1. Newborn infants require careful management in the delivery room to prevent heat loss through drying, swaddling, and use of a radiant warmer. The Apgar score is used to assess the infant's transition and need for additional support.
2. Abnormal findings in a newborn such as delayed passage of meconium or lethargy require prompt evaluation which may include a physical exam, labs, imaging, or specialist consultation to identify potential issues such as infection, metabolic disorder, or obstruction.
3. Infants exhibiting signs of neonatal abstinence syndrome from in utero drug exposure require specialized care including a controlled environment and potential pharmacologic treatment to manage withdrawal symptoms over weeks. Their discharge
This document provides information on caring for preterm infants in the neonatal intensive care unit (NICU). It begins by describing the characteristics of preterm neonates, noting their underdeveloped organs and difficulties with respiration, thermoregulation, and nutrition. The document then discusses various respiratory conditions common in preterm infants, such as respiratory distress syndrome, and outlines nursing care to maintain the infant's airway, breathing, and oxygenation. This includes positioning, suctioning, monitoring oxygen levels, and potential supplemental oxygen therapies or mechanical ventilation if needed.
Newborn screening involves a head-to-toe physical examination of a newborn to check for any abnormalities, as well as biochemical screening tests and special screenings to check for conditions like retinopathy of prematurity, hearing issues, and heart defects. The physical exam includes measurements, assessment of vital signs, and examination of features from head to toe to check growth and development. Biochemical screening checks for inborn errors of metabolism, while special screenings aim to identify conditions that require early intervention.
The document provides details on performing a physical examination of the newborn, including assessing vital signs, anthropometric measurements, examining the skin, head, eyes, nose, mouth and ears, and noting any abnormalities that require follow up. Key parts of the examination include evaluating the heart rate, respiratory rate, temperature, and blood pressure as vital signs, as well as measuring the head circumference, length, and weight. The examination also involves inspecting the skin, fontanels, and features for any signs of congenital anomalies or other issues.
An appropriate for gestational age (AGA) baby is one whose size falls within the normal range for their gestational age and sex. AGA babies tend to have the lowest health risks. Gestational age can be determined through physical and neurological criteria. Small for gestational age (SGA) refers to babies smaller than the 10th percentile, while large for gestational age (LGA) means greater than the 90th percentile. Factors that influence birth weight include genetics, infections, fetal growth issues, and maternal health behaviors and characteristics. Complications for SGA infants include respiratory issues and infections, while LGA babies face risks like shoulder dystocia and hypoglycemia. Gestational age and fetal growth are
The document discusses neonatal assessment, which involves evaluating a newborn's medical history, conducting a physical exam, and assessing vital signs and growth. The physical exam covers the head, skin, chest/lungs, heart, abdomen, genitals, extremities, and reflexes. Common findings and variations are described for each system. The Apgar score is used to evaluate a newborn's health after delivery and determine if resuscitation is needed.
The document discusses Apgar scoring, which evaluates newborns on factors like heart rate, breathing effort, muscle tone, and skin color to assess their transition from fetus to newborn. It notes that various medical factors can affect Apgar scores, either raising or lowering them despite the infant's actual condition. It also presents data showing greatly increased risk of neonatal death for infants with very low 5-minute Apgar scores. Additional sections cover definitions of preterm and postterm birth, risk factors for jaundice, signs that jaundice requires further evaluation, and graphs on neonatal mortality rates and average daily weight gain by postnatal age.
The document provides guidance on newborn examination including:
- Classifying newborns by birth weight, gestational age, and weight percentiles.
- Assessing vital signs, growth measurements, gestational age, and examining different body systems.
- Recognizing normal findings as well as common problems in newborns such as jaundice, rashes, and congenital abnormalities.
The document provides guidance on assessing the newborn, including:
1. A general examination should assess color, respiratory rate, posture, movement, reaction to stimuli and obvious abnormalities before undressing the baby.
2. Specific areas to examine include skin, umbilicus, head and face, eyes, mouth, nose, abdomen, back, limbs, heart rate, temperature, weight, urine/stool, feeding, Apgar score, and primitive reflexes.
3. Certain signs require attention, such as respiratory distress, lethargy, or failure to pass meconium. Estimating gestational age can be done using the Dubowitz score and examining external features.
This document provides information on caring for preterm infants in the neonatal intensive care unit (NICU). It begins by describing the characteristics of preterm neonates, noting their underdeveloped organs and difficulties with respiration, thermoregulation, and nutrition. The document then discusses various respiratory conditions common in preterm infants, such as respiratory distress syndrome, and outlines nursing care to maintain the infant's airway, breathing, and oxygenation. This includes positioning, suctioning, monitoring oxygen levels, and potential supplemental oxygen therapies or mechanical ventilation if needed.
Newborn screening involves a head-to-toe physical examination of a newborn to check for any abnormalities, as well as biochemical screening tests and special screenings to check for conditions like retinopathy of prematurity, hearing issues, and heart defects. The physical exam includes measurements, assessment of vital signs, and examination of features from head to toe to check growth and development. Biochemical screening checks for inborn errors of metabolism, while special screenings aim to identify conditions that require early intervention.
The document provides details on performing a physical examination of the newborn, including assessing vital signs, anthropometric measurements, examining the skin, head, eyes, nose, mouth and ears, and noting any abnormalities that require follow up. Key parts of the examination include evaluating the heart rate, respiratory rate, temperature, and blood pressure as vital signs, as well as measuring the head circumference, length, and weight. The examination also involves inspecting the skin, fontanels, and features for any signs of congenital anomalies or other issues.
An appropriate for gestational age (AGA) baby is one whose size falls within the normal range for their gestational age and sex. AGA babies tend to have the lowest health risks. Gestational age can be determined through physical and neurological criteria. Small for gestational age (SGA) refers to babies smaller than the 10th percentile, while large for gestational age (LGA) means greater than the 90th percentile. Factors that influence birth weight include genetics, infections, fetal growth issues, and maternal health behaviors and characteristics. Complications for SGA infants include respiratory issues and infections, while LGA babies face risks like shoulder dystocia and hypoglycemia. Gestational age and fetal growth are
The document discusses neonatal assessment, which involves evaluating a newborn's medical history, conducting a physical exam, and assessing vital signs and growth. The physical exam covers the head, skin, chest/lungs, heart, abdomen, genitals, extremities, and reflexes. Common findings and variations are described for each system. The Apgar score is used to evaluate a newborn's health after delivery and determine if resuscitation is needed.
The document discusses Apgar scoring, which evaluates newborns on factors like heart rate, breathing effort, muscle tone, and skin color to assess their transition from fetus to newborn. It notes that various medical factors can affect Apgar scores, either raising or lowering them despite the infant's actual condition. It also presents data showing greatly increased risk of neonatal death for infants with very low 5-minute Apgar scores. Additional sections cover definitions of preterm and postterm birth, risk factors for jaundice, signs that jaundice requires further evaluation, and graphs on neonatal mortality rates and average daily weight gain by postnatal age.
The document provides guidance on newborn examination including:
- Classifying newborns by birth weight, gestational age, and weight percentiles.
- Assessing vital signs, growth measurements, gestational age, and examining different body systems.
- Recognizing normal findings as well as common problems in newborns such as jaundice, rashes, and congenital abnormalities.
The document provides guidance on assessing the newborn, including:
1. A general examination should assess color, respiratory rate, posture, movement, reaction to stimuli and obvious abnormalities before undressing the baby.
2. Specific areas to examine include skin, umbilicus, head and face, eyes, mouth, nose, abdomen, back, limbs, heart rate, temperature, weight, urine/stool, feeding, Apgar score, and primitive reflexes.
3. Certain signs require attention, such as respiratory distress, lethargy, or failure to pass meconium. Estimating gestational age can be done using the Dubowitz score and examining external features.
This document outlines the components and process of neonatal assessment. It discusses the aims of assessment including identifying prenatal influences, potential problems, and needs for intervention. The components include history of the mother and baby, physical examination from head to toe, and potential investigations. The physical examination involves assessing vital signs, appearance, measurements, and neurological and physical systems. The goal is to detect any issues that may impact health and develop appropriate care plans.
This document provides an overview of physical assessment of the newborn. It discusses classifying newborns by weight, gestational age, and growth percentiles. Key aspects of assessment are covered, including vital signs, physical exam, neurological exam, and estimating gestational age. Specific systems like skin, head, eyes, ears, etc. are reviewed. Common problems and exam findings are described. The objectives are to explain how to properly assess the newborn and recognize any issues.
This document provides guidance on assessing the health of a newborn infant. It discusses evaluating the well-being of the fetus during pregnancy through tests such as non-stress tests and biophysical profiles. It also outlines examining the newborn after delivery to screen for problems, diagnose issues, and collect baseline medical information. The order of a full physical examination is provided, covering assessment of the skin, heart, lungs, abdomen, head, eyes, and other areas. Key vital signs and measurements are also reviewed.
The document provides guidance on conducting a thorough health assessment of newborns, including initial assessment using APGAR scoring, transitional assessment of vital signs, gestational age assessment, behavioral assessment using the NBAS scale, physical examination of each body system, and special screening tests for conditions like hearing, hypothyroidism, and eye diseases. The assessment aims to identify any abnormalities, evaluate maturity based on reflexes and muscle tone, and ensure newborns have properly adjusted to extrauterine life.
