Pediatrics and Adolescent Medicine 1 - Module 2: The Neonate PDF

Pediatrics and Adolescent Medicine 1 Module 2: The Neonate Angela Deubel, PA-C University of New Mexico History taking of the pediatric patient is different from adult due to content and parent as the historian. Chief complaint Pregnancy and birth history...

Pediatrics and Adolescent Medicine 1 Module 2: The Neonate Angela Deubel, PA-C University of New Mexico History taking of the pediatric patient is different from adult due to content and parent as the historian. Chief complaint Pregnancy and birth history Developmental history History of present illness (HPI) Feeding history Past medical history Vaccine history Review of systems Family history Social history Walmart.com Neonatal history depends heavily on maternal and family history. Maternal history Family & genetic history Previous pregnancies and outcomes Labor and delivery General history of the infant since delivery General history of the mother since delivery Dr. Martin Couney The Components of Neonatal Evaluation Age, Length Apgar Vitals & Weight Physical Sex Exam  Neonate Apgar scoring What is the purpose of obtaining an Apgar score? When do you obtain Apgar scores? What are the 5 components? What Apgar score identifies the neonate in need of resuscitation?  1-minute 5-minute 8-10 Normal 8-10 Normal 5-7 Some CNS 0-7 High risk depression for CNS/organ 0-4 Severe dysfunction depression HillsboroughCommunityCollege Next up: Group Work Apgar Scoring https://twohours.files.wordpress.com/2011/03/100_3111.jpg?w=455h=341 (Source: Twohours.wordpress.com) (Source: ACOG) 1 minute: What does “acrocyanotic” mean? HR: 70 bpm Resp: 25 bpm; Weak cry Irritability: Grimace What are normal vital signs for a newborn? Is 25 breaths/min a normal respiratory rate? Image result for acrocyantic neonate (Source: Studyblue.com) 5 minutes: (Source: ACOG) HR: 92 bpm Resp: 27 bpm; weak cry Irritability: Grimace Image result for normal neonate (Source: pedchrome.com) (Source: ACOG) 10 minutes: HR: 103 bpm Resp: 36 bpm; crying Irritability: crying and withdrawing Good job, Team! Now what?  Newborn Vital Signs Heart rate: 100-165 beats/min (awake) 90-160 beats/min (sleeping) up to 180 beats/min (crying) Resp rate: 40-60 breaths/min BP: 67-84 mmHg (systolic) 35-53 mmHg (diastolic) Temp: 36.5C to 37C axillary Infants double their birth weight by four months of age and triple their birth weight by one year. Full-term average: 3.5-6 kg (7lb 9 oz-13 lb) Drops up to 5-10% of body weight in the first week Should be regained 7-10 days Average length at (term) birth is 51 cm or 20” 10 inches during the first year 2 inches/year between age four years and puberty Brain weight doubles by four to six months and triples by one year of age. Head circumference Average at birth is 35 cm Increases ~1 cm/month during the first year. Head circumference usually is 1 to 2 cm larger than chest circumference at birth  Classification by Preterm