Podcast
Questions and Answers
At what gestational age is the Galant reflex well-established?
At what gestational age is the Galant reflex well-established?
Which reflex disappears at around 3-4 months after birth?
Which reflex disappears at around 3-4 months after birth?
What is the accuracy of the Ballard Score for postnatal assessment of gestational age?
What is the accuracy of the Ballard Score for postnatal assessment of gestational age?
Which characteristic is NOT assessed in the Physical Maturity section of the Ballard Score?
Which characteristic is NOT assessed in the Physical Maturity section of the Ballard Score?
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Which elicited response describes the Babinski reflex?
Which elicited response describes the Babinski reflex?
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At what age does the suck reflex typically disappear?
At what age does the suck reflex typically disappear?
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Which reflex is elicited by stroking the cheek or corner of the mouth?
Which reflex is elicited by stroking the cheek or corner of the mouth?
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What is the onset age for the tonic neck reflex?
What is the onset age for the tonic neck reflex?
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A persistent Moro reflex beyond what age may indicate severe neurological defects?
A persistent Moro reflex beyond what age may indicate severe neurological defects?
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Which response is associated with the Moro reflex?
Which response is associated with the Moro reflex?
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Which reflex disappears at around 2 months of age?
Which reflex disappears at around 2 months of age?
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What is the well-established age for the stepping reflex?
What is the well-established age for the stepping reflex?
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What age range marks the onset of the rooting reflex?
What age range marks the onset of the rooting reflex?
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What is the condition characterized by a scaphoid head shape resulting from the fusion of the sagittal suture?
What is the condition characterized by a scaphoid head shape resulting from the fusion of the sagittal suture?
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Which sign might indicate chest distress in a newborn?
Which sign might indicate chest distress in a newborn?
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What is the estimated heart rate range for a newborn?
What is the estimated heart rate range for a newborn?
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Which condition describes the presence of an extra nipple commonly found along the milk line?
Which condition describes the presence of an extra nipple commonly found along the milk line?
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Which of the following assessments is important when examining the abdomen of a newborn?
Which of the following assessments is important when examining the abdomen of a newborn?
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In which situation would hydrocele most likely occur in an infant?
In which situation would hydrocele most likely occur in an infant?
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What abnormality is characterized by the presence of a tuft of hair or hemangioma on the back?
What abnormality is characterized by the presence of a tuft of hair or hemangioma on the back?
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Which reflex is NOT considered a primary neonatal reflex?
Which reflex is NOT considered a primary neonatal reflex?
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What condition is indicated by an extended arm at the side of the head with internal rotation in a newborn?
What condition is indicated by an extended arm at the side of the head with internal rotation in a newborn?
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Which gastrointestinal abnormality is characterized by abdominal wall defect with exposed viscera?
Which gastrointestinal abnormality is characterized by abdominal wall defect with exposed viscera?
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What is the purpose of the Apgar score in newborn examination?
What is the purpose of the Apgar score in newborn examination?
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Which of the following describes a precaution to take before examining a newborn?
Which of the following describes a precaution to take before examining a newborn?
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What skin condition is characterized by slate-gray to blue-black lesions primarily found on the lumbosacral area of newborns?
What skin condition is characterized by slate-gray to blue-black lesions primarily found on the lumbosacral area of newborns?
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How long do Mongolian spots typically persist before fading?
How long do Mongolian spots typically persist before fading?
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Which of the following findings during the examination may indicate a potential issue such as sepsis or asphyxia?
Which of the following findings during the examination may indicate a potential issue such as sepsis or asphyxia?
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What distinguishes cephalhematoma from caput succedaneum?
What distinguishes cephalhematoma from caput succedaneum?
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Which of the following is a common variant skin rash found in newborns?
Which of the following is a common variant skin rash found in newborns?
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What characteristic observation could suggest a nerve injury in a newborn during examination?
What characteristic observation could suggest a nerve injury in a newborn during examination?
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What is a potential cause of high-pitched crying in a newborn?
What is a potential cause of high-pitched crying in a newborn?
