Peripartum Events and Growth Assessment

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Questions and Answers

Which of the following is NOT considered a significant peripartum event?

  • Maternal fever
  • Duration of ruptured membranes
  • Parental size (correct)
  • Apgar scores

What is considered the best indicator of gestational age?

  • Neurologic development
  • Date of the last menstrual period (correct)
  • Postnatal physical characteristics
  • Birth weight

The Ballard method estimates gestational age based on which criteria?

  • Maternal age and health
  • Birth weight and length
  • Parental size and birth history
  • Physical and neurologic development (correct)

What does 'AGA' stand for when plotting birth weight and gestational age?

<p>Appropriate Gestational Age (B)</p> Signup and view all the answers

What does the term 'IUGR' refer to?

<p>Intrauterine Growth Restriction (A)</p> Signup and view all the answers

Which of the following factors does NOT typically influence birth weight for gestational age?

<p>Infant's eye color (B)</p> Signup and view all the answers

In SGA infants, what is indicated by a symmetrical growth disorder?

<p>Weight, length, and OFC are all ≤ 10% (A)</p> Signup and view all the answers

What is used to supplement the birth weight related to gestational age for IUGR diagnosis?

<p>Clinical data, including physical exam (B)</p> Signup and view all the answers

What is indicated by asymmetrical growth restriction?

<p>A problem late in pregnancy such as pregnancy-induced hypertension or placental insufficiency. (A)</p> Signup and view all the answers

Which of these conditions is commonly associated with symmetrical growth restriction?

<p>Drug or alcohol use during pregnancy. (C)</p> Signup and view all the answers

Compared to AGA infants, what is generally true of SGA infants?

<p>They have increased morbidity and mortality rates. (A)</p> Signup and view all the answers

Which of the following is a common risk for LGA infants of diabetic mothers (IDMs)?

<p>Hypoglycemia. (C)</p> Signup and view all the answers

Which of these is a common risk specifically for SGA infants?

<p>Hypocalcemia. (B)</p> Signup and view all the answers

What is generally the prognosis for asymmetrical growth-restricted infants whose intrauterine brain growth has been spared?

<p>A better outlook for normal growth and development. (A)</p> Signup and view all the answers

Which of the following is a risk often associated with LGA infants, regardless of the mother's diabetic status?

<p>Birth trauma. (D)</p> Signup and view all the answers

What does the knowledge of birth weight in relation to gestational age allow?

<p>The anticipation of some neonatal issues. (B)</p> Signup and view all the answers

What is the primary goal of a newborn physical examination?

<p>To identify any abnormalities or difficulties the infant is experiencing in transitioning to life outside of the womb. (B)</p> Signup and view all the answers

In what order should the newborn physical assessment be completed?

<p>Observation, then auscultation of the chest, then palpation of the abdomen. (A)</p> Signup and view all the answers

Which maneuvers should be performed last during a newborn physical exam?

<p>Examination of the eyes, ears, throat, and hips. (C)</p> Signup and view all the answers

What is the expected range for a newborn's heart rate?

<p>120 to 160 beats/min. (D)</p> Signup and view all the answers

What is the normal respiratory rate range for a newborn?

<p>30 to 60 breaths/min. (B)</p> Signup and view all the answers

What is the typical range for a newborn's systolic blood pressure on the first day of life?

<p>50 to 70 mm Hg. (B)</p> Signup and view all the answers

What is typically the cause of an irregularly irregular heart rate in a newborn?

<p>Premature atrial contractions. (A)</p> Signup and view all the answers

What is mentioned as something being identified, other than the infant's health, during the newborn exam?

<p>Membranes and vessels, as well as placental infarcts or clots. (A)</p> Signup and view all the answers

What is the typical size range for the anterior fontanelle in a newborn?

<p>Between 1 and 4 cm in any direction (D)</p> Signup and view all the answers

A bony defect along the sagittal suture in the parietal bones, sometimes seen in genetic syndromes, is known as which type of fontanelle?

<p>Third fontanelle (B)</p> Signup and view all the answers

Which of the following is a concern if found after birth, rather than immediately after birth as a normal presentation?