This document provides guidelines for assessing newborns. It describes performing a comprehensive history and physical examination at birth and within 24 hours. The examination includes evaluating vital signs, appearance, gestational age, and screening for abnormalities of various body systems. The physical examination involves inspection, palpation, auscultation and measurement of things like temperature, heart rate, abdominal organs and limbs. The goals are to ensure healthy transition after birth, detect any malformations, and establish breastfeeding.
This document provides information on newborn assessment including risk factors, immediate post-birth care, transitional assessment, physical examination, and specific assessments of various body systems. Key points include:
- Maternal/fetal risk factors can be modified (e.g. smoking) or inherent (e.g. diabetes) and are important to anticipate potential problems.
- Immediate post-birth care includes maintaining ABCs, thermoregulation, vitamin K administration, breastfeeding, and skin care.
- The transitional period involves periods of reactivity in the first 24 hours as the newborn adapts to extrauterine life. Physical examination follows a head-to-toe sequence and includes measurements, vital signs
This document provides guidance on performing a newborn history and examination. It outlines key components to include in the history such as the mother's obstetric history, antenatal care, labor/delivery details, and newborn's immediate care and current problems. The examination section describes assessing the newborn's appearance, vital signs, measurements, and performing a full physical exam including the neurological exam and evaluating primary reflexes like the Moro reflex. The goal is to obtain a thorough history and perform an examination of all body systems to identify any issues in the newborn.
This document provides guidance on performing a neonatal examination within the first 24 hours of birth. It describes examining the infant's vital signs, appearance, skin color, head, neck, face, ears, and eyes. Specific things to note include gestational age, weight, any abnormalities present, fontanelles, skin rashes, bruising or bleeding. The goal is to evaluate the infant's overall health and identify any issues that require follow up or treatment.
This document provides guidance on performing a neonatal examination within the first 24 hours of birth. It describes assessing the infant's vital signs, appearance, skin color, head, length/weight/head circumference, gestational age, and performing a physical exam. The exam involves inspecting the skin for any abnormalities, checking the fontanelles, listening to the heart and lungs, and looking for any signs of distress, jaundice or abnormalities. Growth measurements are plotted on charts and the gestational age is estimated based on physical criteria and scores.
This document provides information on newborn assessment including:
1) Describing the Apgar score system used to evaluate a newborn's health after delivery.
2) Outlining the steps of the physical examination of a newborn including assessment of vital signs, skin, head, chest, heart, abdomen, extremities and genitals.
3) Detailing the measurements taken of a newborn including weight, length, head circumference and gestational age assessment.
This document provides information about a normal newborn, including circulatory changes at birth, lung changes, carbohydrate metabolism, temperature regulation, and essential newborn care. It discusses assessment of gestational age, physical examination of the newborn, and neonatal immunization in Singapore. The key points are circulatory adaptation to extrauterine life, lung fluid reabsorption, temperature regulation, glucose level changes, screening for malformations, danger signs, and the neonatal immunization schedule in Singapore.
This document discusses the assessment of fetal well-being through various antenatal monitoring techniques. It outlines the objectives of fetal monitoring as avoiding fetal death and ensuring growth. Common indications requiring monitoring include pregnancies with obstetric or medical complications. Components of assessment include clinical monitoring of maternal weight, blood pressure, uterine size and liquor volume. Antenatal tests described are fetal movement monitoring, the non-stress test (NST), contraction stress test (CST), biophysical profile, and Doppler ultrasonography of the umbilical artery blood flow. The NST and CST assess fetal heart rate patterns in response to movement or contractions respectively.
The document describes the characteristics of a healthy newborn. It defines a healthy newborn as one born at term between 38-42 weeks, with an average birth weight over 2.5 kg that cries immediately and establishes independent respiration. It outlines the physical characteristics including average weight, length, head circumference and chest circumference. It also describes the vital signs, skin, head, face features, chest, abdomen, extremities and physiological behaviors expected in a healthy newborn. Key reflexes exhibited by newborns are also outlined.
Premature & Growth retarded infants - Part 1Eneutron
The document discusses preterm and growth-retarded infants. It defines preterm infants as those delivered before 37 weeks gestation or weighing less than 2500g. Growth-retarded infants may also weigh less than 2500g. The document classifies newborns based on birth weight and discusses survival rates, which depend on factors like birth weight, hospital care available, and whether delivery occurs in a hospital equipped for neonatal care. Causes of preterm birth and growth retardation include fetal, placental, maternal, and environmental factors. Management of growth-retarded infants includes examination for abnormalities and testing for infections.
Newborn Assessment by Hadi Hospital NICU.Shaju Edamana
The document provides information on assessing a full term newborn. It describes the APGAR scoring system used to evaluate how well a newborn tolerated birth. It details various anthropometric measurements including head circumference, chest circumference, weight, and length. The document discusses examining the newborn's skin, eyes, ears, mouth, cardiovascular and respiratory systems, and abdomen. Common physical findings in newborns like jaundice, bruising, and heart murmurs are described. The assessment of gestational age based on size and physical maturity is also covered.
This document provides a cram sheet for the NCLEX-RN nursing exam, summarizing key test information, normal vital signs and lab values, therapeutic drug levels, common medical conditions and diets, and cultural considerations for patients. It condenses important nursing content into an easy to remember format for study.
The document provides details from a newborn assessment of Elisha Jr. It includes sections on Apgar scoring, birthweight measurements, vital signs measurements, physical exam findings for various body systems, and developmental assessments. Key findings included normal Apgar scores, appropriate birthweight, clear lung sounds, normal heart rate, no dysmorphic features or abnormalities detected.
This document provides guidelines for assessing the health of a newborn infant. It describes evaluating the infant's history including prenatal and delivery factors. Physical appearance is assessed including skin, tone, head size and overall appearance. Vital signs like temperature, heart rate, respiratory rate and status are examined. Laboratory tests including arterial and capillary blood samples are outlined. Gestational age assessment tools like the Dubowitz Scale and Ballard Scale are presented. Proper technique for obtaining capillary blood samples is also covered.
This document provides an outline for a basic neonatology course. It includes:
1. Seven intended learning outcomes covering topics like job description, components of the NICU, common cases, and history taking.
2. Descriptions of the resident's job, components of the NICU, most common cases, and how to take a patient history.
3. Suggested complementary topics like fluid balance, procedures, and normal lab values to learn.
This document outlines the tools and procedures used to assess a newborn infant, including measurements of growth, reflex and nutritional evaluations, and observation of sleep patterns and parent-infant interactions. Key areas of assessment include head circumference, weight, length, reflexes, formula intake, stooling, skin turgor, and parental bonding. The assessment also addresses educating new parents on safety, feeding, hygiene and other infant care topics. Finally, the maternal postpartum recovery is evaluated.
This document defines and describes intrauterine growth restriction (IUGR), including types (symmetrical vs asymmetrical), causes (maternal, fetal, placental, unknown), assessment methods during pregnancy, physical features at birth, potential complications (both during pregnancy and after birth), and prognosis. IUGR refers to babies with birth weights below the 10th percentile for gestational age and can be caused by factors that restrict the fetus' growth intrinsically or through reduced nutrient/oxygen transfer from mother via placenta.
This document provides information on performing a physical exam of an equine neonate (newborn foal). It discusses examining the foal's history, environment, and mare. The physical exam involves assessing the foal's mentation, conformation, respiratory rate, temperature, pulse, mucous membranes, jugular pulses, cardiac and lung sounds, oral cavity, abdomen, umbilicus, eyes, muscles, joints, and neurologic status. Common medical disorders that can occur in the first two weeks of life are also reviewed, including meconium retention, neonatal maladjustment syndrome, ruptured bladder, neonatal isoerythrolysis, diarrhea, sepsis, umbilical problems, and white muscle disease.
This document outlines the components and process of neonatal assessment. It discusses the aims of assessment including identifying prenatal influences, potential problems, and needs for intervention. The components include history of the mother and baby, physical examination from head to toe, and potential investigations. The physical examination involves assessing vital signs, appearance, measurements, and neurological and physical systems. The goal is to detect any issues that may impact health and develop appropriate care plans.
This document provides an overview of physical assessment of the newborn. It discusses classifying newborns by weight, gestational age, and growth percentiles. Key aspects of assessment are covered, including vital signs, physical exam, neurological exam, and estimating gestational age. Specific systems like skin, head, eyes, ears, etc. are reviewed. Common problems and exam findings are described. The objectives are to explain how to properly assess the newborn and recognize any issues.
This document provides guidance on assessing the health of a newborn infant. It discusses evaluating the well-being of the fetus during pregnancy through tests such as non-stress tests and biophysical profiles. It also outlines examining the newborn after delivery to screen for problems, diagnose issues, and collect baseline medical information. The order of a full physical examination is provided, covering assessment of the skin, heart, lungs, abdomen, head, eyes, and other areas. Key vital signs and measurements are also reviewed.
