Perinatal History, Newborn PE, and Essential Intrapartum Newborn Care PDF

Y2B9M2L3 LECTURER DR. JOHN A. COLACION GROWTH & DEVELOPMENT AUGUST 20, 2024 | 8:00-9:...

Y2B9M2L3 LECTURER DR. JOHN A. COLACION GROWTH & DEVELOPMENT AUGUST 20, 2024 | 8:00-9:00 PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE ○ Poor fetal growth TABLE OF CONTENTS Labor – “Is it induced or spontaneous?” ○ If the mother has an induced delivery and the baby is big, I. Medical and Pregnancy G. Abdomen there may be complications leading to fetal distress or History H. Genitalia arrest during labor. II. Neonate Physical Interview I. Anus and Rectum Delivery A. Skin J. Spine ○ NSVD, CS, Forceps or vacuum delivery B. Head K. Extremities ○ Cephalic, Breech C. Eyes III. Essential Intrapartum and ○ Clear/meconium-stained amniotic fluid D. Nose, Ears, Mouth Newborn Care ○ Active/depressed E. Neck A. EINC Campaign Check for the following: F. Thorax, Lungs, Heart a. Insulin-dependent dia b. Polyhydramnios I. MEDICAL AND PREGNANCY HISTORY c. Oligohydramnios Gravida – number of times mother has become pregnant d. Abnormal presentation Parity – number of times the mother has given birth e. Intrauterine growth restriction (IUGR) ○ G5P4 - the mother has become pregnant 5x and has given Table 1. Effect of drugs on fetus/newborn birth 4x. ○ Multigravid - a woman who has been pregnant more than DRUG EFFECT ON TYPE OF PROBLEM once. → Might pose risk factors to the baby. Wanted or unwanted pregnancy? Adrenal cortical Fetus Cleft palate steroids ○ Wanted pregnancy - likely to prioritize regular prenatal check-ups ○ Unwanted pregnancy - more inclined to conceal it and Cyclophosphamide Fetus Malformations avoid seeking prenatal care from an obstetrician Age of the mother at the time of baby’s birth Illnesses during pregnancy Facial anomalies, Alcohol Fetus growth retardation ○ 1st Trimester - most vulnerable period for the baby to develop congenital anomalies → When organogenesis occurs Cleft palate, lip and Dilantin Fetus → Where viral infections can seriously affect the baby and other malformations cause significant harm Drugs, exposure to x-ray and hazardous chemicals Ammonium Newborn Acidosis ○ If the mother takes illicit drugs, the baby may be born small chloride for gestational age. ○ Exposure to X-rays and hazardous chemicals can lead to Tetracycline Newborn Skeletal growth, teeth congenital anomalies. Emotional stress ○ Can be caused by death, divorce, change of location Vitamin K Newborn Hyperbilirubinemia Insulin-dependent diabetes ○ May lead to: → Big baby (macrosomic) Lecturer notes: → Weak cry Kernicterus – effect of high bilirubin on the fetus. → Seizure ○ Deposition of bilirubin in the basal ganglia → Heart defects ○ Note: 1 mg of vitamin K is equal to 0.1 mL → Cardio-pulmonary distress → Do not confuse it with 1 mL, as it would render the May result from immature lungs due to inadequate baby susceptible to hyperbilirubinemia. surfactant development. Polyhydramnios II. NEONATE PHYSICAL INTERVIEW ○ Esophageal/duodenal atresia ○ Anencephaly 3 distinct periods to examine the newborn: ○ Gestational diabetes 1. Brief exam after birth Oligohydramnios → A thorough examination is typically not performed ○ Renal agenesis immediately after delivering the newborn; only the ○ Premature rupture of membrane following instead: ○ Post-term pregnancy Breathing – Breathing normally or apneic? 🔊🗃️ MG 2 | MG 6 1 of 12  Y2B9M2L3: PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE ⎻ Does the baby need some degree of Cardiovascular resuscitation? ○ Pinpoint the point of maximal impulse (PMI) ⎻ A head-to-toe examination is not needed to ○ Important to document both the brachium and femoral know that a baby is in distress. pulses Muscle tone – Weak or flaccid? ○ Note the character of the pulse Color – Cyanotic? 