Neurology in Newborns 35 Weeks Gestation and Older ppt:

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Questions and Answers

What is the significance of a positive indirect antiglobulin test in a mother?

It shows that the mother requires immediate delivery of the newborn.

It suggests that the fetus is at risk for congenital anomalies.

It means the mother's immune system has been sensitized against the fetus' RBCs. (correct)

It indicates that the mother has a chronic medical condition.

Which of the following factors is NOT considered a risk factor for sepsis in the newborn?

Prolonged rupture of membranes.

Maternal fever during labor.

Maternal hypertension during pregnancy. (correct)

Inadequate antibiotic prophylaxis for Group B streptococcus.

What best describes the purpose of the Apgar score?

To predict long-term morbidity and mortality in newborns.

To evaluate maternal health during pregnancy.

To assess the need for immediate resuscitation in the delivery room. (correct)

To measure the newborn's physical growth parameters.

What is the ideal timing for establishing prenatal care?

As early as possible in the first trimester. Signup and view all the answers

Which of the following conditions could potentially increase the risk for postpartum depression?

Mental health conditions. Signup and view all the answers

What is indicated by an Apgar score below 8 for a newborn?

Immediate resuscitation may be required Signup and view all the answers

Which of the following methods is NOT used to assess neonatal pulse?

Count respiratory effort over 5 seconds Signup and view all the answers

What is the normal heart rate range for a newborn when awake?

120 – 160 bpm Signup and view all the answers

What does AGA stand for in the context of growth parameters?

Appropriate for Gestational Age Signup and view all the answers

Which component of the Apgar score assesses skin color?

Appearance Signup and view all the answers

What signifies a lamellar appearance with increasing gestational age?

Increased opacity and wrinkles of the skin Signup and view all the answers

What is the significance of scoring from 0 to 4 in neuromuscular maturity?

Provides an estimated gestational age of the infant Signup and view all the answers

How is the respiratory rate of a newborn best measured?

Measure over a full minute due to irregularities Signup and view all the answers

What does a normal body temperature for a newborn range from?

36.1°C – 37.0°C Signup and view all the answers

Which characteristic does NOT indicate SGA in a newborn?

Weight falling between the 10th and 90th percentiles Signup and view all the answers

What is the primary reflex assessed to determine CN 5 (trigeminal nerve) function in infants?

Rooting reflex Signup and view all the answers

Which cranial nerve is primarily responsible for facial motor function, including the symmetry of the nasolabial folds?

CN 7 (facial nerve) Signup and view all the answers

What is a normal plantar response for children over 2 years old?

Plantar flexion of the toes Signup and view all the answers

Which reflex is characterized by the infant's arm extending on the side their head is turned?

Asymmetric tonic neck reflex Signup and view all the answers

What indicates contralateral CN 12 palsy when observed during a tongue examination?

Deviation of the tongue to one side Signup and view all the answers

What reflex occurs when the paraspinal muscles are stroked, causing lateral flexion of the trunk?

Gallant reflex Signup and view all the answers

When assessing deep tendon reflexes, what method is typically used?

Tapping the tendon with a reflex hammer Signup and view all the answers

What behavior indicates habituation in newborns when exposed to a loud noise?

Stop startling after repeated exposure Signup and view all the answers

What is a sign of neurologic dysfunction in a newborn related to consolability?

Difficult to console using the Five S's Signup and view all the answers

Which of the following is NOT typical for deep tendon reflex assessment in children?

Palmar grasp reflex Signup and view all the answers

What indicates a potential craniosynostosis in an infant?

Persistent skull asymmetry after 2-3 weeks Signup and view all the answers

Which of the following findings is considered normal regarding the anterior fontanelle?

Open, soft, and flat Signup and view all the answers

What condition may webbing of the neck suggest in an infant?

Turner Syndrome Signup and view all the answers

Which of the following sacral findings is considered normal?

Normal sacral dimple Signup and view all the answers

Which of the following states of alertness is indicative of a medical emergency?

Moderate stupor Signup and view all the answers

Which condition is characterized by a baby exhibiting asymmetric movements?