The document provides guidance on conducting a thorough health assessment of newborns, including initial assessment using APGAR scoring, transitional assessment of vital signs, gestational age assessment, behavioral assessment using the NBAS scale, physical examination of each body system, and special screening tests for conditions like hearing, hypothyroidism, and eye diseases. The assessment aims to identify any abnormalities, evaluate maturity based on reflexes and muscle tone, and ensure newborns have properly adjusted to extrauterine life.
This document provides guidelines for assessing newborns. It describes performing a comprehensive history and physical examination at birth and within 24 hours. The examination includes evaluating vital signs, appearance, gestational age, and screening for abnormalities of various body systems. The physical examination involves inspection, palpation, auscultation and measurement of things like temperature, heart rate, abdominal organs and limbs. The goals are to ensure healthy transition after birth, detect any malformations, and establish breastfeeding.
This document provides information on newborn assessment including risk factors, immediate post-birth care, transitional assessment, physical examination, and specific assessments of various body systems. Key points include:
- Maternal/fetal risk factors can be modified (e.g. smoking) or inherent (e.g. diabetes) and are important to anticipate potential problems.
- Immediate post-birth care includes maintaining ABCs, thermoregulation, vitamin K administration, breastfeeding, and skin care.
- The transitional period involves periods of reactivity in the first 24 hours as the newborn adapts to extrauterine life. Physical examination follows a head-to-toe sequence and includes measurements, vital signs
This document provides guidance on performing a newborn history and examination. It outlines key components to include in the history such as the mother's obstetric history, antenatal care, labor/delivery details, and newborn's immediate care and current problems. The examination section describes assessing the newborn's appearance, vital signs, measurements, and performing a full physical exam including the neurological exam and evaluating primary reflexes like the Moro reflex. The goal is to obtain a thorough history and perform an examination of all body systems to identify any issues in the newborn.
This document provides guidance on performing a neonatal examination within the first 24 hours of birth. It describes examining the infant's vital signs, appearance, skin color, head, neck, face, ears, and eyes. Specific things to note include gestational age, weight, any abnormalities present, fontanelles, skin rashes, bruising or bleeding. The goal is to evaluate the infant's overall health and identify any issues that require follow up or treatment.
This document provides guidance on performing a neonatal examination within the first 24 hours of birth. It describes assessing the infant's vital signs, appearance, skin color, head, length/weight/head circumference, gestational age, and performing a physical exam. The exam involves inspecting the skin for any abnormalities, checking the fontanelles, listening to the heart and lungs, and looking for any signs of distress, jaundice or abnormalities. Growth measurements are plotted on charts and the gestational age is estimated based on physical criteria and scores.
This document provides information on newborn assessment including:
1) Describing the Apgar score system used to evaluate a newborn's health after delivery.
2) Outlining the steps of the physical examination of a newborn including assessment of vital signs, skin, head, chest, heart, abdomen, extremities and genitals.
3) Detailing the measurements taken of a newborn including weight, length, head circumference and gestational age assessment.
This document provides information about a normal newborn, including circulatory changes at birth, lung changes, carbohydrate metabolism, temperature regulation, and essential newborn care. It discusses assessment of gestational age, physical examination of the newborn, and neonatal immunization in Singapore. The key points are circulatory adaptation to extrauterine life, lung fluid reabsorption, temperature regulation, glucose level changes, screening for malformations, danger signs, and the neonatal immunization schedule in Singapore.
This document discusses the assessment of fetal well-being through various antenatal monitoring techniques. It outlines the objectives of fetal monitoring as avoiding fetal death and ensuring growth. Common indications requiring monitoring include pregnancies with obstetric or medical complications. Components of assessment include clinical monitoring of maternal weight, blood pressure, uterine size and liquor volume. Antenatal tests described are fetal movement monitoring, the non-stress test (NST), contraction stress test (CST), biophysical profile, and Doppler ultrasonography of the umbilical artery blood flow. The NST and CST assess fetal heart rate patterns in response to movement or contractions respectively.
The document describes the characteristics of a healthy newborn. It defines a healthy newborn as one born at term between 38-42 weeks, with an average birth weight over 2.5 kg that cries immediately and establishes independent respiration. It outlines the physical characteristics including average weight, length, head circumference and chest circumference. It also describes the vital signs, skin, head, face features, chest, abdomen, extremities and physiological behaviors expected in a healthy newborn. Key reflexes exhibited by newborns are also outlined.
Premature & Growth retarded infants - Part 1Eneutron
The document discusses preterm and growth-retarded infants. It defines preterm infants as those delivered before 37 weeks gestation or weighing less than 2500g. Growth-retarded infants may also weigh less than 2500g. The document classifies newborns based on birth weight and discusses survival rates, which depend on factors like birth weight, hospital care available, and whether delivery occurs in a hospital equipped for neonatal care. Causes of preterm birth and growth retardation include fetal, placental, maternal, and environmental factors. Management of growth-retarded infants includes examination for abnormalities and testing for infections.
Newborn Assessment by Hadi Hospital NICU.Shaju Edamana
The document provides information on assessing a full term newborn. It describes the APGAR scoring system used to evaluate how well a newborn tolerated birth. It details various anthropometric measurements including head circumference, chest circumference, weight, and length. The document discusses examining the newborn's skin, eyes, ears, mouth, cardiovascular and respiratory systems, and abdomen. Common physical findings in newborns like jaundice, bruising, and heart murmurs are described. The assessment of gestational age based on size and physical maturity is also covered.
This document provides a cram sheet for the NCLEX-RN nursing exam, summarizing key test information, normal vital signs and lab values, therapeutic drug levels, common medical conditions and diets, and cultural considerations for patients. It condenses important nursing content into an easy to remember format for study.
The document provides details from a newborn assessment of Elisha Jr. It includes sections on Apgar scoring, birthweight measurements, vital signs measurements, physical exam findings for various body systems, and developmental assessments. Key findings included normal Apgar scores, appropriate birthweight, clear lung sounds, normal heart rate, no dysmorphic features or abnormalities detected.
This document provides guidelines for assessing the health of a newborn infant. It describes evaluating the infant's history including prenatal and delivery factors. Physical appearance is assessed including skin, tone, head size and overall appearance. Vital signs like temperature, heart rate, respiratory rate and status are examined. Laboratory tests including arterial and capillary blood samples are outlined. Gestational age assessment tools like the Dubowitz Scale and Ballard Scale are presented. Proper technique for obtaining capillary blood samples is also covered.
This document provides an outline for a basic neonatology course. It includes:
1. Seven intended learning outcomes covering topics like job description, components of the NICU, common cases, and history taking.
2. Descriptions of the resident's job, components of the NICU, most common cases, and how to take a patient history.
3. Suggested complementary topics like fluid balance, procedures, and normal lab values to learn.
This document outlines the tools and procedures used to assess a newborn infant, including measurements of growth, reflex and nutritional evaluations, and observation of sleep patterns and parent-infant interactions. Key areas of assessment include head circumference, weight, length, reflexes, formula intake, stooling, skin turgor, and parental bonding. The assessment also addresses educating new parents on safety, feeding, hygiene and other infant care topics. Finally, the maternal postpartum recovery is evaluated.
This document defines and describes intrauterine growth restriction (IUGR), including types (symmetrical vs asymmetrical), causes (maternal, fetal, placental, unknown), assessment methods during pregnancy, physical features at birth, potential complications (both during pregnancy and after birth), and prognosis. IUGR refers to babies with birth weights below the 10th percentile for gestational age and can be caused by factors that restrict the fetus' growth intrinsically or through reduced nutrient/oxygen transfer from mother via placenta.
This document provides information on performing a physical exam of an equine neonate (newborn foal). It discusses examining the foal's history, environment, and mare. The physical exam involves assessing the foal's mentation, conformation, respiratory rate, temperature, pulse, mucous membranes, jugular pulses, cardiac and lung sounds, oral cavity, abdomen, umbilicus, eyes, muscles, joints, and neurologic status. Common medical disorders that can occur in the first two weeks of life are also reviewed, including meconium retention, neonatal maladjustment syndrome, ruptured bladder, neonatal isoerythrolysis, diarrhea, sepsis, umbilical problems, and white muscle disease.
Health Assessment of the Newborn
The newborn requires thorough skilled observation to ensure a satisfactory adjustment to extra uterine life.
Health assessment of newborn after delivery can be divided into:
1. Initial Assessment
2. Transitional Assessment
3. Assessment of gestational age
4. Behavioural asessment
5. Systemic physical examination
Initial Assessment:
Initial assessment is done by using the APGAR scoring system.
APGAR score: It is method use to assess the newborn’s immediate adjustment to extra uterine life.
• The score based on five signs
1. Appearance (colour)
2. Pulse (Heart rate)
3. Grimace (Reflex irritability )
4. Activity (Muscle tone)
5. Respiratory rate
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluations of all five categories are made on 1-5 min after birth.
APGAR score:
Sign 0 1 2
Appearance (colour) Blue or pale Body pink, Extrimities Blue Completely Pink
Pulse (Heart rate) Absent Slow (<100 /> 100/m
Grimace (Reflex irritability ) No response Grimace Cough Or Sneeze
Activity(Muscle tone Limp Some flexion Active movement
Respiratory rate Absent Slow, Irregular Good, Crying
Other initial assessment are-
• Stabilization
• Measuring weight.