2. Complete exam within 24 hours after birth Umbilical Cord → If the baby is stable, then a thorough physical ○ Check for the presence of three vessels in the umbilical examination can be performed. cord 3. Focused exam before discharge → 2 arteries and 1 vein → Examine the baby before discharge, which normally ○ Note for any remnants, discharge, and other signs of occurs after 24 hours. infection → If issues arise, the discharge is delayed to after 48 hours for further evaluation. Lecturer notes: There is no hard rule for examining a newborn. You can either perform a head-to-toe examination or do a regional examination, it depends on the examiner. Supplementary Video: Clinical Skills Normal Newborn Exam Figure 2. Umbilical cord by UBC Faculty of Medicine Abdomen Link to the video: ○ Inspect the contour of the abdomen Clinical Skills - Normal Newborn Exam.mov → Check for masses, bulges, peristaltic waves, distended ambience PRE-EXAM ○ Listen for bowel sounds in all four quadrants Review the chart for perinatal history → Normal, high-pitched, tingling, absent Vital signs and growth data Ensure they are normal in quality and not high pitched or tingling or absent. TOOLS NEEDED FOR THE EXAM a. Pediatric stethoscope b. Otoscope c. Ophthalmoscope d. Tongue depressor e. Diapers and clothes REMINDERS Always wash your hands before touching the newborn Figure 3. Auscultation of the abdomen Remember to avoid letting the baby get cold GENERAL INSPECTION Integument ○ Color, pigmentation, bruising, lesion, spots, and presence of rashes are checked. ○ To minimize distraction from the baby, start from the head, chest, abdomen. Figure 4. Palpation of the abdomen ○ First palpation is to assess evidence of gross masses. → Liver Start in the right lower quadrant and move upwards In newborns, liver is 1-2 cm below the muscle margin Figure 1. Integument Respiratory ○ Check for signs of respiratory distress. ○ Check for chest symmetry ○ Auscultate the lungs. ○ Observe for respiratory efforts such as nasal flaring ○ Know the spacing and formation of nipples. Figure 5. Liver Examination MG 2 | MG 6 2 of 12  Y2B9M2L3: PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE → Spleen Start from the right lower quadrant and move up to the left upper quadrant → Kidney Place one hand on the back and do a very deep palpation in the right and left lower quadrants Note the baby’s reaction for any tenderness ○ Percussion of the abdomen → Percuss from below and then the back Figure 8. Muscle Examination Ano-Genital Examination ○ Babinski Reflex (Primitive Plantar Grasp Reflex) ○ Mostly inspection → Primitive reflex for the toes to try and contest to grasp ○ Needs to be gender-specific your thumb ○ First observe the general genitalia and formation of the ○ Grasp Reflex external genitalia → Done with one hand, the other hand, and bilaterally to ○ In females: know the symmetry of this reflex → Not uncommon to see plenty of minora as a major ○ Root reflex structure as compared to the lengthy majora → Done by stroking the baby’s cheek → To examine the deeper structures, separate the labia Baby would move his mouth or head towards the majora finger that triggered the reflex ○ Note the position and formation of the anus → Depending on the state of arousal and the when the baby has last fed, the baby may not elicit this reflex Figure 6. Genital Figure 9. Babinski Reflex ○ Always wash your hands before touching the newborn and after examining the genital area. ○ Moro Reflex Neurological Examination → Abduction of the arms followed by adduction and ○ Inspect the baby for levels of arousal and alertness flexion ○ Observe for gross indicators of abnormal health, posture, → Baby’s head has to be gently held in the hand with and quality of the cry the arm raised ○ Observe the nature, quality, and normalcy of the infant’s Followed by a short descent of the hand. spontaneous movements ○ At rest, the infant should be in a semi-flex position and alert for sleepy state of arousal ○ Palpation should include assessing the tone of the extremities → Perform passive range of motions for muscles in the arms and in the legs → Assess for resistance against the passive range of motion Figure 10. Moro Reflex → Assess for symmetry between both sides of the body ○ Knee-Jerk Reflex → Assess for performance by stretching the Achilles → Tap gently on the patellar tendon, with the infant in a tendon with an abrupt dorsiflexion at the ankle relaxed state ○ Assessing the infant’s primitive reflexes Musculoskeletal ○ Assess for any obvious deformities, asymmetry, bowing, lumps, or bumps ○ Clavicles can be broken around the time of delivery → Palpation of the clavicles progress from the