Weakness Signup and view all the answers

What abnormal finding might indicate spina bifida occulta?

Hair tuft greater than lanugo Signup and view all the answers

Which cranial nerves are assessed through the Doll’s Eye Phenomenon?

CN 3 (oculomotor), CN 4 (trochlear), and CN 6 (abducens) Signup and view all the answers

Which condition is characterized by newborns having a high resistance to passive stretching?

Hypertonia Signup and view all the answers

Which behavior is commonly mistaken for a seizure in newborns?

Choreoathetoid movements Signup and view all the answers

What does caput succedaneum signify in a newborn?

Edema from pressure against the pelvis Signup and view all the answers

Which of the following statements regarding resting posture in newborns is correct?

Posture becomes increasingly flexed with maturity. Signup and view all the answers

How is deep stupor in an infant characterized?

Unresponsive, absent response to arousal stimuli Signup and view all the answers

Study Notes

Maternal History

Past Medical History:
Chronic medical conditions may affect a newborn's health.
Mental health conditions in mothers can increase the risk of postpartum depression.
Social History:
Strong social support from a partner and family is crucial for the newborn's wellbeing.
Maternal employment status can influence resources available for the newborn.
Substance use during pregnancy can lead to Neonatal Abstinence Syndrome or Fetal Alcohol Spectrum Disorder.
Domestic violence and homelessness can lead to malnutrition and insufficient prenatal care.
Pregnancy History:
Prenatal care should ideally begin in the first trimester and be consistent throughout pregnancy.
Pregnancy-related conditions, like gestational diabetes and hypertension, can impact the newborn.
Obstetrical complications, such as oligohydramnios or abnormal ultrasounds, may indicate issues during pregnancy.
Labor & Delivery History
Prolonged rupture of membranes (more than 18 hours) increases the risk of infection for the newborn.
Lengthy labor can lead to maternal exhaustion.
Mode of delivery, including vaginal vs. C-section, can impact the newborn's health.
Risk factors for neonatal sepsis include maternal fever, premature rupture of membranes, chorioamnionitis, inadequate antibiotics for maternal Group B strep, and prematurity.
Routine Labs
Vaginal Group B Strep testing helps determine if antibiotic prophylaxis is needed before delivery.
Serologies for Rubella, Varicella, Syphilis, HIV, Hepatitis B, and Hepatitis C ensure the mother and newborn are protected from these diseases.
Sexually transmitted infections, like Gonorrhea and Chlamydia, should be tested for and treated.
COVID-19 testing is crucial for both the mother and newborn's safety.
Blood typing is critical for potential blood transfusions and incompatibility issues.
Indirect Coombs test detects antibodies against fetal red blood cells, indicating potential complications for the newborn.

### Apgar Score

Used to assess a newborn's need for resuscitation in the delivery room.
Not used for diagnosis or prediction of morbidity or mortality.
Invented by Dr. Virginia Apgar in 1952.
Score assesses five components: Appearance, Pulse, Grimace, Activity, and Respirations.
Each component receives a score of 0, 1, or 2, with a total score calculated.
Score is calculated at 1 minute and 5 minutes after birth, and then every 5 minutes during resuscitation.
A normal score is 8-10. Scores below 8 may indicate a need for resuscitation.

### Apgar Score: Components

Appearance (Skin Color):
0: Blue all over
1: Acrocyanosis (blue hands/feet, normal trunk)
2: Pink all over
Pulse (Heart Rate):
0: No pulse
1: < 100 beats per minute
2: ≥ 100 beats per minute
Grimace (Reflex Response):
0: No response
1: Weak cry, small facial movement
2: Strong cry
Activity (Muscle Tone):
0: Limp, no movement
1: Some flexion, some movement
2: Extremities well-flexed, vigorous movement
Respirations (Breathing):
0: No respirations
1: Weak cry, slow/irregular breaths
2: Strong cry, regular rate (30-60 breaths/min), normal effort

### Apgar Score: Assessing Neonatal Pulse

Three methods available:
Auscultation with a stethoscope
Palpating the umbilical cord vessels
Palpating the brachial or femoral pulse
Regardless of the method, count heartbeats for 6 seconds and multiply by 10 to get the beats per minute.

