circulation
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What is kernicterus?
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Chronic Bilirubin Encephalopathy
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What does the high level of unconjugated bilirubin in chronic bilirubin encephalopathy cause?
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Yellow staining and degenerative lesions in the basal ganglia
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What are the complications of chronic bilirubin encephalopathy?
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Palsy
Deafness Limitation of upward gaze Dental dysplasia |
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What are risk factors for jaundice?
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Blood group incompatible
Gestational age 35-36 weeks Family history of Jaundice with sibling Cephalohematoma (respects sutures) East Asia Race |
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What tests are done to evaluate a neonate for jaundice?
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Blood type (Direct Coombs test)
CBC w/ smear Serum Albumin Total Bilirubin |
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What is the clinical level of jaundice?
What is the level if extremities are involved? How does jaundice progress? |
Clinical level = 5 mg/dL
Extremities involved = Likely Bilirubin at least 15 mg/dL Progresses head down |
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What is the most common treatment and prevention of jaundice in neonates?
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Phototherapy: that converts unconjugated bilirubin to water soluble compound
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When do you start a neonate on phototherpay?
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If the newborn TSB level is >95%ile, and follow level every 6 hours
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When should phototherapy be administered continuously?
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When TSB level > 20mg/dL, administer until levels below 20 mg/dL
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When is exchange blood transfusion appropriate treatment?
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ABO incompatibile
Rh isoimmunization Hereditary spherocytosis |
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What are the most common causes of unconjugated hyperbilirubinemia?
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Physiological Jaundice
Prematurity breast feeding associated jaundice |
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What is lacrimal duct obstruction most commonly due to?
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Incomplete canalization of the duct or membranous obstructions
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What happens to most cases of lacrimal duct obstruction?
What is the mainstay treatment option? |
MOST cases clear spontaneously
Mainstay surgical treatment is probing |
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What are milia?
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benign, keratin-filled cysts
appear as superficial white to yellow domed papules Measure 1-2 mm |
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Where do milia usually present?
What are they called if they present intraorally? |
Face, especially the nose
Epstein pearls |
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What is the most common neonatal skin lesion?
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Erythema Toxicum
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How does Erythema Toxicum look on exam and where does it present?
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Exam: 1-2mm white to yellow papules on erythematous base
Found on *Chest*, arms, legs, and back |
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When does Erythema Toxicum most commonly present?
How long does it take to disappear? |
2nd and 3rd days of life
(Can present anytime during the first week) Within 2-4 weeks of life |
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What causes mongolian spots?
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Caused by uneven migration of melanocytes
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What do mongolian spots look like?
Where are they usually found? |
Looks like: blue to slate gray (resembles bruise)
Base of spine and buttocks |
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What race do mongolian spots affect?
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>50% of African Americans, Native American and Asians
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What is nevus simplex?
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"salmon patch" or "stork bites"
Pink-red capillary malformations |
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Where does nevus simplex present and when is it most prominent?
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Presents: neck (base of neck MC) , eyes, or upper lid
Most prominent = when baby is upset |
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Does nevus simplex blanch with pressure?
When does nevus simplex usually disappear by? |
Yes.
Age 2. |
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What can be used to treat nevus simplex?
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Laser therapy if persist into adolescence
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Which newborn skin rash is non-blanchable?
AND What does it look like? |
Port-wine stain or Nevus Flammeus
Macular, sharply circumsribed, pink to purple lesion |
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Why does port-wine stain or nevus flammeus not blanch?
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It is a permanent developmental defect of vascular malformation of dilated capillaries
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What regions do port-wine stain or nevus flammeus most commonly affect?
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Head and Neck
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What is another name for baby acne?
What does it look like? |
Cephalic pustulosis
inflammatory papules or pustules, with absence of comedones |
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Cephalic pustulosis is generally limited to what area?
When does it onset and resolve? |
Face
Onset: 3 weeks after birth Resolve: around 4 months |
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What is the treatment for Cephalic pustulosis?
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No treatment necessary
May use soap and water, 1% hydrocortisone or 2% ketoconazole (avoid oils and lotions) |
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What are causes of subconjunctival hemorrhage in infants?
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Traumatic Delivery
Spontaneous Occasionally Sneezing or Coughing |
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When do subconjunctival hemorrhages usually resolve?
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1-2 weeks without any permanent damage
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What is colic characterized by?
When does it begin and peak? |
Severe and paroxysmal crying that occurs mainly in the late afternoon
Begins:First few months of life Peaks: 2-3 months |
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What is the Wessel Criteria?
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Rules of three for a healthy well fed infant:
- Cries > 3 hours/day - for more than 3 days/week - for more than 3 weeks |
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What is the etiology of Colic?
What are some characteristics/signs a baby with colic may present with? |
Etiology = unknown
Knees drawn up, fists clinched, flatus may be expelled Facies appear pained and minimal response to soothing |
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What is the recommend management for colic?
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Education, reassurance, soothing strategies
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What is NOT recommended for colic management?
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Sedatives, antihistamines, and motion sickness meds (dicyclomine) are NOT safe or effective
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What is SIDS?
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Sudden infant death of an infant under one year of age, which remains unexplained after thorough investigation/autopsty.
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What causes SIDS?
What sex predominates with SIDS? |
Unknown cause
Males |
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When do most deaths due to SIDS occur?
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Few weeks to 6 months of age
Between 12 a.m. and 8 a.m. |
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What are risk factors for SIDS?
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Exposure to cigarette smoke
Maternal age <20 years of age Prematurity Prone sleeping position Soft bedding Overheating Bed sharing |
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What is the most common finding in postmortum SIDS?
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Brainstem abnormalities
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