sternum out to the acromioclavicular (AC) joint Figure 7. Posture Figure 11. Knee Jerk Reflex MG 2 | MG 6 3 of 12  Y2B9M2L3: PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE ○ Spine → Done to reduce the dislocated hip → Place the baby gently on its side with support to → A click may be felt as the head of the femur relocates examine the spine for alignment into the acetabulum → Look also at the staple region to ensure that there are enough temples along the length of the spine running out of other unusual findings. Figure 17. [Left] Barlow Maneuver, [Right] Ortolani Maneuver ○ Barlow Maneuver Figure 12. Spine Examination → Isolates each hip and attempts to dislocate the joint ○ Hips by stabilizing one hip and flexing the other hip 90° → Assess skin folds of the thighs for symmetry and displacing the leg posteriorly to elicit dislocation Asymmetry in the creases and thigh segments of that joint may be an indication of a dislocated hip → Any clicks should be known → Passive Range of the Hips: Flexion, Extension, ○ Head: Abduction, Adduction → Shape of the head → Inspecting if there are any forceps, vacuum marks, lacerations and abrasions → Palpation - anterior and posterior fontanelles should be described Flat, bulging, or tensed → Inspect for any abnormal hair patterns of the scalp or defects in the skin ○ Skin → Inspect for any redundant skin folds, masses, hits, or Figure 13. Flexion claps Figure 14. Extension Figure 18. Palpation of the Head ○ Neck → Display full range of motion of the neck ○ Eyes → Assess the infant’s sclera, location of jaundice → Ensure that the conjunctiva are clear → Red reflex: Inspected using ophthalmoscope Figure 15. Abduction Retina shining from the pupil upon light exposure Absence requires urgent assessment of the ophthalmologist If the baby is sleeping, the eyelids need to be separated Figure 16. Adduction Special Parameters: ○ Ortolani Maneuver → Place first finger over the greater trochanter and do flexion of infant's hips to 90° and abduction Figure 19. Inspection of the Eye MG 2 | MG 6 4 of 12  Y2B9M2L3: PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE ○ Nose → Inspect for structure and deformities → Ensure that the nasal passages are pink ○ Mouth → Look for any abnormalities in the filter or formation of the vermillion border → Inspect the gingiva → Tongue position → Palpate the full length of the palate by putting finger Figure 23. Asymmetric Moro reflex into the mouth to ensure no clefts or deformities A. SKIN Without touching the infant, notice the following: a. Color b. Posture/tone c. Activity d. Maturity Figure 20. [Left] Inspection of the Tongue Position; [Right] Palpation of the Palate ○ Ear → Otoscopy Exam → Can be challenging due to the small size of the canal → DO NOT force the otoscope into the canal → Unlikely to see the tympanic membrane → General examination: a. Position of ears b. Shape c. Curvature/structure of pinna d. Ensure that both sides are symmetrical Figure 24. Normal Flexed Posture Term Newborns - flexed posture, pinkish skin Preterm Newborns - extended posture/extremities Table 2. Skin conditions CONDITION DESCRIPTION Benign self-limiting skin lesion that fades in 5-7 days Intense erythema with a central papule or Figure 21. Inspection of Ear using Otoscope pustule Final General Inspection Lesions may be few to several hundreds ○ Examination of the hands and feet Erythema Can be seen as individual or → Look for palmar creases toxicum conglomeration of rashes Single or split No management is needed → Alignment of fingers Mechanism: activation of immune system ○ Nail development Will disappear in a few days Make a summary of the timing, and state what general Myth: May be attributed to allergy to health and well-being the child is in milk/milk products Moro/Startle reflex - note for symmetry or asymmetry ○ Absence of movement of the opposite extremity means Purple, bruise-like macular spots usually that baby may be: located at the sacrum → Immunologically depressed; Mongolian Most common birthmarks → Fractured clavicle; or spots Usually disappear by 4 years old → Overstretching of the brachial plexus ○ Disappears as patient grows Usually present in buttocks Also called sweat rash Seen in head, neck and trunk Caused