APGAR - scoring system (everything)
(appearance, pulse, grimace, activity, respiration)
HR: 0 / <100 / >100
Resp: none / irregulalar shallow gasps / cry
color: blue / blue extrem / pink
tone: none / weak passive / active
reflex: none / facial grimace / active withdrawal
APGAR - outcome
not predictive - score 0-3 in 5 mins and longer compared to infants with score 7-10 have worse neurologic outcome
newborn care
- vit K (IM) 2. umbilical cord care 3. hearing test
4. newborn screening test 5. prophylactic eye erythromycin (only n. gonor, not for chlamydia)
caput succedaneum vs cephalehematoma according to definition + outcome
caput –> diffuse swelling, crosses sutures lines, disappears in 1st days, may lead to molding for weeks
cephal –> subper hemorr, NOT cross. may have underling fracture, may calcify, jaundice, resolve in 1/2-3 months
birth injury - skull fractures - definition + outcome
in utero from bones or forcerps pressure:
linear: no symptoms + no treatment (MC)
depressed: elevate to prevent cortical injury
birth injury - clavicular fracture - definition + outcome
with shoulder dystocia in vertex position + arm extension in breech, assymetric moro
palpable callus within a week
treatment: immobilization of arm + shoulder
birth injury - facial nerve palsy - definition + outcome
- in utero or delivery from bones or forcerps pressure
- improvement over weeks (as long fibers were not torn)
- need eye care, neuroplasty of no improvement (torn)
birth injury - brachial palsy - definition
- Erb-Ducenne (C5-6): cannot abduct, ext rotate + supinate
2. Klumpke (C7-8 +/- T1): paralyzed hand +/1 Horner
birth injury - brachial palsy - outcome/treatment
- most full recover in months (depends on injured or lacerated
- proper positioning + partial immobilization
- massage + range motion exercise
- if no recovery in 3-6 months –> neuroplasty
physical examination of newborns - extremities
- syndactyly: fusion of fingers or toes (x-rays before surgery, to see if 2 bones)
- polydactyly: >5, no treatment if good blood supply
- finger tag: thin stalk, poor circulation, tie off at base
- -> autoamputation
physical examination of newborns - head
- aniridia: iris hypoplasia (defect mey go through retina) (wilms tumor)
- coloboma of iris: cleft at 6 o clock (most with other abnorm, associated with CHARGE)
- prearicular tags/pits: look for hearing loss + GU probl