<p>Craniosynostosis (B)</p> Signup and view all the answers

Facial nerve palsy in a newborn is best identified during which activity?

<p>Crying (A)</p> Signup and view all the answers

What is a hyphema of the eye in the context of a new born?

<p>Layering of blood in the anterior chamber of the eye (B)</p> Signup and view all the answers

What do dark spots or an absent red reflex in an infant's eye require?

<p>Ophthalmologic evaluation (B)</p> Signup and view all the answers

Why might bilateral choanal atresia or stenosis be a cause for concern in newborns?

<p>It can cause respiratory distress (A)</p> Signup and view all the answers

How is the patency of the nares typically checked in a newborn?

<p>By observing the fog on a cold surface held under the nose (C)</p> Signup and view all the answers

What does a high-pitched cry in a newborn, especially when coupled with hypotonia, potentially indicate?

<p>A possible central nervous system disorder (B)</p> Signup and view all the answers

At what gestational age does the sucking reflex typically become observable in newborns?

<p>14 weeks' gestation (C)</p> Signup and view all the answers

Until what age is the palmar grasp reflex typically present in a newborn?

<p>4 months (D)</p> Signup and view all the answers

Which action is characteristic of the Moro (startle) reflex in newborns?

<p>Abduction with extension of the arms then adduction with flexion. (C)</p> Signup and view all the answers

What is the primary focus of care in a level 1 nursery for well neonates?

<p>Promoting mother--infant bonding, establishing feeding, and teaching newborn care. (A)</p> Signup and view all the answers

Which of the following is typically administered to prevent gonococcal ophthalmia in newborns?

<p>Erythromycin ointment (D)</p> Signup and view all the answers

Why do some newborns require cord blood to be collected and tested at birth?

<p>To check for a risk of jaundice. (D)</p> Signup and view all the answers

What action should be taken if a newborn's bedside glucose reading is below 45 mg/dL?

<p>Confirm the result with laboratory testing and treat it. (A)</p> Signup and view all the answers

At what age should hematocrit be measured in infants at risk for polycythemia or anemia?

<p>3--6 hours of age (C)</p> Signup and view all the answers

When are state-sponsored newborn genetic screens typically performed?

<p>Prior to discharge, ideally after 24-48 hours of age (B)</p> Signup and view all the answers

Why is a repeat PKU test often required at 8-14 days of age?

<p>To ensure the first test was not done too early, which may cause a false negative (D)</p> Signup and view all the answers

Which of the following conditions is NOT explicitly mentioned as part of newborn genetic screens?

<p>Respiratory Distress Syndrome (D)</p> Signup and view all the answers

In infants at risk of hypoglycemia, bedside glucose testing is recommended; what level should prompt a lab confirmation and treatment?

<p>Below 45 mg/dL (D)</p> Signup and view all the answers

What is the recommended duration for nursing each breast during a feeding session?

<p>10 minutes per side (B)</p> Signup and view all the answers

What can a mother do to improve latch if the breast is too firm for the baby?

<p>Hand express or pump a few drops of milk to soften the nipple (D)</p> Signup and view all the answers

Besides the standard inborn errors tested, what other conditions are sometimes included in an expanded newborn screen?

<p>Fatty acid oxidation defects and amino or organic acid disorders (B)</p> Signup and view all the answers

Which of the following peripartum events is MOST likely to influence immediate neonatal care decisions?

<p>Duration of ruptured membranes (A)</p> Signup and view all the answers

What aspect of a newborn's assessment provides the MOST direct insight into the developmental maturity of the nervous system?

<p>Neurologic development (A)</p> Signup and view all the answers

Which factor has the MOST direct impact on the determination of a baby's size relative to its gestational age?

<p>Access to obstetric care (B)</p> Signup and view all the answers

An infant with a birth weight at the 7th percentile, length at the 15th percentile, and OFC at the 6th percentile would be classified as which of the following?

<p>Symmetrical small for gestational age (SGA) (D)</p> Signup and view all the answers

When evaluating an infant’s growth, in what aspect is asymmetrical growth restriction primarily characterized?

<p>Disproportionate reduction in weight compared to length and OFC (B)</p> Signup and view all the answers

In a scenario where regional standards for gestational age are not available, what should be given MOST consideration when assessing a newborn's size?