by obstruction or inflammation of sweat ducts Miliaria Types: (According to color) ○ Miliaria Crystallina – white ○ Miliaria Rubra - red Figure 22. Symmetric Moro reflex Disappears with time MG 2 | MG 6 5 of 12  Y2B9M2L3: PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE Table 3. Common conditions causing lump Small white bump that usually appears in the nose and face or chin CONDITION DESCRIPTION Occurs when keratin becomes trapped beneath the skin surface Subcutaneous swelling Milia Pearls – large single milia or inclusion cysts ○ Diffuse edematous swelling that can occur in the newborn of the scalp ○ e.g. Epstein pearl - found in the palate Caused by pressure of the uterus Caput ○ Normal or vaginal wall on areas of the fetal Succedaneum ○ Do not attempt to remove head during labor or delivery Crosses the midline Resolves within a few days (24-48 hrs) Subperiosteal collection of blood that doesn’t cross the suture lines ○ Since it is blood, the head is soft to touch May be due to traumatic or forceps delivery Cephalohematoma Might take several hours to Figure 25. Erythema toxicum appreciate and can last up to several weeks Baby’s head is more difficult to hold (vs. in caput succedaneum) Possible complication: hyperbilirubinemia Figure 26. Mongolian spots Figure 29. Caput Succedaneum (depression seen during palpation) Figure 27. Miliaria Figure 30. Cephalohematoma Figure 28. Milia C. EYES B. HEAD Assess the eyes for: Inspect and palpate the head, noting for: a. Symmetry a. Lumps - usually due to traumatic or difficult delivery b. Shape 1. Caput succedaneum (Scalp edema) c. Discharges 2. Cephalhematoma (Subperiosteal bleed) d. Erythema Both should be distinguished from each other e. Red light reflex b. Bruising → Can be seen using an ophthalmoscope c. Edema Eyes should be symmetrical and in a normal position d. Molding Slightly yellowish discharge is normal MG 2 | MG 6 6 of 12  Y2B9M2L3: PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE Table 4. Eye conditions Table 5. Nose, ears, and mouth conditions CONDITION DESCRIPTION CONDITION DESCRIPTION Occurs in 5% of newborns as a result Aka tongue-tied of rupture of conjunctival capillaries. Frenulum is very near the tip of the Due to: tongue a. Traumatic delivery If the patient protrudes the tongue, it will b. Pertussis Ankyloglossia form a heart shape c. Persistent Cough Lingual frenulum is restricting tongue → Causing bursting of blood elevation when the baby cries. Subconjunctival vessels in eye Cutting of the frenulum (frenotomy) Hemorrhage Can occur normally but is more may be necessary. common after a traumatic delivery Petechiae in the forehead may be an aka cleft uvula associated finding. Uvula that is split into two No need for medical management Always look out for some congenital such as giving antibiotics anomalies present in the newborn, Will just resolve in due time through Bifid Uvula especially the submucous cleft palate. resorption ○ Cleft is found underneath the mucous membrane – the tissue that Abnormally large distance between covers the roof of the mouth. the eyes. ○ Usually part of a congenital syndrome Hypertelorism 20 mm (2 cm) – normal distance between the eyes for newborns ○ Distance between eyes is approximately equivalent to horizontal length of one eye Figure 34. Ankyloglossia Figure 31. Subconjunctival Hemorrhage Figure 35. Bifid Uvula E. NECK Examine the neck and clavicles for: a. Range of motion Figure 32. Hypertelorism b. Asymmetry c. Masses d. Crepitus To palpate the clavicle, use a firm, steady pressure along the entire length of the bone, from shoulder to sternum. Figure 33. Conjunctival Infection on right eye (Abnormal; eyes look red due to increased number of blood vessels; appearance similar to sore eyes) D. NOSE, EARS, MOUTH Take note of: a. Ear shape Figure 36. Swelling over the left clavicle due to fracture b. Nasal shape and patency c. Palate Most clavicle fractures are treated nonoperatively. d. Gums ○ Area of injury is immobilized. MG 2 | MG 6 7 of 12  Y2B9M2L3: PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE F. THORAX, LUNGS, HEART Umbilical Cord – assessed if fresh (clean and dry) ○ Normal Findings: There should be 2 arteries and 1 vein Observe: (AVA) a. Shape of thorax → Vein – wide, thin-walled b. Position of nipples → Artery – small, thick-walled c. Work of breathing Listen/note for: ○ Breath sounds ○ Lung sounds – should be clear and equal ○ Heart murmurs Normal Values for Infants: ○ Respiratory Rate = 40-60/min ○ Heart Rate = 120-160 bpm 4th ICS – point of maximal impulse for newborns and infants ○ e.g If heard at the 5th ICS anterior of the mid-axillary line, Figure 40. 