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What does the examination of the head circumference and shape help assess in a newborn?
What does the examination of the head circumference and shape help assess in a newborn?
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Study Notes
Newborn Examination
- Objectives: Indication and importance, Precautions prior to exam, Systematic approach, Neonatal reflexes, Normal variants
Indications
- Earliest possible detection of deviations
- Establishes a baseline for subsequent examinations
- Parents' assurance and counseling
Newborn Examination Timing
- Immediately after birth
- Before discharge from maternity unit
- Whenever there is any concern about the infant's progress
Newborn First Exam (Apgar Score)
- Heart rate
- Respiratory effort
- Color
- Tone
- Reflex irritability
Examination Precautions
- Hand washing: Thorough hand washing is crucial
- Thermal environment: Maintain a suitable room temperature
- Light and noise: Minimize distractions
- Brief examination time: Keep the examination concise
General (Growth Parameters)
- Weight (Naked)
- Length (Straight)
- Head Circumference (3 Measurements)
General (Well, Distress, or Not?)
- Skin:
- Pink is normal
- Acrocyanosis is normal
- Cyanosis
- Bruised part looks blue
- Jaundice
- Common variants skin rash (erythema toxicum, mongolian spot, benign pustular melanosis)
DD: Impetigo Neonatorum
- Vesicular, pustular, or bullous lesions developing as early as day 2-3 up to 2 weeks of life
- Lesions occur in moist or opposing skin surfaces
- Unroofed lesions do not form crusts
- Treat with antibiotics
General (Inspection)
- Obvious dimorphism or malformations (e.g., Down syndrome, ear tag, neural tube defect)
- Tone & Movements: Flexion of upper and lower extremities—Asymmetric movement: Brachial plexus and fractured clavicle, Ventral, vertical suspension and head control for tone assessment
- Cry: Vigorous cry is assuring, Weak cry (sepsis, asphyxia, metabolic, narcotic use)—Hoarseness (hypocalcemia, airway injury)—High pitch cry (CNS causes, kernicterus).
Head
- Forceps and vacuum marks
- Caput succedaneum: Boggy edema in presenting part of head (cross suture lines), disappears in a few days
- Cephalhematoma: Subperiosteal, weeks to resolve (does not cross sutures)
Head (cont'd)
- Head circumference
- Shape: Molding, Brachycephaly: flat occiput
- Widening of suture
- Fontanelles
- Head auscultation: bruits
Infant Skull
- Includes images of coronal, lamboidal, squamous, sagittal sutures and fontanelles
Craniosynostosis
- Definition: premature closure of one or more cranial sutures
- Growth of the skull occurs parallel to the suture(s) involved
- Early correction optimizes cosmetic appearance
- Can be part of syndromes: Crouzon's, Apert's syndrome
Craniosynostosis (Types)
- Sagittal synostosis results in scaphocephaly
- Coronal synostosis results in brachycephaly
- Coronal, sagittal, and lambdoid synostosis results in acrocephaly
- Single suture on one side of the head can result in plagiocephaly
Craniotabes
- Description of craniotabes
Epicanthal folds
- Many variations exist—The boy on the left does not have folds—On the right image, the effect of the epicanthal fold extending above the inner canthus is illustrated
Chest and Abdomen
- Inspection: Scaphoid, Distention, Abdominal wall defect (gastroschisis)
- Palpation: Kidneys are normally palpable (liver 2-3 cm), spleen palpable, umbilical vessels (2 artery, one vein), hernias (umbilical and inguinal)
Umbilical cord cyst
- Description of umbilical cord cyst
Diastasis recti
- Description of diastasis recti
Genitalia
- Penile size
- Hypospadias, epispadias
- Testes (2% cryptorchid, hydrocele)
- Female: Prominent clitoris and minora, Vaginal skin tag, Vaginal discharge/blood, Labial fusion
- Anus: patency and location
Hydroceles & Inguinal Hernias
- Descriptions
Increased androgen production
- Results in ambiguous genitalia in newborn girls
Hip and Extremities
- Erb's palsy: Extended arm and internal rotation with limited movement
- Humerous fracture
- Digital abnormality (Syndactyly, brachyodactyly, polydactyly)
- Single palmar crease
- Hip dislocation (female, breach)
Feet and Back
- Feet deformities
- Back and spine (abnormal curvature, sinus tract, tuft of hair)
CNS
- Awakenes and alertness
- moving extremities
- Flexed body posture
- Minimal Head lag
- Ventral suspension
- Vertical suspension
Neonatal reflexes
- Also known as developmental, primary, or primitive reflexes
- They consist of autonomic behaviors that do not require higher-level brain functioning.