Transitional Assessment during the period of reactivity
First period of reactivity (6- 8 hours after birth):
During the first 30 minutes the newborn is very alert, cries vigorously, may suck a first greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
Second period of reactivity:
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.
Following this stage is a period of stabilization of physiologic systems & vacillating patern of sleep & activity.
Mrs. O.I., a 26-year-old banker, presented with rapid height increase over the past 6 months and generalized weakness for 4 months. On examination, she was found to have long thin fingers, hypermobility of the spine, and arm span greater than height. Testing found an echocardiogram showed bicuspid aortic valve and mitral valve prolapse. The leading diagnosis was tall stature secondary to Marfan syndrome due to her physical exam findings and family history of tall stature. She was started on a treatment plan including hormonal and cardiac testing to confirm the diagnosis and monitor for complications.
IUGR
Intrauterine growth restriction is said to be present in those babies whose birth weight is below the tength percentile of the average for gestational age.
INCIDENCE
Dysmaturity comprised about one third of low birth weight babies.
In developed countries , its overall incidence is about
3-10%
Term babies (5%)
Post term babies (15%)
CAUSES OF IUGR
The causes of IUGR can be grouped as
Maternal causes
Fetal causes
Placental causes
Uterine and Environmental causes.
MATERNAL CAUSES
Pregnancy weight of mother influences the fetal size
Chronic maternal disease condition
Renal disease condition
Malnutrition
Multiple pregnancy
Hypertensive disorders of pregnancy
Severe anemia
Previous baby suffered iugr etc.
FETAL CAUSES
Chromosomal anomalies
Exposure to an infection
German measles (rubella), cytomegalovirus, herpes simplex, tuberculosis, syphilis, or toxoplasmosis, TB, Malaria, Parvo virus
Birth defects
(cardiovascular, renal, anencephally, limb defect, etc).
• Placenta or umbilical cord defects.
PLACENTAL FACTORS
Uteroplacental Insufficiency
Fetoplacetal Insufficiency
Abruptio placenta
Placenta previa
Post term pregnancy
UTERINE CAUSES
Septate uterus
Fibroid/ myoma uterus
ENVIRONMENTAL CAUSES
High altitude - lower environmental oxygen saturation
Toxins
PATHOPHYSIOLOGY
Due to maternal and placental causes
Decrease in placental transfer of nutrients and oxygen to the fetus
Resulting in reduced fetal body store of lipids, glycogen
Causes neonatal hypoglycemia
Lack of oxygen
Chronic hypoxia that leads to erythropoietin production
Polycythemia etc
CLASSIFICATION OF IUGR
Based On Pathological Processes
I)Type I- Symmetrical
II)Type II- Asymmetrical
SYMMETRICAL
Symmetric IUGR: (33 % of IUGR Infants)
height, weight, head circumference proportional
early pregnancy insult:
commonly due to congenital infection, genetic disorder, or intrinsic factors
reduced no of cells in fetus
normal ponderal index
low risk of perinatal asphyxia
low risk of hypoglycemia
ASYMMETRICAL
later in pregnancy:
commonly due to utero placental insufficiency, maternal malnutrition, hypoxia, or extrinsic factors
low ponderal index
cell number remains same but size is small
increased risk of asphyxia
increased risk of hypoglycemia
CLINICAL FEATURES OF BABY WITH IUGR AT BIRTH
Weight deficit
Large head circumference
Old man look
Cartilaginous ridges on pinna
Dry wrinkled skin
Length remain unaffected
Open eyes
Well defined creases
Alert and active
Normal reflexes Normal cry
Thin umbilical
Scaphoid abdomen
Signs of recent wasting - soft tissue wasting - diminished skin fold thickness - decrease breast tissue - reduced thigh circumference • Signs of long term growth failure - Widened skull sutures, large fontanelles - shortened crown – heel length - delayed development of epiphyses
Normal reflexes Normal cry
Thin umbilical
Scaphoid abdomen
Hyperemesis Gravidarum, Preterm Labor HandoutsReynel Dan
Hyperemesis Gravidarum is a condition of unremitting nausea and vomiting that persists after the first trimester of pregnancy. It commonly affects women with high levels of human chorionic gonadotropin. Medical management focuses on correcting electrolyte imbalances, maintaining nutrition, and administering antiemetics. Nursing priorities include monitoring for dehydration and nutritional deficiencies and providing emotional support and education.
Premature labor is the onset of contractions before 37 weeks of gestation. It can lead to neonatal complications and death. Assessment focuses on risk factors for preterm birth. Management includes bed rest, hydration, tocolytic drugs, and glucocorticoids to enhance lung maturity
This document provides an overview of intrauterine growth restriction (IUGR). It defines IUGR as fetuses with an estimated fetal weight below the 10th percentile. The prevalence of IUGR is 3-10% of pregnancies and carries high risks of perinatal mortality and morbidity. Causes of IUGR include fetal, placental and maternal factors. Diagnosis involves serial ultrasounds to monitor fetal growth and Doppler studies of blood flow. Management focuses on treating any underlying conditions, fetal monitoring, and timely delivery once the fetus is mature. Strict surveillance of at-risk newborns is also needed due to complications of IUGR.
1) Intrauterine growth restriction (IUGR) refers to babies whose birth weight is below the 10th percentile for gestational age. It can affect preterm, term, or post-term babies.
2) The incidence of IUGR is about 3-10% in developed countries. IUGR babies have an increased risk of perinatal mortality and morbidity that progressively increases as birth weight percentile decreases.
3) IUGR can be symmetrical, affecting growth uniformly, or asymmetrical, where the head is larger than the abdomen indicating preferential shunting of nutrients to the brain. Causes include placental insufficiency, infections, and genetic/structural abnormalities.
1) Intrauterine growth restriction (IUGR) refers to babies whose birth weight is below the 10th percentile for gestational age. It can affect preterm, term, or post-term babies.
2) The causes of IUGR include maternal conditions, fetal abnormalities, infections, placental dysfunction, and unknown etiologies in about 40% of cases.
3) Diagnosis involves clinical assessment, ultrasound measurements of fetal size and growth, biophysical profile testing, and Doppler studies of umbilical and uterine blood flow.
The document discusses guidelines for discharging neonates from the hospital. It outlines several criteria that should be met before discharge, including the infant being physiologically stable and able to feed adequately. Important screening tests that must be completed prior to discharge include pulse oximetry for congenital heart disease, examination for developmental dysplasia of the hip, and checking the red reflex. The guidelines aim to ensure neonates are ready based on developmental factors rather than just weight before being discharged from the hospital.
Newborn screening involves a head-to-toe examination of a newborn to check for any abnormalities and includes biochemical screening tests and special screenings like screening for retinopathy of prematurity, hearing, and echocardiograms. The examination involves measurements, vital signs checks, examination of skin, head, face, chest, heart, abdomen, genitals, extremities, spine, and hips as well as assessment of muscle tone, reflexes, and any other abnormalities. Biochemical screening checks for conditions like G6PD deficiency and congenital hypothyroidism to identify issues early to prevent intellectual disabilities or death. Special screenings include screening preterm infants for retinopathy of prematurity, hearing screening for those
Spina bifida is a neural tube defect where there is an incomplete closure of the vertebrae and neural tube. It can range from mild forms where there are no symptoms to more severe forms with neurological deficits depending on the location and severity of the defect. Management involves surgery to close the defect early in life as well as lifelong multidisciplinary care to address issues like bowel and bladder dysfunction, mobility, skin integrity, and neurodevelopment. Hydrocephalus is an excess of cerebrospinal fluid in the brain that can be congenital or acquired and may require surgical treatment like shunt placement to drain the fluid.
High risk newborns and child during illness and hospitalization pediatric nur...DENNIS MUÑOZ
This document discusses several classifications and characteristics of high-risk newborns. It defines a high-risk newborn as one with a greater chance of morbidity or mortality due to complications surrounding birth. High-risk newborns are then classified based on factors such as birth weight, gestational age, and physiological maturity. Specific types discussed include preterm infants, post-mature infants, and those with hyperbilirubinemia. Diagnostic evaluation and therapeutic management are also outlined.
This document outlines various methods for monitoring fetal health during labor, including intermittent auscultation, electronic fetal monitoring, fetal scalp blood sampling, and umbilical cord blood gas analysis. It discusses how these methods are used to detect potential fetal distress or decompensation in order to allow timely interventions. It also provides guidelines for interpreting test results and responding to abnormal findings through techniques like intrauterine resuscitation or expedited delivery. Key goals are preventing brain injury from birth asphyxia or other adverse outcomes. The document pays special attention to monitoring high risk pregnancies.
Spina bifida/ dysraphism - assessment and physiotherapy management Susan Jose
refrences kessler tecklin darcy.
a all round description of assesment in physiotherapeutic methods and management techniques.
participationn increasing measures and limitation reduction stratergies
ASSESSMENT OF FETAL WELL BEING in obstetric bms.pptxByamugishaJames
This document discusses various methods for assessing fetal well-being during pregnancy. It describes biochemical techniques like maternal serum alpha-fetoprotein levels, clinical techniques like fetal movement counting and abdominal exams, and biophysical techniques like non-stress tests, biophysical profiles, and fetal heart rate monitoring. The goals of fetal surveillance are to identify fetuses at risk for preventable problems and intervene early. High-risk pregnancies require more frequent monitoring to detect signs of fetal compromise.