2 arteries and 1 vein of the umbilical cord (newborn) the heart may be enlarged. Umbilical Hernia — bulging in the umbilical area due to weakness of the abdominal wall muscles or umbilical ring ○ Usually resolves in a year without treatment ○ A binder and hard object should be used → Hard object will be wrapped with the binder One peso coin/coins should not be used for umbilical hernia → Hard object can be a wood or cardboard → If binder only, it cannot be beneficial Figure 37. Intercostal Retractions Figure 38. Auscultation of the Infant’s Chest Figure 41. Umbilical hernia G. ABDOMEN H. GENITALIA Assess the bowel sounds, liver, spleen, kidneys, and Table 7. Female vs. Male umbilical cord CHECK FOR GENITALIA Table 6. Inspection of the abdomen AREA OF INSPECTION NORMAL FINDINGS Note for: labia majora, labia minora, and hymen Bowel sound Present Whitish discharge is normal in female newborns ○ Especially during the first 3 weeks of life Female Abdomen Soft ○ Due to tapering of hormone level from mother ○ There are instances of a bloody discharge Usually palpable 1-2 cm below right → Should be explained to caregivers Liver edge Anus should be patent costal margin Spleen Not palpable Hydrocele – collection of (excess) fluid around the testicles May be palpated by an experienced ○ Presents as painless scrotal swelling Kidneys ○ No significance, can be resolved on its own examiner (reabsorbed by the body over time) → Disappears by 1 year of age → If this persists: at risk for inguinal hernia Male ○ Diagnosed via transillumination test Hypospadias – abnormal location of the meatus on the ventral side of the penis ○ Below tip of glans penis ○ Associated with dorsal hood → Chordee – dorsal or ventral curvature of the penis Figure 39. Umbilical cord of newborn MG 2 | MG 6 8 of 12  Y2B9M2L3: PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE ○ Do not subject patients to circumcision because the skin will be used for reconstructive surgery Epispadias – abnormal location of the meatus on the dorsal surface of the penis ○ Above tip of glans penis Ambiguous Genitalia – disorder of sex development ○ Infant should be given gender assignment until a formal endocrinologic and urologic evaluation has been performed. Others ○ Congenital Adrenal Hyperplasia - Figure 45. Ambiguous Genitalia ultrasound is done to check for ovaries and uterus present or confirm if testes I. ANUS AND RECTUM ○ Chromosomal Analysis – definitive diagnosis for ambiguous sex Check if anus is patent Absent anal opening Lecturer notes/Nice-to-Knows/Additional Information: Transillumination Test – a diagnostic test which involves shining of a bright light against the scrotum ○ A positive transillumination test indicates that there is fluid in the scrotum Figure 46. Imperforate Anus Baby’s poop at birth is black ○ As days progress, it becomes green and yellow → If poop is yellow, there is adequate milk for the patient ○ Presence of poop signifies anus is patent Figure 42. Female whitish discharge is normal (Meconium – black J. SPINE spot at anal area). Assess the back and spine for: a. Symmetry b. Skin lesions c. Masses Take note of some nevus, rashes, and bumps ○ Bumps might indicate abnormalities in the skeleton (e.g. meningomyelocele) Figure 43. Transillumination of fluid in the scrotum (hydrocele) Figure 47. Infant during spine assessment. K. EXTREMITIES Inspect the extremities for mobility, deformity and stability. Figure 44. Hypospadias (abnormal development of the urethral Ortolani and Barlow maneuvers are used to evaluate hips for fold and the ventral foreskin of the penis that causes abnormal dislocation and subluxation. positioning of the urethral opening) ○ Should be performed by an experienced clinician. MG 2 | MG 6 9 of 12  Y2B9M2L3: PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE Figure 52. Neurological problem in infants After doing the regional examination, go back to doing the Figure 48. Newborn with bilateral clubfoot general survey and check whether you have missed Simian Crease – usually associated with Down syndrome something. ○ Single palmar crease ○ Thorough examination must be done within 24 hours. ○ Can be seen in 1-7% of normal newborns III. ESSENTIAL INTRAPARTUM AND NEWBORN CARE A. THE EINC CAMPAIGN Performed after the patient has his first full feeding. 