Pediatrics Module 2: The Neonate

Study Notes

Pediatric history taking differs from adult due to parent involvement as historian
Key elements of pediatric history taking include: chief complaint, history of present illness (HPI), past medical history, review of systems, family history, social history, pregnancy and birth history, developmental history, feeding history, and vaccine history
Neonatal history heavily relies on maternal and family history, including: maternal history, family and genetic history, previous pregnancies and outcomes, labor and delivery, general history of the infant since delivery, and general history of the mother since delivery
Neonatal evaluation components include: Apgar score, vital signs, age, length, and weight, sex, and physical exam

Apgar scoring assesses a neonate's immediate condition after birth
Apgar scores are obtained at 1 minute and 5 minutes after birth
The 5 components of the Apgar score encompass: Appearance, Pulse Rate, Grimace, Activity, and Respiration
Apgar scores of 8-10 are considered normal, 5-7 are indicative of some central nervous system depression, and 0-4 necessitates resuscitation

Normal heart rate ranges from 100-165 beats/minute (awake), 90-160 beats/minute (sleeping), and up to 180 beats/minute (crying)
Normal respiratory rate ranges from 40-60 breaths/minute
Normal blood pressure (systolic) is 67-84 mmHg and (diastolic) 35-53 mmHg
Normal axillary temperature is 36.5C to 37C

Full-term infants typically double their birth weight by four months and triple it by one year
Full-term infants average 3.5-6 kg (7lbs 9 oz -13 lbs)
Infants may lose up to 5-10% of their birth weight during the first week, regaining it within 7-10 days
Average length at birth for a term infant is 51 cm (20 inches)
Head circumference typically increases by approximately 1 cm per month during the first year, and is usually 1-2 cm larger than the chest circumference at birth; at birth average is 35 cm

Preterm is less than 37 weeks
Term is 37-42 weeks
Postterm is greater than 42 weeks
Weight classifications by low birth weight categories: ELBW(<1000g), VLBW(<1500g), LBW(<2500g), and Normal weight is greater than or equal to 2500g
Smaller for gestational age (SGA) is less than 10th percentile
Appropriate for gestational age (AGA) is 10-90th percentile
Larger for gestational age (LGA) is greater than 90th percentile

Over 45 disorders are screened for in New Mexico testing panel
The categories covered in the panel are amino acids, endocrine, fatty acid oxidation, hemoglobin, organic acids, and other
Timing for healthy infants is generally within 24 to 48 hours of life
Timing for infants in the NICU varies depending on the infant's condition.
Hearing tests may be conducted at 1 month, 3 months and 6 months old.
Congenital heart disease is screened during this newborn phase using pulse Ox.

Jaundice, hypoglycemia, respiratory distress, birth trauma, maternal drug use, prematurity, and multiple births
Infections

Three Primitive reflexes include: grasp reflex, rooting reflex, and Moro reflex.
Barlow and Ortolani tests are used to assess for hip dysplasia in newborns