<p>Published international standards for weight and gestational age (B)</p> Signup and view all the answers

What is the primary focus of the physical examination conducted immediately in the delivery room?

<p>Identification of major congenital anomalies and birth trauma. (D)</p> Signup and view all the answers

What is the primary purpose of using the Ballard method in newborn assessment, in addition to, not instead of, the date of the last menstrual period?

<p>To provide physical and neurological data for estimating gestational maturity (B)</p> Signup and view all the answers

When a diagnosis of intrauterine growth restriction (IUGR) is suspected, the use of birth weight related to gestational age serves primarily as which of the following ?

<p>A screening tool that requires confirmation (D)</p> Signup and view all the answers

What do serial Apgar scores best describe?

<p>The severity of perinatal depression and response to resuscitation. (A)</p> Signup and view all the answers

What does cyanosis or pallor in a newborn suggest?

<p>Inadequate cardiac output. (B)</p> Signup and view all the answers

During the skeletal examination at delivery, which situation would warrant the closest inspection of bones?

<p>LGA infants or those born after a protracted second stage of labor. (B)</p> Signup and view all the answers

A finding of only one artery and one vein in the umbilical cord slightly increases the risk of which condition in the newborn?

<p>Associated congenital defects. (B)</p> Signup and view all the answers

Which finding during placental examination is associated with small infants?

<p>Small placenta. (D)</p> Signup and view all the answers

Why is the identification of placental membranes and vessels particularly important?

<p>Especially in multiple gestations. (D)</p> Signup and view all the answers

What is the main reason for examining the placenta for infarcts or clots?

<p>To identify placental abruption. (A)</p> Signup and view all the answers

What is the significance of a posterior fontanelle measuring greater than 1 cm in a newborn?

<p>It may indicate an underlying condition and warrants further investigation. (C)</p> Signup and view all the answers

What finding, during a newborn eye examination, most urgently warrants an ophthalmologic consultation?

<p>A unilateral blunted red reflex (B)</p> Signup and view all the answers

Why are newborns obligate nose breathers?

<p>Their mouth anatomy is not fully developed for efficient breathing. (A)</p> Signup and view all the answers

A newborn presents with an asymmetric grimace during crying. This is most suggestive of what condition?

<p>Facial nerve palsy. (C)</p> Signup and view all the answers

What does the presence of a hyphema in a newborn indicate?

<p>A layering of blood in the anterior chamber of the eye. (B)</p> Signup and view all the answers

While examining a newborn for patency of the nares, what confirms that there is no obstruction?

<p>Equal fogging of a cold surface placed under each nare. (B)</p> Signup and view all the answers

What is the clinical significance of overriding sutures shortly after birth?

<p>It is a normal finding secondary to the birthing process. (C)</p> Signup and view all the answers

What could Leukokoria be caused by in a newborn?

<p>Glaucoma, cataract, or retinoblastoma. (D)</p> Signup and view all the answers

During a newborn physical exam, what finding might indicate a hip dislocation?

<p>A 'clunk' felt when abducting the legs after attempting to dislocate the femur posteriorly. (C)</p> Signup and view all the answers

What does palpating the abdomen of a neonate commonly reveal due to their superficial positioning?

<p>The liver and spleen can often be easily felt. (B)</p> Signup and view all the answers

What is considered a normal finding in a female infant's genitalia during the initial days after birth?

<p>A whitish vaginal discharge with or without blood. (D)</p> Signup and view all the answers

What should be assessed concerning the anus during a newborn exam?

<p>Both the patency and location of the anus. (C)</p> Signup and view all the answers

Which of these would be a specific finding when assessing the skeleton of a newborn?

<p>Webbing of digits or extra digits. (B)</p> Signup and view all the answers

What is a common underlying cause of arthrogryposis in newborns?

<p>Chronic limitation of movement in utero resulting from lack of amniotic fluid or congenital neuromuscular disease. (C)</p> Signup and view all the answers

What sensory abilities are normal in newborns that facilitate recognition of their mother soon after birth?

<p>Both hearing and smell. (A)</p> Signup and view all the answers

What is the typical visual acuity of a newborn at birth?