- They can provide information about lower motor neurons and muscle tone.
- They are often protective and disappear as higher-level motor functions emerge.
Suck Reflex
- Onset: ~28 weeks gestation (GA)
- Well-established: 32-34 weeks GA
- Disappears: around 12 months
- Elicited by stroking the lips—Infant's mouth opens—Examiner introduces gloved finger, sucking starts
Rooting Reflex
- Onset: 28 weeks GA
- Well-established: 32-34 weeks GA
- Disappears: 3-4 months
- Elicited by stroking the cheek or corner of the infant's mouth—Infant turns head toward the stimulus, opens mouth.
Palmar Grasp Reflex
- Onset: 28 weeks GA
- Well-established: 32 weeks GA
- Disappears: 2 months
- Elicited by placing finger on palmar surface—Infant grasps the finger—Attempts to remove finger result in tightening grasp
Tonic Neck Reflex
- Onset: 35 weeks GA
- Well-established: 4 weeks post-conception (PCA)
- Disappearance: 7 months
- Elicited by rotating the infant's head from midline to one side—Arm on side to which head is turned extends—Opposite arm flexes—Lower extremities respond similarly.
Moro Reflex
- Onset: 28-32 weeks GA
- Well-established: 37 weeks GA
- Disappearance: 6 months
- Examiner holds infant (one hand supports head, other supports buttocks)—Sudden dropping of head elicits reflex—Infant's hands open, extension and abduction of upper extremities—Followed by anterior flexion of upper extremities and audible cry
Moro Reflex Significance
- Absent or inadequate Moro response on one side: Hemiplegia, brachial plexus palsy, or fractured clavicle
- Persistence beyond 5 months of age indicates severe neurologic defects
Stepping Reflex
- Onset: 35-36 weeks GA
- Well-established: 37 weeks GA
- Disappearance: 3-4 months
- Elicited by touching infant's foot to edge of table—Infant makes stepping movements
Galant Reflex
- Onset: 28 weeks GA
- Well-established: 40 weeks GA
- Disappearance: 3-4 months
- Infant held in ventral suspension—Firm pressure applied to side parallel to spine in thoracic area—Response consists of flexion of pelvis toward the side of the stimulus
Babinski Reflex
- Onset: 34-36 weeks GA
- Well-established: 38 weeks GA
- Disappearance: 12 months
- Elicited by stimulus to outer edge of sole—Infant responds by plantar flexion and either flexion or extension of toes.
Postnatal Assessment of Gestational Age
- Ballard Score: Accuracy within 1-2 weeks (2 parts: neurologic characteristic & physical characteristic)
- Part of general examination
Physical Maturity
- Skin: thicker, less translucent, dry, peeling
- Lanugo: fine non-pigmented hair all over (27-28 weeks gestation), gradually disappears
- Plantar surface: presence or absence of creases
- Breast: areola development
- Ear cartilage
- Eyelid opening
- External genitalia (rugation, descent, prominent labia majora)
Neuromuscular Maturity
- Posture
- Square window
- Arm recoil
- Popliteal angle
- Scarf sign
- Heel to ear
Remember
- Wash hands prior to examination
- Inspect, inspect, inspect, then touch
- Neonatal reflexes implications
- Normal variations
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Description
This quiz explores the essential aspects of newborn examinations, emphasizing their importance, timing, and systematic approach. Learn about the Apgar score and the necessary precautions to ensure a safe and effective assessment of newborns. Understand how to identify normal variations and the parameters for growth during the initial evaluations.
