Pediatrics Module 2: The Neonate & Apgar Scoring

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Questions and Answers

Which aspect of pediatric history taking is most significantly different from adult history taking?

The review of systems

The use of a parent or guardian as the historian (correct)

The inclusion of past medical history

The emphasis on social history

Which of the following maternal history elements is typically most relevant to a neonatal history?

Details of previous pregnancies and their outcomes (correct)

The mother's personal experiences of early childhood

The mother's income and education level

The mother's favorite foods and activities during pregnancy

Besides the Apgar score, which component is part of the initial neonatal evaluation?

Complete blood count

Detailed cognitive testing

Recording of age, length and weight (correct)

Comprehensive family psychological evaluation

What does an Apgar score of 6 at 5 minutes indicate?

Some CNS depression (D) Signup and view all the answers

A neonate has a heart rate of 95 bpm and a respiratory rate of 29 bpm, and demonstrates a grimace to stimulation. Based on the initial assessment, how should this infant be classified?

Requires intervention (B) Signup and view all the answers

According to the content, what vital sign is given in the image?

Pulse rate of 70 bpm (A) Signup and view all the answers

At what point is a full-term infant expected to have tripled their birth weight?

One year (B) Signup and view all the answers

What is a key element that is assessed using the Apgar score?

Reflexes (A) Signup and view all the answers

According to the content, what aspect of the neonate is defined as their skin having a bluish tint?

Acrocyanotic (D) Signup and view all the answers

What is the expected increase in head circumference during the first year of life?

Approximately 1 cm per month (B) Signup and view all the answers

A full-term newborn weighs 8 lbs at birth. How much weight loss is expected in the first week?

4 to 8 ounces (C) Signup and view all the answers

If a neonate's Apgar score is 4 at 1 minute, what does this indicate?

The neonate has severe depression (A) Signup and view all the answers

Following a normal full-term birth, a neonate's heart rate is expected to be within a certain range while sleeping. Which range below would be considered the normal sleeping range?

90-160 beats/min (B) Signup and view all the answers

What is a common reason for a neonate to be at high risk according to the Apgar score?

Having a score of 7 or less on the 5 minute mark (C) Signup and view all the answers

An infant has reached their first birthday. By how much would we expect the infant's brain weight to have increased since birth?

It would have tripled (C) Signup and view all the answers

How does the content describe a respiratory rate of 25 breaths per minute for a newborn?

Normal respiratory rate (D) Signup and view all the answers

What is the typical average length of a full-term newborn at birth?

20 inches (B) Signup and view all the answers

What is the average head circumference of a newborn at birth?

35 cm (D) Signup and view all the answers

A newborn is crying, what is the upper limit for heart rate within normal range at this time?

180 beats/min (C) Signup and view all the answers

After a week of life, when should an infant regain their lost weight from birth?

Within 7-10 days (A) Signup and view all the answers

Study Notes

Pediatrics and Adolescent Medicine 1 - Module 2: The Neonate

Pediatric history taking differs from adult history taking, involving the parent as the historian.
Key components of pediatric history: 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, encompassing maternal history, family and genetic history, previous pregnancies and outcomes, labor and delivery, and general history of the infant and mother since delivery.
Neonatal evaluation consists of Apgar score, vital signs, sex, and physical examination.

Apgar Scoring

Apgar scoring assesses the physical condition of a newborn immediately after birth.
It's performed at 1 minute and 5 minutes after birth.
The Apgar score evaluates five components: appearance, pulse rate, grimace, activity, and respiration.
Each component is scored 0, 1, or 2, with a higher score indicating better newborn condition.
An Apgar score below 7 may indicate a need for newborn resuscitation.
Scores at 1 minute and 5 minutes are recorded.

Newborn Vital Signs

Heart rate: 100-165 beats/min (awake), 90-160 beats/min (sleeping), up to 180 beats/min (crying)
Respiratory rate: 40-60 breaths/min
Blood pressure: 67-84 mmHg (systolic), 35-53 mmHg (diastolic)
Temperature: 36.5°C to 37°C axillary

Newborn Growth

Infants double their birth weight by four months and triple it by one year.
Average full-term birth weight is 3.5-6 kg (7 lb 9 oz - 13 lb).
Average full term birth length: 51 cm (20 inches).
Head circumference is typically 1-2 cm larger than chest circumference at birth.

Newborn Classification Systems

Classification based on gestational age:
- Preterm: <37 weeks
- Term: 37-42 weeks
- Postterm: >42 weeks
Classification based on weight:
- Extremely low birth weight (ELBW): <1000 grams
- Very low birth weight (VLBW): <1500 grams
- Low birth weight (LBW): <2500 grams
- Normal: ≥2500 grams
Classification based on percentile:
- Small for gestational age (SGA): <10th percentile
- Appropriate for gestational age (AGA): 10th-90th percentile
- Large for gestational age (LGA): >90th percentile

Newborn Screening

New Mexico's newborn screening panel covers over 45 disorders.
The categories covered include amino acids, endocrine, fatty acid oxidation, hemoglobin, organic acids, and bilirubin.
Screening for congenital heart disease is done via pulse oximetry.

Newborn Examination

The newborn examination aims to assess all vital signs, overall appearance, whether the physical size is age appropriate, head, neck, clavicles, chest, eyes, ears, nose, throat, and mouth.
Palpate (feel) for femoral pulses, auscultate heart and lungs, and examine the abdomen, genitalia, anus, back, spine, and extremities.
Assess newborn reflexes.

Common Newborn Problems

Jaundice (common; not pathological if after 24 hours).
Hypoglycemia (<40 mg/dL in 0-4 hours or <45 mg/dL in 4-24 hours)
Respiratory distress (tachypnea >60 breaths/min, retractions, grunting, cyanosis)
Murmurs (common; usually benign)
Birth trauma, maternal drug use, prematurity and multiple births, infections

Additional

Prenatal problems of prematurity include inadequate development of tissues and organs, difficulties with sucking/swallowing/breathing, inability to regulate body temperature, and deficiencies in pulmonary, breathing, stroke, nutrient absorption, dealing with fluids and electrolytes, predisposition to infection, and immature metabolism.
Some common abnormal features of newborns include cleft lip, ambiguous genitalia, and closed rectum.

Additional Procedures

The Barlow and Ortolani tests are used to evaluate hip joints in newborns.

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Description

This quiz covers key aspects of pediatric history taking and neonatal evaluation. Focused on the neonate, it includes the importance of maternal and family history as well as the Apgar scoring system. Test your knowledge on the components involved in assessing the health of newborns and the differences in pediatric history compared to adults.