<p>20/400 (B)</p> Signup and view all the answers

A neonate exhibits a high-pitched cry and hypotonia. What potential underlying issue should be considered?

<p>Central nervous system (CNS) disease or systemic illness (B)</p> Signup and view all the answers

When does the palmar grasp reflex typically develop and disappear in a newborn?

<p>Develops by 28 weeks' gestation; disappears by 4 months of age (A)</p> Signup and view all the answers

What is the primary goal of screening for critical congenital heart disease in newborn nurseries?

<p>To identify infants with structural heart disease needing intervention within the first year. (B)</p> Signup and view all the answers

What is the expected arm movement pattern when eliciting the Moro (startle) reflex in a newborn?

<p>Abduction at the shoulder and extension at the elbow with spreading of the fingers, followed by adduction with flexion (A)</p> Signup and view all the answers

When is pulse oximetry typically performed for critical congenital heart disease screening in newborns?

<p>On the second day of life. (B)</p> Signup and view all the answers

Which preventative measure is routinely used in the newborn nursery to protect against gonococcal ophthalmia?

<p>Application of erythromycin ointment within 1 hour of birth (D)</p> Signup and view all the answers

When is vitamin K typically administered to a newborn and what is the purpose?

<p>Within 4 hours of birth to prevent hemorrhagic disease (C)</p> Signup and view all the answers

What is the recommended positioning for infants to minimize the risk of sudden infant death syndrome (SIDS)?

<p>Supine position. (C)</p> Signup and view all the answers

Within what timeframe should a healthy full-term infant be allowed to feed on demand?

<p>Every 2-5 hours. (A)</p> Signup and view all the answers

If a mother's HBsAg status is unknown, when should the Hepatitis B vaccine be administered to the neonate?

<p>Before 12 hours of age (B)</p> Signup and view all the answers

Why is cord blood collected for blood typing and Coombs testing when the mother's blood type is O or Rh-negative?

<p>To assess the risk for development of jaundice (A)</p> Signup and view all the answers

What is a key criteria in determining if a neonate is ready for feeding?

<p>Being alert and vigorous with no abdominal dissension and good bowel sounds. (C)</p> Signup and view all the answers

Under what conditions is a newborn's discharge at 24-36 hours considered safe and appropriate?

<p>If there are no contraindications and follow up within 48 hours is ensured. (D)</p> Signup and view all the answers

A newborn's bedside glucose reading is below 45 mg/dL. What is the next recommended action?

<p>Confirm the value with a laboratory blood glucose test and start treatment (D)</p> Signup and view all the answers

Which of the following conditions is a clear contraindication for early newborn discharge?

<p>Jaundice at 24 hours or less. (B)</p> Signup and view all the answers

According to the American Academy of Pediatrics, which infants should be observed in the hospital for at least 48 hours?

<p>Infants whose mothers received no or inadequate intrapartum antibiotic prophylaxis for GBS or cefazolin. (C)</p> Signup and view all the answers

Flashcards

Significant peripartum events

Events surrounding childbirth that affect mother and infant such as duration of ruptured membranes and fetal distress.

Gestational age

The age of the fetus or newborn, usually determined by the last menstrual period or early ultrasound.

Ballard method

A scoring system assessing physical and neuromuscular signs to estimate gestational age in newborns.

Appropriate for gestational age (AGA)

Infants whose birth weight is within the normal range for their gestational age.

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Small for gestational age (SGA)

Infants whose birth weight is below the normal range for their gestational age, also called intrauterine growth restriction (IUGR).

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Large for gestational age (LGA)

Infants whose birth weight is above the normal range for their gestational age.

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Symmetrical growth disorder

A growth issue where weight, length, and OFC are all ≤ 10% for gestational age.

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Asymmetrical growth disorder

A growth issue where only weight is ≤ 10%, while length and OFC remain normal.

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Asymmetrical Growth Restriction

A problem occurring late in pregnancy, often due to hypertension or placental insufficiency.

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Symmetrical Growth Restriction

Occurs due to issues in early pregnancy, such as chromosomal abnormalities or substance use.