### Vital Signs

Temperature:
Normal: 36.1°C – 37°C (97°F – 98.6°F)
Measure rectally.
Fever: ≥ 38°C (≥ 100.4°F)
Respiratory Rate:
Normal: 30 – 60 breaths per minute
Count over a full minute due to irregular respirations.
It takes 10+ minutes for oxygen levels to return to normal.
Heart Rate:
Awake: 120 – 160 bpm
Asleep: 80 – 90 bpm.
Blood Pressure:
Varies by gestational age, birth weight, and chronological age.
Normal blood pressure falls within the 50th to 94th percentiles.

### Growth Parameters

Overall:
Indicate how well the intrauterine environment supported the newborn's growth.
Measured and plotted on Olson growth curves.
Normal growth should be between the 10th and 90th percentiles.
Birth Weight:
AGA (Appropriate for Gestational Age): Weight between the 10th and 90th percentiles.
SGA (Small for Gestational Age): Weight below the 10th percentile.
LGA (Large for Gestational Age): Weight above the 90th percentile.

### New Ballard Score

Assesses physical and neuromuscular maturity of newborns.
Used to estimate gestational age.
Higher score indicates greater maturity.
Physical Maturity:
Skin: Increasing opacity and wrinkles with maturity.
Lanugo: Decreasing with maturity (assess the back).
Plantar Surface: Increased creases with maturity.
Breast Tissue: Larger and more defined with maturity.
Eyes/Ears: Eyelids unfuse and pinnas thicken with maturity.
Genitalia: Scrotum becomes more pendulous and has more rugae; vulva develops labia minora then labia majora with maturity.
Neuromuscular Maturity
Posture: Increasing flexion indicates maturity.
Square Window (Wrist Flexibility): Increasing laxity at the wrist indicates maturity.
Arm Recoil: Increasing recoil after flexion and resistance indicates maturity.
Popliteal Angle: Decreasing angle with maturity.
Scarf Sign: Increasing inability to cross the midline with maturity.
Heel to Ear: Decreasing ability to reach the ear with maturity.

### Physical Exam

General Appearance:
Assess the infant's overall health and well-being.
Check for any gross abnormalities or dysmorphic features.
Observe the cry (robust, hoarse, cat-like).
Assess the level of activity (all four extremities moving equally).
Examine the skin color (pink, acrocyanosis, central cyanosis).
Evaluate respiratory rate and effort (30-60 breaths per minute, unlabored).
Determine the sex.
Assess for adequate fetal nutrition.
Head:
Observe the size and shape of the skull.
Palpate for sutures (overriding is normal), fontanelles (open, soft, flat).
Potential Issues:
Persistent skull asymmetry or a palpable ridge over a suture line beyond 2-3 weeks of age may indicate craniosynostosis.
Tense and bulging fontanelles may indicate intracranial bleeding, meningitis, or hydrocephalus.
Head - Birth Injury:
Bruising, Lacerations, or Abrasions: Signify traumatic delivery and raise concerns for intracranial bleeding.
Caput Succedaneum: Edema of the scalp; resolves in a few days.
Cephalohematoma: Bleeding between the periosteum and skull; resolves in a few weeks.
Neck:
Head should be midline when the infant is supine.
Full passive range of motion.
Potential Issues:
Congenital torticollis may occur due to muscle injury, C-spine anomaly, or intrauterine positioning.
Neck webbing may indicate a genetic syndrome.
Spine:
Inspect and palpate the vertebral spinous processes.
Spine should be straight when supine or held by the axilla.
Potential Issues: Congenital scoliosis.
Sacrum:
Inspect for clues of spina bifida.
Potential Issues:
Meningocele and Myelomeningocele: Obvious on exam.
Spina Bifida Occulta: Not obvious; look for abnormal sacral dimple or hair tuft.
Normal Findings: Normal sacral dimple, hemangioma, skin tags, lanugo, Mongolian spot.
Suspicion for Spina Bifida Occulta Increases: If there are three or more of the above sacral skin findings.