1st Implementation Sites ○ Quirino Memorial Medical Center (govt) ○ St. Luke’s Medical Center QC (private) 2010: Scaling Up Project in 11 hospitals in Luzon, Visayas and Mindanao Continued dissemination nationwide Integrated in the curricula of schools of medicine, nursing and midwifery Incorporated in PRC Board Examinations 2015: Care for the Small Baby Course created by DOH (EINC and KMC combined in 1 program) Figure 49. Simian crease 2016: Incorporated in PhilHealth’s Z Benefit Package for Premature and Small Newborns Lecturer notes/Nice-to-Knows/Additional Information: If the patient is: ○ Normal: Proceed to EINC ○ Abnormal: Perform resuscitation Do your PE in the manner that suits you and your patient. ○ e.g. If the patient is not cooperative, do not insist on getting his heart rate and do auscultation while he’s crying. Do other PE’s that you could perform and that the patient can cooperate in. Figure 50. Polydactyly (supernumerary digits) → Wait for the patient to be calm before auscultating. IV. SUMMARY Medical and Pregnancy History ○ Review of mother’s medical and pregnancy history → Parity → Gravida → Wanted or unwanted pregnancy? → Mother’s age at time of baby’s birth → Illnesses during pregnancy → Drugs, exposure to x-ray, hazardous chemicals → Emotional stress → Insulin-dependent diabetes → Polyhydramnios → Oligohydramnios → Labor → Delivery Figure 51. Syndactyly (having some or all of the fingers or ○ Effects of Drugs on fetus/newborns (refer to Table 1, toes wholly or partly united) page 1) MG 2 | MG 6 10 of 12  Y2B9M2L3: PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE Neonate Physical interview Spine ○ 3 distinct periods to examine the newborn: ○ Assess the back and spine for: → Brief exam after birth → Symmetry → Complete exam within 24 hours after birth → Skin lesions → Focused exam before discharge → Masse Supplementary Video Extremities ○ Pre-Exam ○ Ortolani and Barlow maneuvers – evaluate hips for ○ Tools needed for the exam dislocation and subluxation. ○ Reminders ○ Simian crease – usually associated with Down syndrome ○ General inspection → Integument V. REVIEW QUESTIONS → Respiratory → Cardiovascular 1. A type of maneuver used to confirm hip dislocation; it involves → Umbilical cord flexing the hips and knees to 90 degrees, then applying an → Abdomen anterior pressure over the greater trochanter and gently → Liver adducting the leg with the thumbs. → Genital Examination A. McRoberts maneuver → Neurological examination B. Valsalva maneuver → Babinski Reflex C. Jendrassik maneuver → Moro Reflex D. Ortolani maneuver → Spine 2. T/F. After examining other regions of the baby, the examiner → Hips could not go back to doing the general survey since it must be → Special parameters: done first. Ortani Maneuver 3. It is the number of times that the mother became pregnant Barlow Manuever A. Gravida → Head B. Parity → Neck C. Birth Term → Eyes D. APGAR Score → Nose → Mouth 4. What is the point of maximal impulse for newborns & infants? → Ears A. 3rd ICS ○ Final General Inspection B. 4th ICS ○ Summary C. 5th ICS Skin D. 6th ICS ○ Color 5. During the physical examination of a female neonate, you ○ Posture/tone observe a whitish discharge from the genital area. Which of ○ Activity the following statements is true regarding this finding? ○ Maturity A. This discharge is abnormal and suggests a possible ○ Skin Conditions infection. → Erythema toxicum B. This discharge is normal and typically seen in the first 3 → Mongolian Spots weeks of life due to the tapering of maternal hormone → Miliaria levels → Milia C. A bloody discharge is always abnormal and requires Head immediate investigation Ortolani and Barlow maneuvers - evaluate hips for D. The presence of this discharge indicates a need for dislocation and subluxation. immediate