Term
|
Definition
• Appearance
• Pulse
• Grimace
• Activity
• Respiration
• Scaleis0–2
• Performedatoneminuteandfiveminutes...
• Andatfive-minuteintervalsthereafteruntil20 minutes for infants with a score less than 7
• Approximately90percentofneonateshave APGAR scores of 7 to 10, and generally require no further intervention
-skin color, pulse rate, reflex irriatability grimace, activity, respiratory effort |
|
|
Term
|
Definition
• A low score on the one-minute test may show that the neonate requires medical attention but does not necessarily indicate a long-term problem, particularly if the score improves at the five-minute test.
• An APGAR score that remains below three at later times—such as 10, 15, or 30 minutes—may indicate longer-term neurological damage, including a small but significant increase in the risk of cerebral palsy. |
|
|
Term
|
Definition
• The answers to the below questions are used to determine whether the infant is admitted
to the normal nursery (neonatal level of care one) or requires
a higher level of care
(neonatal level of care
two or three)
– Is the infant’s GA >35 weeks?
– Does the infant have good muscle tone? – Is the infant breathing or crying? |
|
|
Term
|
Definition
• The transitional period between intrauterine and extra-uterine life is during the first 4–6 hours after birth.
• Physiologic changes occur:
– Decreasing pulmonary vascular resistance
– Increased blood flow to the lungs
– Lung expansion with clearance of alveolar fluid and improved oxygenation
– Closure of the ductus arteriosus
• Infant should be monitored every 30–60 minutes.
• Monitor in the delivery room and continuing into the mother’s/infant’s room or nursery. |
|
|
Term
|
Definition
• Headcircumference:33–37cm • Chest/abdominalcircumference
• Length—from crown of head to heel: 45 to 55cm • Vital signs—temperature, pulse, pulse ox, RR |
|
|
Term
| Birthmarks and other skin findings |
|
Definition
– Nevus simplex/salmon patch/stork bite—a common congenital capillary malformation present in newborns, most commonly on the eyelid, glabella, or back of the neck. It usually disappears during the first year of life
– Port wine stain—a vascular malformation that does not regress
– Milia—tiny white cysts containing keratin and sebaceous
material; on face
– Erythema toxicum—erythematous macules, papules, and pustules—lesions that usually appear from 48 hours of age and resolve spontaneously |
|
|
Term
|
Definition
| isadiffusesubcutaneous fluid collection with poorly defined margins (often crossing suture lines) caused by the pressure on the presenting part of the head during delivery. It does not usually cause complications and resolves over the first few days. |
|
|
Term
|
Definition
| isasubperiosteal hemorrhage which occurs in 1–2% of infants and may increase in size after birth. The hemorrhage is bound by the periosteum; therefore, the swelling does not cross suture lines (in contrast to a caput succedaneum). Cephalohematoma is more common with instrumental delivery and may cause jaundice; therefore, bilirubin should be monitored |
|
|
Term
|
Definition
| occur between the aponeurosis of the scalp and periosteum which form a large, fluctuant collection that crosses sutures lines. They are rare, but may cause life-threatening blood loss. |
|
|
Term
|
Definition
| is a condition in which one or more of the fibrous sutures in an infant skull prematurely fuses, changing the growth pattern of the skull, which can result in raised intracranial pressure and damage to intracranial structures. Surgical intervention is required with the primary goal being to allow normal cranial vault development to occur. This can be achieved by excision of the prematurely fused suture and correction of the associated skull deformities |
|
|
Term
The Dubowitz/Ballard/New Ballard
Examination for Gestational Age |
|
Definition
• Gestational age (GA), also called menstrual age or menstrual dating, is the age of the fetus or newborn based upon the completed weeks from the date of the mother’s last menstrual period (LMP).
• GA is determined in the fetus by menstrual history or ultrasound dating and in the newborn by physical examination and neuromuscular assessment. This determination is used to assess intrauterine growth, make decisions about the timing of delivery in complicated pregnancies, and predict the infant’s clinical course.
• GA assesses appearance, skin texture, motor function, and reflexes.
• The physical maturity part of the examination is done in the first few hours of birth.
• The neuromuscular maturity examination is completed within 24 hours after delivery. |
|
|
Term
|
Definition
• Eye care
• Vitamin K
• Umbilical cord
• Hepatitis B vaccine
• Newborn screening
– Hearingloss
– Metabolicandgeneticdisorders – Criticalcongenitalheartdisease
• Feeding
• Glucose screening
• Circumcision
• Hyperbilirubinemia
• Education
• Discharge criteria |
|
|
Term
|
Definition
• Gonococcal conjunctivitis
is markedly reduced by prophylactic administration of ophthalmic antibiotic agents shortly after birth
• Erythromycin ophthalmic
ointment (0.5 percent) is recommended by the American Academy of Pediatrics (AAP)
• 1% silver nitrate solution, 1% tetracycline not available in U.S. market
• Place within two hours after birth |
|
|
Term
|
Definition
• Universal vaccination of newborns, regardless of maternal hepatitis B virus surface antigen (HBsAg) status, is recommended.
• The vaccination should be given within 24 hours of delivery.
• Infants of HBsAg-positive mothers should receive hepatitis B vaccine (HBV) in addition to hepatitis B immunoglobulin (HBIG) shortly after birth, preferably within 12 hours of birth.
• If mother’s HBsAg status is unknown at the time of delivery, the neonate should receive HBV within 12 hours of birth while awaiting the results of mother’s HBsAg; if mother is subsequently found to be HBsAg positive, HBIG should be given to the newborn within the first week of life. |
|
|
Term
|
Definition
• Hearing loss
• Metabolic and genetic disorders
• Critical congenital heart disease—pulse ox |
|
|
Term
| Weight Gain in the Newborn |
|
Definition
• Birth weight is an important indicator of health.