### Neurologic Exam

Alertness:
Assess level of alertness using arousal and noxious stimuli.
Normal states of alertness:
Quiet awake
Active awake
Crying
Drowsiness
Active sleep (like REM sleep)
Quiet sleep (like non-REM sleep)
Abnormal states of alertness (mental status):
Mild stupor (lethargy)
Moderate stupor
Deep stupor
Coma
Posture and Muscle Tone:
Use the New Ballard neurologic criteria.
Assess resting posture when the infant is supine and quiet awake.
Assess tone by resisting passive stretching.
Hypotonia: Low tone for gestational age.
Hypertonia: High tone for gestational age.
Spontaneous Movement:
Newborn should move all four extremities equally.
Potential Issues: Asymmetric movements may indicate weakness.
Muscle Strength Against Gravity:
Ventral Suspension: Infant should be able to lift head and legs to be in line with their trunk.
Vertical Suspension: Infant should be able to support themselves with examiner's hands under the axilla.
Step Reflex: Infant should be able to lift and lower legs, as if stepping.
Cranial Nerves:
CN 1 (Olfactory): Smell is not usually assessed.
CN 2 (Optic) and CN 3 (Oculomotor): Direct and indirect pupillary light response.
CN 3 (Oculomotor), CN 4 (Trochlear), and CN 6 (Abducens): Assess conjugate eye movements using Doll's Eye Phenomenon.
CN 8 (Vestibulocochlear): Hearing is assessed by startle or blink to a loud sound.
CN 11 (Accessory): Functions can't be assessed.
Cranial Nerves:
CN 5 (Trigeminal): Facial sensation assessed by rooting reflex.
CN 7 (Facial): Facial motor function assessed by sucking ability, symmetry of nasolabial folds, and ability to close eyes while crying.
CN 9 (Glossopharyngeal) and CN 10 (Vagus): Needed for swallowing, palatal movements, gag reflex, vocalization, and crying.
CN 12 (Hypoglossal): Responsible for tongue movements; deviation indicates contralateral palsy.
Deep Tendon Reflexes:
Biceps Tendon Reflex:
Brachioradialis Tendon Reflex:
Patellar Tendon Reflex:
Masseter Tendon Reflex: Tap below the chin.
Achilles Tendon Reflex: 5-10 beats of ankle clonus is normal for children under 2 years old.
Plantar Reflex:
Plant Flexion: Normal for people over 2 years old.
Dorsiflexion (Babinski Sign): Normal for people under 2 years old.
Elicit the Reflex: Drag a reflex hammer along the lateral aspect of the sole of the foot.
Persistence or New Babinski Sign: Always abnormal in people over 2 years old.
Newborn Reflexes:
Controlled by the basal ganglia, brain stem, and spinal cord.
Disappear by 4-6 months of age.
Persistence beyond that time is abnormal.
Asymmetry is also abnormal.
Moro Reflex (Startle): Sudden head dropping causes abduction and extension of arms.
Rooting Reflex: Tactile stimulation near mouth causes head turning and mouth movement.
Sucking Reflex: Infant will reflexively suck on objects placed in the mouth.
Asymmetric Tonic Neck Reflex (Fencer Reflex): Turning the head results in extension of the ipsilateral arm and flexion of the contralateral arm.
Palmar Grasp Reflex: Hand reflexively closes on an object placed in the palm.
Gallant Reflex: Stroking paraspinal muscles causes trunk to laterally flex.
Sensory:
Newborn should respond to light touch and withdraw from pain or noxious stimuli.
Behavior (Cortical Function):
Habituation: Newborn should stop startling to a loud noise repeated 4-5 times.
Consolability: Use the "Five S's" (Suck, Swaddle, Shush, Swing, Side or Stomach).

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Description

This quiz covers essential aspects of maternal history, including medical, social, and pregnancy history that affect newborn health. It explores the importance of prenatal care, maternal conditions, and social support in ensuring the well-being of newborns. Assess your knowledge on how various factors can influence maternal and neonatal outcomes.