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SGA Infants

Small for gestational age infants, at higher risk of complications compared to AGA infants.

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AGA Infants

Appropriate for gestational age infants, considered healthier than SGA infants.

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Risks for LGA Infants

Large for gestational age infants face potential issues like birth trauma and hypoglycemia.

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Complications for IDM Infants

Infants of diabetic mothers are at risk for hypoglycemia and congenital anomalies.

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Fetal Distress in SGA Infants

SGA infants may suffer fetal distress during labor and delivery, among other complications.

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Importance of Birth Weight Knowledge

Understanding birth weight relative to gestational age helps anticipate neonatal problems.

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Anterior fontanelle size

The anterior fontanelle varies from 1 to 4 cm in any direction.

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Posterior fontanelle size

The posterior fontanelle should be less than 1 cm.

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Craniosynostosis

Prematurely fused suture causing abnormal cranial shape.

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Facial nerve palsy

Asymmetric grimace during crying due to facial muscle weakness.

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Subconjunctival hemorrhages

Frequent result of birth trauma affecting the eyes.

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Brushfield spots

Speckling in the iris indicative of trisomy 21.

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Choanal atresia

Congenital nasal obstruction causing respiratory distress.

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Retinal red reflex

Normal finding in eye examination indicating healthy retinas.

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Newborn Physical Examination Purpose

To identify abnormalities and evaluate transition difficulties.

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Initial Steps of Examination

Start with observation, then auscultation, followed by palpation.

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Disturbing Maneuvers in Examination

Eyes, ears, throat, and hips examination should be last.

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Normal Heart Rate for Newborns

Heart rate should range from 120 to 160 beats/min.

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Normal Respiratory Rate for Newborns

Respiratory rate should be 30 to 60 breaths/min.

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Systolic Blood Pressure Day 1

Ranges from 50 to 70 mm Hg, increases in the first week.

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Irregular Heart Rate Causes

Usually caused by benign premature atrial contractions.

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Gentle Examination Approach

Examiner should have warm hands and a gentle demeanor.

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Sucking reflex

Newborn's response of sucking when a nipple is placed in the mouth; evident by 14 weeks gestation.

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Palmar grasp reflex

Newborn's ability to grasp an examiner's finger; appears by 28 weeks gestation, disappears by 4 months of age.

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Moro reflex

Startle reflex seen when the infant’s head drops suddenly; arms will extend and then retract; develops by 28 weeks gestation, disappears by 3 months.

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Well neonate care

Care focused on promoting bonding, feeding, and teaching basic newborn care; includes monitoring for illness signs.

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Signs of illness in newborns

Watch for temperature instability, refusal to feed, pallor, and other critical warnings in infants.

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Erythromycin prophylaxis

Erythromycin ointment applied to newborns' eyes within 1 hour of birth to prevent gonococcal ophthalmia.

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Vitamin K administration

1 mg of Vitamin K given to newborns within 4 hours to prevent hemorrhagic disease of the newborn.

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Hepatitis B vaccination

Newborns receive hepatitis B vaccine and HBIG if mother's HBsAg status is positive or unknown, within specified time frames.

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Hematocrit Measurement Timing

Hematocrit should be measured at 3-6 hours in infants at risk of anemia or polycythemia.

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Newborn Genetic Screens

State-sponsored screenings for inborn errors of metabolism are done before discharge, ideally after 24-48 hours.

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PKU Test Timing

A repeat PKU test is required at 8-14 days if first test is before 48 hours to avoid false negatives.

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Bedside Glucose Testing

Glucose testing should be done in infants at risk for hypoglycemia; values below 45 mg/dL need confirmation.

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Nipple Tenderness Expectation

Expect some nipple tenderness while nursing; consider expressing milk if too firm.

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Expanded Screening Panel

Many states include expanded screens for other metabolic disorders like fatty acid oxidation defects and amino disorders.

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Normal Breastfeeding Duration

Aim for 10 minutes of nursing on each breast per feeding for the infant.

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Risk Factors for Hypoglycemia

Infants at risk for hypoglycemia include IDM, preterm, SGA, LGA, or stressed infants.

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Ruptured membranes duration

The length of time since the amniotic sac has broken before delivery, important for assessing risk factors.

