Newborn Examination Apgar score - PowerPoint Presentation

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Uploaded On 2022-07-28

Newborn Examination Apgar score - PPT Presentation

The Apgar score is a simple assessment of how a baby is doing at birth which helps determine whether the newborn is ready to meet the extra uterine life If your baby scores between 7 and 10 it usually means hes in good condition and doesnt need more than routine postdelivery care ID: 930841

examination skin lesions months skin examination months lesions response stimulus disappearance common neck suture weeks increased side normal newborn

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Slide1

Newborn Examination

Slide2

Apgar score

The Apgar score is a simple assessment of how a baby is doing at birth, which helps determine whether the newborn is ready to meet the extra uterine life

If your baby scores between 7 and 10, it usually means he's in good condition and doesn't need more than routine post-delivery care

If your baby scores 6 or less need medical help and the practitioner will determine what steps need to be taken

Slide3

Slide4

Small for Gestational Age

Symmetric

HC, length, weight all <10 percentile

Cause: Infection, chromosomal abnormalities, inborn errors of metabolism, smoking, drugs

Asymmetric

Weight <10 percentile, HC and length normal

Cause: placental insufficiency, Chronic hypertension or disease, Preeclampsia

Slide5

Large for Gestational Age

Etiologies

Infants of diabetic mothers

Beckwith-

Wiedemann

Syndrome

characterized by macroglossia, visceromegaly, macrosomia, umbilical hernia or omphalocele, and neonatal hypoglycemia Hydrops fetalisLarge mother

Slide6

Skin

Color

Pallor

: associated with low hemoglobin

Cyanosis

: associated with hypoxemia

Plethora: associated with polycythemiaJaundice: elevated bilirubin grey color: associated with methemoglobinemia

Slide7

Skin

Jaundice

Total and direct bilirubin levels should be measured in newborns with jaundice.

Causes can be related to increased unconjugated

hyperbilirubinemia

(physiologic, breastfeeding, increased production, decreased hepatic uptake/conjugation) or conjugated (

hepatobiliary disorders, ductal disturbances)0

Slide8

Slide9

Skin

Lanugo

Fine hair on shoulders and back

Usually disappears in 2-4 weeks

Vernix

CaseosaCheesy white covering

Slide10

Skin Lesions

Hemangiomas

Usually enlarges in 1

year of life.

Large facial

hemangiomas may be associated with posterior fossa malformations. benign tumor of infancyMost require no intervention

Slide11

Skin Lesions

Cutis

Marmorata

Transient mottling of the skin

Occurs when baby is exposed to the cold

Slide12

Skin Lesions

Milia

Pinpoint white papules of

keratogenous

material.

Usually on nose, cheeks and forehead.

Can last for several weeks.

Slide13

Skin Lesions

Transient Neonatal

Pustular

Melanosis

Small

vesicopustules, generally present at birth.Contain WBCs and no organisms.Intact vesicle ruptures to reveal a pigmented macule surrounded by a thin skin ring.

Slide14

Skin Lesions

Erythema

Toxicum

Neonatorum

Most common newborn rash.

Lesions are firm, yellow or white pustules on a red and swollen base.Lesions may be found in face, trunk and limbs.Lasts about 5-7 days.

Slide15

Skin Lesions

Café au

lait

spots

Suspect

nuerofibromatosis

if there are many large spots

Slide16

Skin Lesions

Mongolian spots

Well demarcated symmetric bluish gray to deep brown to black skin markings

Often on the base of the spine, on the buttocks and back

Generally fade in a few years and disappear by puberty

Slide17

Neurological Exam

Posture

Term infants normal posture is hips abducted and partially flexed, with knees flexed.

Arms are abducted and flexed at the elbow.

Fists are often clenched, with the fingers covering the thumb

Slide18

What are Infant Reflexes

A reflex is an involuntary muscle reaction to a certain type of stimulation.

Occur

subcortically

(below the level of the higher brain centers)

Newborns’ reflexes to evaluate neurological function and development

Slide19

Stimulus / Response

S: Touching palms R: 4 fingers (not thumb) close

Disappearance

3- 4 months postpartum

Concerns

No palmer grasp may indicate neurological problems

Palmar Grasp

Slide20

Stimulus / Response

S: touch of lips R: sucking action

Disappearance

3 months postpartum

Concerns

No reflex problematic for nutrition

Sucking

Slide21

Stimulus / Response

S: touching the cheek R: head moves toward stimuli

Disappearance

4 to 6 months postpartum

Concerns

No reflex problematic for

nutrition.

Rooting

Slide22

Stimulus / Response

S: Suddenly but gently lower baby’s head R: Arms and legs extend

Disappearance

3-6 months postpartum

Concerns

May signify CNS dysfunction

May indicate injury to one side of brain

Moro

Slide23

Moro

Slide24

Stimulus / Response

S: sudden loud noise R: Arms and legs flex

Disappearance

4 months

Startle

Slide25

Stimulus / Response

S: turn head to one side R: Limbs flex on one side, extend on other side

Disappearance

3- 4 months

Concerns

Facilitates bilateral body awareness

Facilitates hand-eye coordination

Tonic Neck

Slide26

Stimulus / Response

S: Touching the ball of foot R: Toes grasp

Disappearance

3-4 month

Other

Must disappear before the baby can stand or walk.