Neonatal and Pediatric Critical Care - Mostafa QalavandWang Lang
Neonatal and pediatric critical care is markedly different from adult critical care because of the physiologic and hemodynamic dissimilarities between immature and adult animals. Clinicians are often wary of treating these patients because of their small size and the presumptive limitations in diagnostic and therapeutic interventions. Nevertheless, we have the ability to treat these young animals aggressively. In doing so, however, we must be cognizant of the unique distinctions among pediatric patients with regard to normal physiologic variables that affect physical examination findings and diagnostic test results.
This document discusses the neurological assessment of a newborn baby. It begins by outlining the current practice of neurological examinations in hospitals, noting that full examinations are often not possible due to large patient volumes and staffing shortages. The document then provides details on various components of a comprehensive neurological assessment, including gestational age assessment, examination of the head and fontanelles, assessment of tone, posture and reflexes, and cranial nerve evaluation. It discusses the typical timing of appearance and disappearance of various reflexes. The document concludes by discussing the use of rapid neurodevelopmental assessments at discharge to screen for developmental issues.
This document summarizes the management of late preterm infants. Key points include monitoring infants for common complications like respiratory distress, hypoglycemia, and feeding difficulties. Supplementation with expressed breastmilk or formula is often needed due to challenges with exclusive breastfeeding. Close follow-up is important to assess growth, development, and prevent future health issues that late preterm infants are at higher risk for. Lifestyle changes and interventions during pregnancy can help prevent preterm births.
This document discusses the approach to evaluating and diagnosing a hypotonic infant. It begins by defining hypotonia and noting that determining the cause can be challenging. A detailed history and physical exam are important to localize the cause as central or peripheral. Differential diagnosis involves considering central nervous system, genetic, infectious, metabolic, and muscular causes. Basic lab tests include screening for infection and metabolic/genetic disorders. Imaging, EMG/NCV, muscle biopsy and genetic testing can further evaluate potential peripheral and muscular etiologies. The case presented is of a newborn with hypotonia, absent reflexes, and no family history or dysmorphic features to suggest a cause.
Bibliography for peds pain and symptomEmily Riegel
This document provides references on pediatric pain and symptom management, organized into textbooks, journal articles on specific topics, and other symptoms. It lists 8 textbooks that cover topics like pain in neonates and infants, palliative care for children, care of dying children, and pain management guides. It also lists several journal articles on managing pain, as well as other common symptoms experienced by pediatric patients, such as gastrointestinal issues, fatigue, dyspnea, neurological symptoms, existential suffering, and the withdrawal of life-sustaining treatments.
This document summarizes several craniofacial and genetic syndromes, listing their key signs and symptoms as well as inheritance patterns. Some of the syndromes discussed include Treacher-Collins syndrome, characterized by cleft palate and lower eyelid abnormalities; Apert syndrome, which involves craniosynostosis and syndactyly; and Williams syndrome, seen in individuals with mental retardation, stellate iris, and heart defects. Many of the syndromes described have autosomal dominant or recessive inheritance patterns.
This document provides guidance on recognizing, evaluating, and managing various blood and neoplastic disorders in children. Key points include recognizing signs of quantitative or qualitative leukocyte disorders like recurrent infections; distinguishing causes of bruising or purpura; evaluating anemia based on cell size and shape; managing neutropenia with growth factors or addressing causes; treating thrombocytopenia based on count and symptoms; and surveillance for tumors in overgrowth syndromes. Evaluation involves a thorough history, physical exam, and interpretation of blood tests to identify underlying etiologies and guide therapeutic approaches like transfusions or medications.
This document discusses various topics in cardiology as they relate to pediatrics. It covers general aspects of blood pressure and chest pain, syncope, murmurs, congestive heart failure, cyanotic and acyanotic congenital heart disease, infectious endocarditis, and more. Key points include distinguishing innocent from pathological murmurs, signs of congestive heart failure, cardiac causes of cyanosis in newborns, complications of polycythemia, management of cardiogenic shock, indications for antibiotic prophylaxis, and initial management of a premature infant with a patent ductus arteriosus.
This document provides guidance on preventive pediatrics including immunizations, screening tests, disease prevention, and anticipatory guidance. It details immunization schedules and indications for vaccines such as hepatitis A/B, meningococcal, tetanus, varicella and outlines contraindications. It also covers screening recommendations for blood pressure, lead levels, hearing and vision. Anticipatory guidance is provided on safety, poison prevention, water safety, sun exposure and firearm risks.
Bone age radiographs can provide information about a child's adult height potential and exposure to sex steroids if their bone age is advanced compared to their chronological age. Children with familial short stature usually have a normal bone age, while those with constitutional delay of growth usually have delayed bone age. The cause of failure to thrive is nonorganic in the majority of patients, and extensive lab evaluation should be deferred until outpatient dietary management has been tried. Regular, periodic developmental screening using tools such as PEDS, ASQ, or M-CHAT can help identify developmental delays or risks. Key motor, cognitive, and language milestones include the ability to sit independently by 9 months and speak in 3 word sentences by 36 months
1. Newborn infants require careful management in the delivery room to prevent heat loss through drying, swaddling, and use of a radiant warmer. The Apgar score is used to assess the infant's transition and need for additional support.
2. Abnormal findings in a newborn such as delayed passage of meconium or lethargy require prompt evaluation which may include a physical exam, labs, imaging, or specialist consultation to identify potential issues such as infection, metabolic disorder, or obstruction.
3. Infants exhibiting signs of neonatal abstinence syndrome from in utero drug exposure require specialized care including a controlled environment and potential pharmacologic treatment to manage withdrawal symptoms over weeks. Their discharge
This document discusses normal nutritional requirements and deficiencies in infants and children. It covers age-related nutritional needs, breastfeeding benefits, formula feeding, and vitamin deficiency states including iron deficiency anemia, rickets, and vitamin B12 deficiency. The key points are:
1) Nutritional requirements vary based on age and developmental stage. Breastfeeding provides antibodies and benefits but human milk is low in iron. Formula is carefully formulated but some infants are at risk for allergies.
2) Iron deficiency is the most common nutritional deficiency and can cause developmental delays if severe. Rickets results from vitamin D or calcium/phosphorus deficiencies and causes bone deformities.
3) Vitamin deficiencies may result from
The document discusses various respiratory disorders in children. It covers signs and symptoms of conditions like stridor, cough, wheezing, and apnea. It describes common etiologies of different respiratory problems in infants and children of various ages. It also outlines approaches to evaluating respiratory symptoms, distinguishing between conditions, and managing specific disorders like croup, epiglottitis, pneumonia, tracheomalacia, and hemoptysis.
The document discusses renal disorders and abnormalities in children. It covers normal renal function and development, causes of proteinuria and hematuria, urinary tract infections, congenital abnormalities like renal dysplasia and posterior urethral valves, and hereditary and acquired kidney diseases. Key points include the appropriate evaluation and management of common pediatric renal problems based on presenting signs and symptoms.
1. The document discusses the evaluation and management of various gastrointestinal disorders in children including abdominal pain, vomiting, diarrhea, constipation, and other issues.
2. Key points include recognizing signs and symptoms of conditions like appendicitis, intussusception, Hirschsprung's disease, gastroesophageal reflux, and infectious causes of diarrhea.
3. Management involves considering differential diagnoses, performing appropriate testing, and treating underlying causes or symptoms while monitoring for complications.
- Hashimoto's thyroiditis is the most common cause of goiter in adolescents. It can cause transient hyperthyroidism early on before developing into hypothyroidism, with symptoms like decreased growth, delayed puberty, constipation, and myxedematous facies. It is confirmed by elevated antibodies and labs showing hyper, hypo, or euthyroid states.
- Untreated congenital hypothyroidism can lead to decreased IQ and neurodevelopmental delays in neonates. Congenital causes include thyroid dysgenesis or dyshormonogenesis, while acquired causes are usually Hashimoto's or subacute thyroiditis.