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Maternal fever significance

Elevated maternal temperature during labor can indicate infection or complications that may affect both mother and infant.

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Meconium-stained amniotic fluid

Amniotic fluid that is stained with meconium, indicating potential fetal distress and risk of aspiration.

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New Ballard score

A scoring system used to assess fetal maturity based on physical and neuromuscular examination of newborns.

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Birth weight classification

Categorizes infant's birth weight as AGA, SGA, or LGA based on gestational age, indicating growth status.

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Symmetrical vs. Asymmetrical growth disorder

Symmetrical means all growth measurements are ≤ 10%, while asymmetrical means only weight is ≤ 10%.

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Postnatal assessment importance

Evaluation of infant's physical and neurologic characteristics can help predict growth problems and health issues.

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Factors affecting birth weight

Variables like gender, maternal nutrition, and access to care impact the expected birth weight for gestational age.

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Newborn Examination

A physical check of the newborn's health at birth.

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Apgar Score

A system to evaluate newborn health at 1 and 5 minutes after birth.

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Congenital Anomalies

Birth defects that occur in approximately 1.5% of live births.

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Cardiac Output Indicator

Skin color can suggest the infant's cardiac health.

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Umbilical Cord Examination

Evaluating cord vessels to identify potential anomalies.

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Placenta Examinations

Assessing size and condition of the placenta at birth.

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Skin Color Changes

Cyanosis and pallor signal poor blood circulation in newborns.

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Physical Stress of Birth

Infants experience stress during delivery affecting examination.

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Newborn Cry Characteristics

A high-pitched cry may indicate CNS issues or disease.

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Abnormalities in Newborns

Common anomalies include absence of a bone, clubfoot, and extra digits.

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Hip Dislocation Exam

Test by pushing femur posteriorly and abducting legs to locate a clunk.

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Critical Congenital Heart Disease Screening

Standard practice to identify heart defects in newborns early.

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Neurologic Reflexes

Newborn reflexes like rooting and sucking are vital for survival.

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Visual Acuity in Newborns

At birth, visual acuity is poor (20/400) but improves by 6 months.

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Pulse Oximetry

A test used to measure blood oxygen levels in newborns during screening.

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Positioning to Prevent SIDS

Newborns should be positioned supine to minimize SIDS risk.

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Feeding Readiness Signs

Signs include alertness, no abdominal distention, good bowel sounds, normal hunger cry.

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Safe Early Discharge Criteria

Newborns may discharge 24-36 hours if no contraindications and follow-up is guaranteed.

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Contraindications for Discharge

Conditions preventing early discharge include jaundice ≤ 24 hours and infection risk.

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Observation for GBS Risk

Infants with inadequate maternal GBS prophylaxis should be observed for at least 48 hours.

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Normal Feeding Frequency for Neonates

Healthy full-term infants should be fed every 2-5 hours on demand.

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Study Notes

Introduction

  • The newborn period is the first 28 days of life, although some infants require care for many months
  • Four levels of newborn care exist: Level 1 (basic care), Level 2 (special care for premature infants), Level 3 (subspecialty care), and Level 4 (highest level of care including specialized pediatric surgery)
  • Neonatal history includes maternal/paternal medical/genetic history, maternal obstetric history, and current antepartum/intrapartum obstetric history

Neonatal History

  • Maternal medical history includes chronic conditions, medications, dietary habits, smoking/substance use, occupational exposures, and social history
  • Past obstetric history includes maternal age, gravidity, parity, blood type, and pregnancy outcomes
  • Current obstetric history details procedures like ultrasounds, amniocentesis, tests like rubella antibodies, hepatitis B surface antigen, quadruple screen, HIV, fetal wellbeing tests, and pregnancy complications
  • Significant peripartum events include membrane rupture duration, maternal fever, fetal distress, meconium-stained fluid, delivery type (vaginal/cesarean), anesthesia/analgesia used, and Apgar scores