intervention to prevent complications Genitalia 6. Upon doing the physical examination of the newborn ○ Female: Note for: labia majora, labia minora, and hymen (palpation of the abdomen), you have observed a palpable → Whitish discharge is normal in female newborns organ in the LUQ. Which of the following statements are true: especially during the first 3 weeks of life A. The palpable organ in the LUQ is the spleen, which may ○ Male: necessitate additional evaluation. → Hydrocele - collection of fluid around the testicles that B. The left kidney was palpated in the LUQ, warranting further presents as painless scrotal swelling assessment. → Hypospadias - abnormal location of the meatus on the C. The palpable structure could be the stomach, requiring ventral side of the penis additional investigation. → Epispadias - abnormal location of the meatus on the D. The palpable organ in the LUQ is the liver, which might dorsal surface of the penis. need further examination. ○ Ambiguous genitalia – now known as disorder of sex 7. What is used to confirm the sex of a newborn with ambiguous development. genitalia? → Chromosomal analysis- definitive diagnosis for A. Chorionic Villus Sampling ambiguous sex B. Ultrasound Anus & Rectum C. Chromosomal Analysis → Check if anus is patent D. Amniocentesis → Presence of poop signifies anus is patent → Anal opening contains meconium 8. T/F. Cephalhematoma refers to the subperiosteal collection of blood that crosses the suture lines. MG 2 | MG 6 11 of 12  Y2B9M2L3: PERINATAL HISTORY, NEWBORN PE, AND ESSENTIAL INTRAPARTUM NEWBORN CARE 9. Which of the following skin conditions is characterized by 20. What sign can be observed in the palm of the newborn that intense redness of the skin with a central papule or pustule can be associated with Down Syndrome? and typically resolves within 5-7 days? A. Simian Crease A. Mongolian spots B. Langer’s lines B. Milaria C. Bunny lines C. Erythema toxicum D. Palmar crease D. Milia 10. The following are true about cephalhematoma EXCEPT: ANSWERS: 1D 2F 2B 3A 4A 5C, 6F (does not cross), 7C, 10B, 11A, A. It is due to traumatic or difficult delivery. 12B, 13D, 15F, 16B, 17C, 18A, 19C, 20A B. It may take several hours to appreciate, but it will resolve within a few days. References: C. It features a subperiosteal bleed that doesn’t cross the Dr. Colacion (2024). PPT Presentation on Perinatal History, suture lines. Newborn PE, & Essential Intrapartum Newborn Care D. The baby with this condition is at risk for hyperbilirubinemia. 11. Eye condition/s in newborns that do not occur normally: Trans Team: A. Hypertelorism MG 2: Abellar, Alojado, Balberona, Beñosa, Dofitas, Florentino, B. Subconjunctival hemorrhage Luchana, Magcanam, Santos, Trivilegio C. Slightly yellowish discharge MG 6: Arances, Bontilao, Carbon, Casidsid, Elizalde, Granito, D. A and B Omolon, Pabon, Rasonabe, Tabañar 12. Which of the following does not require any forms of medical Assigned TransCore Editors: management because it will disappear in due time? Elizalde, Florentino, Omolon, Santos, Trivilegio A. Ankyloglossia B. Subconjunctival hemorrhage C. Hypertelorism D. Bifid Uvula 13. Recommended newborn practices are the following except: A. Immediate and Thorough drying B. Skin-to-skin contact C. Properly-timed cord clamping D. Immediate separation of mother and baby 14. A common birthmark which is characterized by a purple, bruise-like macular spots A. Miliaria Rubra B. Erythema toxicum C. Milia D. Mongolian spots 15. T/F. Babinski reflex is a type of reflex where the examiner suddenly lowers the child’s head and body in a dropping motion. 16. What do you call the collection of fluid around the testicles that presents as painless scrotal swelling? A. Hematocele B. Hydrocele C. Spermatocele D. Fluidocele 17. What is the diagnostic test that involves shining a bright light against the scrotum? A. Lighting test B. Luminaire test C. Transillumination test D. Illumination test 18. What is the color of the baby’s poop when they have consumed adequate milk? A. Yellow B. Black C. Brown D. Green 19. What maneuvers are used to evaluate hips for dislocation and subluxation? A. Ortolani maneuver B. Barlow maneuver C. Both A and B D. None of the above MG 2 | MG 6 12 of 12