- Thyroid nodules or masses
1. Fetus and Newborn Infant
♦Normal Newborn Infants
o Delivery room management
Know that a newborn infant who is cold stressed rapidly depletes essential stores of fat
and glycogen
Know that heat loss in the delivery room can be reduced by use of radiant warmer,
drying and swaddling
Recognize the hazards and benefits associated with the use of radiant warmers for
neonates
• Benefits: decrease heat loss
• Hazards: increase water loss
Know that a normal newborn infant can fixate
Know the components of the Apgar score
• Activity
• Pulse
• Grimace (reflex irritability)
• Appearance (skin color)
• Respiration
Know the significance of the one and five minute Apgar scores
• One minute Apgar score indicates the infant’s intrauterine environment and
tolerance of the delivery process
• Five minute Apgar score reflects the success of the infant’s transition
• Infants with a 5-minute score of 7 or less are at risk for suboptimal transition and
may require closer observation
• Infants with a 5-minute of 3 or less need very careful monitoring and observation,
likely the NICU
• Ability of an infant to maintain temp, HR, RR generally indicate a successful
transition
o Fetal Assessment
Know that the nonstress test monitors fetal heart rate reactivity in response to fetal
activity
• This tests the fetal autonomic nervous system integrity
• The nonstress test is the initial eval done to look for fetal HR, short and long term
fetal HR variability, and reactivity to any fetal movement
Recognize that the stress test is used to evaluate uteroplacental insufficiency
• Measures fetal HR response to uterine contractions, and is therefore able to
assess uteroplacental sufficiency and tolerance of labor
Understand the significance and plan the management of dysrhythmias
• Arrhythmias are detected in about 1% of all fetuses and may be quite benign;
when they are sustained they are categorized as brady or tachycardic as follows
• BRADYCARDIC:
∗ Complete heart block
One etiology of these is due to exposure to maternal antibodies
(SS-B/La antigens) and seen most commonly in maternal
autoimmune disorders like SLE
• TACHYCARDIC:
2. ∗ Atrial tachys: a. flutter, a. fib, SVT
∗ Persistent tachycardia can cause myopathy that might lead to heart failure
and to nonimmune hydrops
∗ When tx is required for control it can often be administered to the mother
and then it is transferred across the placenta and txe the fetus
∗ Preferred over preterm delivery or umbilical artery catheterization
o Maternal screening
o Transition
Recognize the need to plot anthropomorphic measurements against the gestational age
on a graph
• Helps to assess whether the baby is outside the 95% range (either small or large),
and this can help guide further workup/management/treatment
Know the physical and behavioral characteristics of the preterm infant
• Physical: thin, moist, transparent skin, flattened thin ears without cartilage or
recoil, small phallus and empty scrotum (if male)
• Behavioral: low muscle tone, relative inactivity, absence of flexed posture,
random, purposeless flailing of extremities in response to tactile stimulation
Distinguish between small for gestational age and preterm gestation in low birth weight
infants
• SGA means that they are underweight for their gestational age;
∗ Term SGA infants have a greater risk for neurodevelopmental disability in
preschool years and beyond than compared with term appropriately
grown infant peers; risk is predicted by serial neurodevelopmental testing,
and is better predictive in the preschool age than earlier (i.e. better
predictive based on outcomes from age 3-5)
• Preterm infants can be AGA but LBW – meaning that if their weight is adjusted for
their GA it will be appropriate, but their actual birth weight is still considered low
• LBW = any baby born weighing <2500g
• SGA = any baby who is below the 10th percentile for their GA
Know the physical and behavioral characteristics of a full term infant
• Physical: pink and chubby
• Behavioral: alert, able to fixate visually, normal muscle tone and reflexes
Know the physical and behavioral characteristics of a post-term infant
• Physical: decreased subQ tissue, dry and peeling skin, wrinkled skin and sparse
hair
o Routine care
Plan appropriate evaluation of an infant with physiologic breast hypertrophy
• Not necessary
Recognize that maternal exposure to drugs that may affect coagulation and can result in
early hemorrhagic disease of the newborn
• Drugs that affect it are certain anticonvulsants, antibiotics and anticoagulants
taken during pregnancy
• Usually due to causing a vit K deficiency in the baby
• Can manifest as cephalohematoma, often accompanied by bleeding at unusual
sites
• All babies should get Vit K at birth
Recognize the caloric requirement per kg for adequate growth is greater for preterm
3. infants than for full term infants
Recognize that preterm infants have a greater daily fluid requirement per kg of body
weight than term infants
Recognize that insensible water loss is increased by prematurity and use of radiant
warmers
Recognize that the rapid assessment of whole blood glucose concentrations may yield
falsely high or low values
• Can be due to methodologic errors/incorrect technique, etc
Know the normal range of the hct for newborn infants
• Term newborn has Hct of about 61%; hgb is about 19.3
Recognize that preterm infants have lower hct than term infants
• Begin with lower baseline hct and hgb and also lower Fe stores
Distinguish between the timing of physiologic anemia of the term and preterm infant
• Term infants have their nadir at about 8-12 weeks of age
• Preterm infants have their nadir between 3-8 weeks of age
Recognize the presenting signs and sx of congenital syphilis
• Congenital syphilis is contracted by transplacental transmission of the spirochetes
and can occur at any stage of pregnancy, more commonly when the mother has a
primary or secondary infection rather than latent infection
• Early congenital syphilis:
∗ Liver manifestations: HSM, jaundice, elevated LFTs, bile stasis
∗ Hematologic: LAD, Coombs negative hemolytic anemia, TCP due to
platelet consumption in the spleen
∗ Mucous membrane involvement: mucous patches, rhinitis (“snuffles”),
condylomatous lesions
∗ Musculoskeletal disease: osteochondritis, pseudoparalysis of Parrot (won’t
move a limb due to pain), periostitis
∗ CNS abnormalities, FTT, choreoretinitis, pancreatitis and renal disease are
also possible
∗ Per a question critique, important to know that early physical signs of
congenital syphilis are hydrops fetalis, IUGR, HSM, hemolytic anemia,
jaundice, maculopapular rash, and radiographic findings of lines of
arrested growth, metaphyseal destruction, periosteal changes (periostitis)
• Late manifestations of congenital syphilis: prominence of forehead (“Olympian
brow”), anterior tibial bowing (“saber shins”), scaphoid scapulae, Hutchinson
teeth (peg shaped upper incisors), mulberry molars, saddle nose (due to the
rhinitis), rhagades (linear scars from prior mucocutaneous fissures), neurologic
abnormalities, interstitial keratitis, eight nerve deafness, Clutton joint (painless
arthritis of the knee)
Know the utility and limitations of PKU testing
• Is able to screen for elevated phenylalanine levels but does not distinguish
between those babies who just don’t yet have matured metabolizing enzymes
and those with true PKU
• Will need to have a repeat screening test or blood to be sent for amino acid
quantification; amino acid analysis allows a geneticist to determine of it is true
PKU, hyperphenylalaninemia, and newborn immaturity
• Note: in the child with true PKU, tyrosine becomes and essential amino acid
Understand the use of OAE devices for neonatal hearing screening
4. • OAE (evoked otoacoustic emissions)
∗ Measures tiny sounds generated in the cochlea that can be measured in
the external auditory canal after acoustic stimulation
∗ Two kinds: transient evoked OAE and distortion product OAE
∗ Requires a quiet environment and a still, quiet infant for best results
Know the recommended methods of umbilical cord care
• Goal of care = maintaining hygiene, avoiding infection, promoting cord separation
• ”Dry cord care” is okay in developed countries and it just calls for drying the
stump after the baby is bathed with water and gentle soap
• There is a trend toward reduced infections with application to triple antibiotic
ointment; use of alcohol may delay cord separation but can allay familial concerns
• Lots of folk remedies – if they aren’t doing harm, don’t worry about it
Recognize that delayed or absent passage of meconium is associated with colonic
obstruction (e.g. meconium plug syndrome, Hirschsprung, imperf anus)
• Meconium plug syndrome
∗ Typically an isolated phenomenon, not associated with anatomic
obstruction
∗ May be associated with maternal mag sulfate tx for
preeclampsia/eclampsia
∗ Plain radiographs show nonspecific findings
∗ Contrast enema will illuminate the plugs AND facilitates their elimination
∗ Colonic motility is usually normal after evacuation of the plug
• Hirschsprung disease: congenital absence of ganglion cells
∗ 95% of those affected fail to pass meconium in the first 24 hours
∗ a contrast enema may show a transition zone in the rectosigmoid colon
∗ if being considered then a diagnostic rectal bx should be performed
• Imperforate anus occurs in about 1 in 4000-5000 births and may be seen in
conjunction with other anomalies (VACTERL syndrome)
• Plan of care for delayed stooling should be a repeat exam of the abd and rectum,
assessing for adequacy of feeding, if no stool for 48 hours then a barium enema,
surgical consult for rectal bx, observing for signs of intestinal obstruction,
hydration and feeding until a dx is established
Know the difference between bottle fed infants and breast fed infants as related to stool
frequency and frequency of feeding
•
Know that a newborn infants who does not void by 24h of age warrants eval
Plan the eval of an anuric infant
• Repeat exam of the abd and genitalia
• Assess for adequacy if feeding
• Cath baby to see if urine present
• Obtain UA
• Check BUN and Cre
• Order renal US
• If starts to void spontaneously and is observed to have no further problem than
no more w/u is required
• If continues not to void a urology referral may be needed
Know that blood pressure varies directly with gestational age
5. •As a rule for preterm infants, know that their MAP should not be less than their