Assessment of Growth & Gestational Age

  • Gestational age is crucial for predicting infant behavior and potential medical issues
  • The last menstrual period is the best indicator, supplemented by early fetal ultrasound
  • Physical characteristics and neurological development also indicate gestational age
  • Ballard method uses physical and neurological criteria to estimate gestational age
  • Birth weight and gestational age are plotted on standard grids to determine if the infant is appropriate for gestational age (AGA), small for gestational age (SGA), or large for gestational age (LGA)
  • Birth weight and gestational age are influenced by factors like gender, race, maternal nutrition, obstetric care access, and environment

Examination at Birth

  • Delivery room examination is limited, focusing on observation and auscultation of the chest, inspection for congenital anomalies
  • Apgar score (Table 2-2) is recorded at 1 and 5 minutes (and 20 minutes in depressed infants)
  • Extensive evaluation of the newborn depends on condition
  • Blood glucose evaluation, hematocrit measurement, and screening for inborn errors of metabolism, such as phenylketonuria (PKU), galactosemia, sickle cell disease, hypothyroidism, congenital adrenal hyperplasia, and cystic fibrosis, are also part of the initial assessment in newborns.

Examination in the Nursery

  • Skin color, skeletal examination, placenta/umbilical cord examination, eye, ear, nose, throat, and hip exams are part of a thorough physical examination

Feeding the Well Neonate

  • A neonate is ready to feed if alert, vigorous, no abdominal distention, good bowel sounds, and a normal hunger cry
  • Feeding should be on demand, typically every 2-5 hours
  • Early discharge is possible for some infants without contraindications
  • Contraindications include jaundice within 24 h, high risk of infection, known or suspected narcotic addiction/withdrawal, physical defects, oral defects, prematurity (<38 weeks gestation), low birth weight (<2700g), issues with feeding, medical/neurological problems, and twins/multiples
  • Mothers who experience difficulties feeding their infants may try options like expressing breast milk and offering the milk with a bottle or cup.

Hearing Screening

  • Important for normal language development, screening is recommended as early as possible
  • Universal screening has reduced the average age of hearing loss confirmation

Neonatal Jaundice

  • Visible jaundice in 65% of newborns, potentially dangerous TSB levels are rare and can cause brain damage
  • TSB levels exceeding 17 mg/dL are considered excessive hyperbilirubinemia
  • Screening newborns for jaundice is essential

Hypoglycemia

  • Glucose levels in the fetus are typically 15 mg/dL lower than the mother's
  • Postnatal glucose levels might drop to as low as 30 mg/dL, which below 40 is considered hypoglycemia
  • Infants at highest risk include those with gestational diabetes, premature births, and SGA infants

Respiratory Distress in the Term Newborn Infant

  • Tachypnea (rapid breathing), sternal/intercostal retractions, and expiratory grunting are potential symptoms
  • Cyanosis in room air is also a relevant symptom

Heart Murmurs

  • Common in newborns; some are transitional and benign, and thus usually resolve in time
  • For persistent murmurs, evaluate for persistent ductus arteriosus or related issues

Birth Trauma

  • Common injuries include soft tissue bruising, fractures (clavicle, humerus, femur), cervical plexus palsies
  • Other potential issues include skull fractures, intracranial hemorrhage, and spinal cord injuries
  • Injuries often depend on delivery complexity

Infants of Mothers Who Abuse Drugs

  • Drug use during pregnancy may result in difficulties in the newborn, both immediately and in the long term.
  • Identification can be difficult due to unreliable reporting of drug history.
  • Alcohol use is a clear issue and may have recognizable features in the infant

Multiple Births

  • Monochorial twins are monozygotic (identical) and higher risk for congenital anomalies
  • Dichorial twins may be mono or dizygotic, with different risks

The Preterm Infant

  • Premature infants often exhibit issues related to respiratory, body temperature regulation, and feeding coordination
  • Many complications including immaturity of lungs, respiratory control, cerebral vasculature and structure, renal function, metabolic processes, etc

Apnea in the Preterm Infant

  • A respiratory pause lasting more than 20 seconds that could cause cyanosis or bradycardia
  • Can occur in infants born before 34 weeks' gestation

Chronic Lung Disease in the Premature Infant

  • Incidence higher in lower gestational ages, and in infants exposed to chorioamnionitis
  • Symptoms include respiratory issues, oxygen requirement & abnormalities on chest x-ray

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