Plantar Grasp

Slide27

Stimulus / Response

S: Stroking outer sole of upward

R: toes to hyper extended

Duration

12 months

Babinski

Slide28

Stimulus / Response

S: Infant upright with feet touching surface R: Legs lift and descend

Disappearance

1 – 2 moths

Other

Sometimes called

walking reflex

Developmental changes in reflex over time

Stepping

Slide29

Microcephaly

Causes

Familial

Trisomy 21

Teratogen Exposure

Fetal Alcohol Syndrome

Radiation exposure in utero (<15 weeks gestation) TORCH Virus congenital infectionCytomegalovirus, Rubella, Toxoplasmosis Other causes Meningitis/Encephalitis

Hypoxic-ischemic encephalopathy

Slide30

Macrocephaly

Causes

Familial

Hydrocephalus

Other conditions

Achondroplasia

(skeletal dysplasia)

Slide31

Head Trauma

Cephalohematoma

Not as common, but can occur after prolonged labor and instrumentation use.

Rupture of blood vessels that traverse skull to the

periosteum

Fluctuant swelling, does not cross suture lines

No overlying discoloration, but possible fractureUncomplicated resolves in 2 weeks to 3 months if fracture, Xray in 4-6 weeks to ensure closure, depressed fractures require neurosurgical consult.

Slide32

Head Trauma

Caput

seccedaneum

Common after prolonged labor.

Accumulation of blood above

periosteum

.Soft tissue swelling that crosses suture lines with overlying petechiae, purpura or bruising.Usually resolves spontaneously over several days.

Slide33

Fontanelles

Junction of coronal suture and sagittal suture

Mean newborn size: 2.1 cm (larger in black infants)

Often enlarges in first few months of life

Closes at 18months

Exam of anterior fontanelle Palpate fontanelle with infant sitting upright quietly

Posterior

Junction of

lambdoidal

suture and sagittal suture

Mean newborn size: 0.5 to 0.7 cm

Closes at birth or by 2 months

Slide34

Fontanelles

Bulging

fontanelle

Crying, coughing or vomiting

Increased intracranial pressure: Hydrocephalus, Meningitis/encephalitis, Hypoxic-ischemic injury, Intracranial hemorrhage

Sunken

fontanelleDecreased intracranial pressure (dehydration) Large

fontanelle

or delayed closure

Congenital

hypothyroidism,Trisomy

21, Rickets,

Achondroplasia

, Increased Intracranial Pressure

Slide35

Facial Examination

Facial Nerve Paralysis

Usually caused by compression of the facial nerve against the sacral promontory or by trauma of a forceps delivery.

The

nasolabial

fold on the affected side is not present, the corner of the mouth droops and the affected eye is unable to close.

Infant will have difficulty with feeding, drooling from the paralyzed side.Most palsies resolved spontaneously within days.

Slide36

Ear Examination

Low set ears

Below canthus of eye

Associated with genitourinary anomalies, because these areas develop at similar times

Slide37

Eye Examination

Normal Eye findings following delivery

Subconjunctival

Hemorrhages

Common after vaginal delivery

Clears spontaneously in 1-2 weeks 0

Slide38

Nose Examination

Babies are obligate nose breathers until 4 months old.

Check patency

Look for nasal flaring as a sign of increased respiratory effort.

Choanal Atresia

Small NG tube unable to pass through nares.

Normally should meet no resistance.Bilateral atresiaCyanosis that is relieved with crying.Is an emergency in the newborn.Requires an oral airway and surgical repair

Slide39

Mouth

Cleft Lip

Can be seen with or without cleft palate

Common in Trisomy 13

Repair is usually at 3 months of age

Cleft Palate

Midline defect starts at uvula May involve soft and hard palate Repair is usually before age 1 for normal speech

Slide40

Neck Examination

Palpation

Palpate all neck muscles

Webbed neck

Associated with Turner’s and Noonan’s Syndromes

Lymph Nodes

Unusual at birth, presence usually indicates congenital infectionTorticollisSternocleidomastoid muscle injury from birth trauma.Hematoma and fibrosis results in muscle shortening. Muscle adaptation from abnormal intrauterine position.

Slide41

Neck Examination

Most common neck masses

vascular malformations, abnormal lymphatic tissue,

teratomas

, and

dermoid cystsCystic hygromasMost common neck massThyroglossal duct cystsTypically midline and inferior to hyoid boneSurgical consultation is required

Slide42

Chest Examination

Inspection

Breast enlargement secondary to maternal hormones

Widely spaced nipples

Turner's Syndrome

Noonan SyndromeAuscultationBreath sounds Adventious sounds

Slide43

Cardiovascular

Inspection

Check for pallor, cyanosis, or plethora

Palpation

Check capillary refill

Should be less than 3 seconds

PrecordiumFeel for increased activity and thrillPulsesDecreased femoral = coarctation of aorta

Bounding pulses often indicated PDA

Slide44

Abdominal Examination

Abdominal wall defects

Usually diagnosed prenatally.

Omphalocoele

Covered with membrane unless it has ruptured.

Cord attachment at apex of defect.

67% have an associated abnormality.GastroschisisNot covered with a membrane.Defect is to right of umbilicus.

Cord attachment to abdominal wall.

Management – immediate surgical consultation

Slide45

Orthopedic Examination

Upper limb

Brachial Plexus Injuries

Results from excessive traction of C5-T3 spinal nerve roots.

Erb-Duchenne

palsyMost common injury, involves C5-C7Arm adducted, internally rotated, elbow extended, arm pronated, wrist flexedKlumpke’s palsyIncidence is rare, involves C8-T1.Hand is paralyzed, no voluntary motion.

Slide46

Orthopedic Examination

Lower limb

Bowing of legs is normal variation

Positional deformities of foot

Foot should be easily replaced to normal position

Talipes Equinovarus (Clubfoot)

Slide47

Orthopedic Examination

Congenital hip dislocation

Ortolani

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