corrected GA in weeks
Recognize the bilious vomiting is a common finding in infants with SBO
• Bilious vomiting in a neonate is unusual and it should be considered a medical
emergency
• About 20% of neonates with bilious vomiting have a condition that requires
surgical intervention; most life threatening condition is midgut rotation with
volvulus
• Other conditions include duodenal atresia, annular pancreas, jejunal atresia, ileal
atresia, colonic atresia, meconium ileus, Hirschprung dz
Understand bilirubin synthesis, transport and metabolism
• Produced from the catabolism of heme in the reticuloendothelial
systemunconjugated bilirubin enters the circulation reversibly but tightly
bound to albuminB-A complex enters the liver and the hepatocytes and is
enzymatically combined with glucuronic acid; the conjugation reaction is
catalyzed by UGTthe mono and diglucuronides are excreted into the bile and
gutin newborns much of the conjugated bili in the gut gets hydrolyzed back to
unconjugated biliunconjugated bili is reabsorbed into the bloodstream vie the
enterohepatic circulationadds to the bili load already in the live
• The enterohepatic circulation is an important part of neonatal jaundice; in adults
the bacteria on the colon rapidly reduce the conjugated bilirubin and little
enterohepatic circulation occurs
Distinguish between physiologic jaundice in a full term infant and physiologic jaundice in
a preterm infant
• Preterm infants are at a much higher risk of complications due to jaundice and
there is a lower threshold for starting tx of the hyperbilirubinemia
o Discharge plans
Know the qualifications for consideration of early discharge on a newborn infant
• Most infants are ready for discharge 48 hours after vaginal delivery and 72-96
hours after cesarean delivery
• Infant is medically ready for discharge when vitals have been stable for 12 hours,
appears healthy and has normal results on physical exam, has stooled and voided,
is feeding well, has completed all screening tests, has appropriate follow up
planned. Additionally, need to have completed parent education and competency
must be demonstrated
• Early discharge is discharge prior to 48 hours
∗ Should only occur after vaginal delivery
∗ When antepartum, delivery and postpartum courses are uncomplicated
for both mother and baby
∗ When baby is term and AGA
∗ When baby has been evaluated for jaundice
Know the benefits and complications of early discharge of a newborn infant
• Benefits: can improve bonding and attachment while minimizing iatrogenic risks
• Complications: delayed detection of treatable medical conditions, hyperbili, poor
feeding, early termination of breastfeeding, hospital readmission
o Home births
♦Abnormal newborn infants
o General
6. Know the management of any neonatal abstinence syndrome
• Early discharge is not an option for any baby with prenatal drug exposure
• Cocaine and amphetamines don’t have a true NAs associated with them, but the
effects of the drug exposure can be damaging nonetheless, especially
CNS/neurotransmitter problems
• Alcohol and barbiturates have similar NAS sx of hyperactivity, irritability, crying,
hyperphagia but poorly controlled sucking and oral feeding, altered sleep wake
periods, tremors, diaphoresis, seizures
∗ Tx = controlled, thermoneutral environment, minimal stimulation, and
using phenobarb for pharmacologic management. Phenobarb dose is
titrated to effect
∗ The phenobarb is then tapered over 4-6 weeks
• Opioid NAS includes hyperirritability, tremors, jitteriness, hypertonia, GI distress
(loose stools, emesis, feeding probs), and autonomic sx like yawning, lip
smacking, persistent sucking, mottling, fever. May have seizures
∗ Tx = methadone or oral morphine
∗ Note that sx may not be evident for up to 5 days, and can be longer if the
exposure was to methadone
Formulate a ddx of lethargy and coma in a neonate
• Can be associated with sepsis and asphyxia, inborn error of metabolism
o Resuscitation
Know that a normal newborn infant has established regular respirations by 1 minute of
age
Recognize that an infant who has a slow heart rate and impaired ventilatory effort
requires immediate PPV
Recognize the need to establish airway before applying PPV
Know that initial lung inflation may require increased pressure for the first breath
Recognize that, in addition to nasopharyngeal suctioning, a newborn infant’s larynx
needs to be visualized and the trachea suctioned if thick or particulate meconium is
present in the amniotic fluid and the infant is not vigorous
• Suctioning does not need to be done in a vigorous infant; but if the infant is not
vigorous then tracheal suctioning needs to be done before additional
resuscitative efforts. If mec is recovered then sxning should be repeated until
little additional mec is aspirated or the HR is no longer stable
Recognize that if mec is present in the amniotic fluid the mouth and hypopharynx of the
infant need to be suctioned
• Only need to do deep sxning as above
Recognize when during resuscitation external cardiac massage needs to be initiated in a
newborn infant (e.g. if the HR does not increase above 60 BPM after effective ventilation
with oxygen has been established)
Know the proper technique for external cardiac massage of a newborn
• Compressions should be directed above the xyphoid process and the chest
depressed to 1/3 the A-P diameter
• Recommended ratio of three compressions to one ventilation at a rate of 100
compressions / minute
• The rescucitator should encircle the baby’s entire chest with the hands and
depress the chest with the thumbs, compressing the entire thorax
circumferentially
7. • Minimize interruptions and allow full chest recoil between compressions
Recognize the metabolic consequences of continued poor perfusion in a newborn infant
• Low cardiac output results in endothelial cell damage with resultant activation of
the coagulation cascade into a procoagulant state
• Subsequent microthrombosis and tissue ischemia result in free radical release,
excessive neurotransmitter release, mitochondrial damage, neutrophil activation,
nitric oxide induced cell apoptosis, activation of additional inflammatory cascades
and cell necrosis all contributing to diffuse tissue damage
o VLBW infant
Recognize that VLBW infants often cannot achieve and Apgar score greater than 6
because they are neurologically immature
• Have diminished tone and reflexes, the HR, RR and color are also interrelated and
affected by the infant’s clinical status
Recognize that initial care of a VLBW infant includes administration of a parenteral
glucose soln
• Have low endogenous fat and glycogen stores and limited capacity for
gluconeogenesis and so they need continuous infusion of glucose to prevent
hypoglycemia
• Initially need to 4-6mg/kg/min of dextrose soln (D10); then eventually need
higher rates
Recognize the initial care of a VLBW infant includes maintenance of a thermoneutral
environment
• Immature skin with minimal keratininzation as well as immature kidneys led to
increased water losses, so a humidified incubator is best
Recognize the initial care of a VLBW infant includes monitoring of blood glucose and
arterial oxygen concentrations
• Goal PaO2 is 50-70 (SaO2 of 85-95%)
• Blood glucose concentrations need to be greater than 50n the first 24 hours after
birth, and greater than 50-60 thereafter
Recognize the initial care of a VLBW infant includes evaluation for sepsis if appropriate
• Unless there is clear noninfectious cause for the preterm delivery can be
identified then workup for sepsis and prophylactic treatment needs to be
undertaken
• Initial lab eval should include a CBC, blood culture and CRP
• Initial abx should be ampicillin and gentamicin
• Usual suspects for infection are GBS, listeria and gram negatives like e. coli; (if
mom was txed with abx there is a greater chance of a gram negative infection)
Understand the prognostic factors for VLBW infants
• Highest risk for neurodevelopmental problems in those who are
∗ Male
∗ GA under 28 weeks
∗ BPD
∗ CP
∗ Cerebral white matter injury
∗ Late onset sepsis or NC and need for surgery
• Other risk factors are persistent poor weight gain or head growth after 36 weeks
postmenstrual age
8. • The degree of immaturity is the principal determinant for prognosticating the
outcome of VLBW infants; the degree of illness experienced in the NICU also
contributes to survival prognostication and acute and long term morbidity
o Conditions, diseases
Know that HIE is the most common cause of seizure in a full term infant
• Accounts for about 67% of early neonatal seizures
• Other causes: intracranial hemorrhage, CVA or hemorrhagic infarct; intracranial
malformation; transient hypoglycemia or hypocalcemia; drug withdrawal; inborn
errors of metabolism
Recognize that neonatal seizures secondary to HIE characteristically occur within 24
hours after birth
• If the seizure onset is beyond the first 24 hours need to broaden the differential
and also consider infection (meningitis, encephalitis)
Recognize the majority of full term newborn infants who have neonatal seizures
secondary to asphyxia do not manifest long term neurodevelopmental sequelae
• Motor abnormalities may be found on exam in a slight majority (53%) of
newborns having an sz for any cause, few have CP
• Severe impairment in neurodevelopmental outcomes occurs in fewer than 50% of
newborns who had sz due to asphyxia; Mild to moderate neurodevelopmental
impairment in cognitive and motor function is about 33%
• Early predictors of outcome for such children may be determined by evaluating
the worst EEG finding, the follow up 1-week EEG, and findings on cranial MRI
Recognize that intrapartum asphyxiation can cause injury to multiple organ systems
• CV: systemic hypotension, pulm htn, dilated cardiomyopathy, myocardial
ischemia
• Pulm: respiratory distress, surfactant depletion/disruption with capillary-alveolar
leak, hypoxic respiratory failure with pulm htn, apnea
• Renal: oliguria, ATN, renal failure
• GI: impaired gastric motility, GI hemorrhage, NEC (even in term infants), ischemic
hepatitis, hepatopathy
• Hematopoietic: anemia, TCP, coagulopathy
• Metabolic: academia, hypoglycemia, hypocalcemia, hypomagnesemia
• CNS: HIE, apnea, irritability, jitterniess, abnormaities in neuromuscular tone,
seizure, coma
Recognize that newborn infants with polycythemia are at risk for hypoglycemia and
hyperbilirubinemia, and manage appropriately
