Pediatrics Module 2: The Neonate & Apgar Scoring

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.