• When a baby is discovered to have polycythemia they need to be screened for
hypoglycemia and hyperbilirubinemia
• If the hypoglycemia does not improve with IV glucose then need to consider
exchange transfusion with IV NS (reduces the RBC mass and helps with circulatory
flow in the microcirculation)
Know that the treatment for symptomatic polycythemia is partial exchange transfusion
Plan the management of a patient with hyperbilirubinemia
•
Understand the strategies for prevention of severe hyperbilirubinemia in newborn
infants (e.g. increased breastfeeding, screening prior to discharge)
•
Plan the evaluation and management of a neonate with intracranial hemorrhage
9. • Requires stabilization of the airway, control of respiratory function, support of
circulation (PRBC transfusion), correction of acidosis and hyperglycemia; can start
anticonvulsant tx of they have seizures (phenobarbital); bedside cranial U/S is
best imaging; also need to investigate for underlying causes like a coagulopathy
or sepsis
• Avoid hyercarbia, hyopxia and hypotension
Recognize the clinical and lab findings associated with intracranial hemorrhage in a
neonate
• Acidosis (metabolic, due to tissue damage and hypovolemic shock),
hyperglycemia (due to acute stress), anemia (acute decrease in HCT into the
brain), TCP (consumptive), hyponatremia (SIADH)
Recognize the SGA infants have a higher neonatal mortality rate than AGA infants
Recognize that SGA infants are prone to fasting hypoglycemia, polycythemia, and
temperature instability, and manage appropriately
• Need glucose infusions, might need NG/OG feeding tubes due to likely feeding
probs
• Keep them in thermoneutral environment
Know that perinatal asphyxia is a frequent complication of IUGR
• Poor tolerance of labor and asphyxia are more common
Know the normal arterial blood gas values for a newborn infant (pO2 60 to 90mmHg,
pCO2 35 to 45 mmHG)
•
Understand the effects of surfactant administration in and infant with RDS
• Clinically will have less work of breathing, improved oxygenation and ventilation,
reduction in assisted ventilation (decreased FiO2), decreased mean airway
pressure (reduction in needed inspiratory pressure), improved pulmonary
compliance (improved changes in lung volume per unit of inspiratory pressure)
• On x-rays the degree of lung aeration improves as the microatelectasis is
overcome, lung volumes also improve
• On lab the academia improves
Recognize that pulmonary air leaks are common in newborn infants who are treated with
assisted ventilation
• Grunting respirations are a clinical sign
Recognize that neonatal pneumonia can mimic RDS
• RDS is due to surfactant deficiency and characteristically affects newborns born
under 32 weeks GA
• In term and late preterm infants who have respiratory dustress, need to look for
other causes, including infection, aspiration, cardiac disease, congenital
anomalies
• Congenital pneumonia can cause resp distress and would be seen in babies of
moms with chorio, prolonged rupture of membranes, GBS carriers
• Would see tachypnea, tachycardia, need for supplemental O2, temp instability,
poor feeding
• Radiographically will resemble RDS with air bronchograms, diffusely hazy lung
fields, low lung volumes
Identify and manage transient tachypnea of the newborn
• Dx is based on clinical and radiographic findings
∗ Frequently a dx of exclusion and need to r/o other conditions like RDS,
10. pneumonia and pneumothorax
∗ Usually presents within a few hours after birth with tachypnea,
retractions, grunting and occasionally with need for supplemental O2
∗ Tachypnea resolves by 72 hours by can last longer
∗ If grunting and other signs of distress persist then may need more
workup/intervention
∗ Barrel shaped chest due to hyperinflation and might be able to feel the
liver and spleen due to the hyperinflation pushing them down
∗ Crackles may be present
∗ BP usually normal
∗ Radiographic findings: prominent perihilar vascular markings due to
engorged periarteriolar lymphatics, edema of the interlobar septae, fluid
in the fissures, possibly hyperinflation, fluid in the costophrenic angles,
widening of intercostal spaces
• Management: “rue of two hours” to determine of it is due to transtion or possibly
other respiratory problems.
∗ if no improvement in the degree of distress than get a CXR; if desats on
room air an ABG might be helpfulif the CXR is abnormal, baby is
worsening clinically, requires >40% O2 to maintain sats, or no
improvement after 2 hours of feasible interventions then need to consider
transfer to higher level of care
∗ if tachypnea associated with increased WOB then need to keep baby NPO,
start IVFs
∗ if the increased WOB persists beyond two hours with the tachypnea then
need to worry about other possible etiologies; majority of cases of TTN
have resolution of the tachypnea by 48 hours of age
∗ preferably give O2 supplementation by hood
∗ cannot have a definitive dx of TTN until the tachypnea resolves; babies
should not be discharged until have a resp rate <60 for more than 12
hours
Know that peripheral cyanosis is a common finding in healthy full term newborn infants
Know that it is difficult to distinguish between persistent pulmonary hypertension
without meconium aspiration and cyanotic congenital heart disease
• Persistent pulmonary hypertension of the newborn is also referred to as
“persistence of fetal circulation”
∗ Called this b/c there remains a persistent right to left shunt via the PDA;
usually due to increased pulmonary vascular resistance cause by one of
many problems. The pulm vascular resistance may be higher than
systemic vascular resistance and so deoxygenated blood from the right
ventricle traverses the PDA and enters the aorta rather than traveling vie
the pulmonary artery to the lungs
• Signs include grunting, tachypnea and respiratory distress and failure; precordial
lift due to increased work of the RV; lower O2 sat in the lower body than the
upper body
• Causes of increased pulmonary vascular resistance include pneumonia, lung
collapse, pulmonary hypoplasia
Recognize the clinical presentation of a neonate with persistent pulmonary hypertension
following mec aspiration
11. • As above, including the differences in oxygenation of upper and lower extremities
• Also have CXR findings of MAS: hyperinflated lung fields, patchy infitrates, varying
degrees of atelectasis and hyperaeration
Know the appropriate abx treatment for suspected sepsis in the immediate newborn
period
• Ampicillin and gentamicin
Know the significance for infection of prolonged premature rupture of the membranes
• Two maternal coditions increase the risk of early onset neonatal sepsis in the face
of PROM
∗ Choriomanionitis
Risk for fetal infection that may not be treated fully with maternal
abx; hence the baby might have partially treated bacteremia, pna,
or meningitis and require treatment for presumed sepsis
∗ GBS colonization
Infants born before 36 weeks gestation are more susceptible to
GBS infection especially in the face of PROM or chorioamnionitis; a
sepsis eval and empiric abx tx is recommended for the preterm
infant following PROM
Understand the risk of sepsis from the use of intravascular catheters
• UAC and UVC lines- get colonized with commensal staph within 24 hours of
insertion; need to be removed by day 10-14, preferably by day 7
Recognize the perinatal infection with CMV may be acquired in utero, during delivery, or
in the neonatal period (e.g. breast milk, blood transfusion)
• If a primary CMV infection during pregnancy the risk of transmission from mother
to fetus is about 50%; if mother infected before pregnancy then risk of
transmission is 0.5-2%
• If term infant acquires during delivery or from breastfeeding, there is no apparent
disease, but there can be illnesses associated with this kind of transmission for
the preterm infant
• Can be transmitted via transfusion of whole blood; it resides in the white cell
fraction
Recognize the si and sx of symptomatic congenital CMV disease
• Blueberry muffin baby, due to extramedullary hematopoiesis
• Petechiae, purpura, HSM, jaundice, SGA, microcephaly
• They get biliary obstruction due to the extramedullary hematopoiesis, leading to
hepatomegaly, hepatitis, and elevated d. bili
• Neurologic features occur in about 2/3 of symptomatic newborns; includes
seizures, ocular abnormalities (notable chorioretinitis), hypotonia, poor suck
Recognize the clinical manifestations of congenital CMV infection including hearing loss
and MR
Recognize that the majority of infants with congenital toxoplasmosis are asymptomatic in
the neonatal period
Plan the eval of a full term infant who has severe respiratory failure at birth that does not
respond to intubation and assisted ventilation
Know the usual presentation of necrotizing enterocolitis, and plan initial management
Know that radiographic findings of pneumointestinalis is the hallmark of NEC
Recognize that intestinal stricture formation is a late complication of NEC
Recognize the clinical si and sx of congenital bowel obstruction
12. Know the tx of abd distention caused by congenital bowel obstruction
Recognize the si and sx of esophageal atresia with tracheoesophageal fistula
Know how to evaluate an infant with TE fistula
Recognize that an infant of a diabetic mother is at risk for hypoglycemia, hypocalcemia,
polycythemia, and neonatal small left colon syndrome
Understand the pathogenesis of hypoglycemia in an infant with a diabetic mother
Understand the management of a newborn whose mother has DM1
Understand the effects of drugs given to the mother during labor (e.g. opiates, beta
andrenergic tocolytic agents) on the fetus/neonate
Know the association between maternal use of alcohol and any fetal abnormalities
and/or neonatal abstinence syndrome
Know the association between maternal use of marijuana and any fetal abnormalities
and/or neonatal abstinence syndrome
Know the association between maternal use of tobacco and any fetal abnormalities and/
or neonatal abstinence syndrome
Know the association between maternal use of opiates and any fetal abnormalities
and/or neonatal abstinence syndrome
Know the association between maternal use of amphetamines and any fetal
abnormalities and/or neonatal abstinence syndrome
Know the association between maternal use of barbiturates and any fetal abnormalities
and/or neonatal abstinence syndrome
Know the association between maternal use of cocaine and any fetal abnormalities and/
or neonatal abstinence syndrome