• Average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs (3.2 kg).
• Small babies and very large babies are at greater risk for problems.
• Weigh daily in the nursery to assess growth, fluid, and nutrition needs.
• Newborn babies may often lose 5 to 7 percent of their birth weight.
– Ababyweighing7pounds3ouncesatbirthmightloseasmuchas8 ounces in the first few days.
• Babies will usually gain weight back by two weeks of age.
• Premature and sick babies may not begin to gain weight right away. |
|
|
Term
|
Definition
• Only performed if risk factors present:
– Infants of GA <37 weeks
– Large for gestational age (LGA)
– Infants of diabetic mothers (IDM)
– Post-term infants (GA >42 weeks)
– Infants with a family history of a genetic form of hypoglycemia or who have physical findings suggestive of a syndrome (Beckwith- Wiedemann) associated with hypoglycemia
– No prenatal care |
|
|
Term
|
Definition
• Glucose-6-phosphate dehydrogenase (G6PD) is an X- linked genetic disorder caused by a deficiency of G6PD in erythrocytes, resulting in risk to develop neonatal hyperbilirubinemia, acute hemolysis, or chronic nonspherocytic hemolytic anemia.
• There are variants of G6PD, from chronic hemolytic disease to an asymptomatic condition with increased risk to develop acute hemolytic episodes that can be triggered by medication, viral or bacterial infections, or ingestion of fava beans. Female carriers are almost always asymptomatic.
• Bilirubin levels
• Assess jaundice |
|
|
Term
| At minimum, screening tools should be administered for developmental delays |
|
Definition
| 9, 18, and 24 or 30 months. |
|
|
Term
|
Definition
| • Administer at 18 and 24 months |
|
|
Term
| Children can be categorized into three subsets according to their developmental status |
|
Definition
– Those with typical development and behavior challenges (temper tantrums and
toilet training)
– Those with developmental delays that may be amendable with appropriate early intervention
– A subset that falls in the middle (those children who do not appear to be delayed but may acquire delays if risk factors aren’t identified and addressed) |
|
|
Term
|
Definition
| Weakness in one or more domains of development; most often refers to performance below the 25th percentile or the 16th percentile |
|
|
Term
|
Definition
| Significant discrepancy between intellectual ability and other skills (language, academics, self-help, etc.) or overall deficits below the 5th percentile |
|
|
Term
|
Definition
| Parents with less than a high school education, being a single parent, being unemployed, parental mental health problems (of which depression is particularly common), housing/food instability, ≥3 children in the home, limited facility with English, limited literacy in any language, being among an ethnic minority, and most importantly problematic parenting style |
|
|
Term
| Broad-band screening tools |
|
Definition
| Measures that detect probable problems in most or all developmental and or behavioral domains (language, motor, cognition, self-help) |
|
|
Term
| Narrow-band screening tools |
|
Definition
| Measures that focus on a single condition (autism spectrum disorder or ADHD) or on a single domain (gross motor). In the case of mental health screening, about 50 percent of children with mental health problems have, as the root cause, undiagnosed developmental problems. |
|
|
Term
Ages and Stages
Questionnaire 3 (ASQ3) |
|
Definition
• Used to screen development in children from 1–66 months
• Written at a 4th–6th grade reading level
• Available in English and Spanish
• 30 items
• 15 minutes to administer
• Generates three outcomes in four developmental domains:
– Cognitive – Motor
– Self-help – Language |
|
|
Term
| 0-1 month developmental milestone red flags |
|
Definition
| sucks poorly, doesn't respond to bright light or loud noise, seems stiff or floppy |
|
|
Term
|
Definition
| doesn't smile at sound of your voice, doesn't notice her hands, not tracking objects |
|
|
Term
|
Definition
| doesn't hole objects, doesn't smile, doesn't support head |
|
|
Term
|
Definition
| doesn't reach for and grasp toys, doesn't babble, always crosses eyes |
|
|
Term
|
Definition
| doesn't roll over, doesn't lift head while on tummy |
|
|
Term
|
Definition
| makes no sounds or fewer sounds esp in response to you, doesn't reach for things |
|
|
Term
|
Definition
| reaches w 1 hand only, one or both eyes consistently turned in or out, refuses to cuddle |
|
|
Term
|
Definition
|
|
Term
|
Definition
| can't push up on arms hwile on tummy can't sit alone can't bear weight in standing position |
|
|
Term
|
Definition
| no special relationship w family members, not moring around |
|
|
Term
|
Definition
| no stranger anxiety, doesn't seek social interaction w familiar ppl |
|
|
Term
|
Definition
| doesn't know their name, not crawling or moving forward, says no single words |
|
|
Term
| “Smilestones” Recommendations |
|
Definition
• Replace child’s toothbrush every three to four months.
• Get child involved in the brushing process. It will make things easier when the child starts brushing their own teeth.
• Around age 4 or 5, children will be ready to practice brushing their own teeth. Children still need help brushing until they are
8 years old or until they can tie their shoes.
• When the sides of child’s teeth touch, floss at least once a day to remove small pieces of food stuck between teeth.
• Most children have all their baby teeth, 20 in all, around the age of 3.
• Children begin to lose them around age 6. last lost about age 12 |
|
|
Term
| WHO-CDC Charts at 2 Years |
|
Definition
• When a child reaches age 24 months, health care providers need to switch from using the WHO growth standards charts to using the CDC growth reference charts for children ages 2 years up through 19 years. During the transition from one chart to another,
children may experience a difference in classification because of a change from:
– Recumbentlengthtostandingheightmeasurements.Notethatthe difference between recumbent length and stature in national survey data is approximately a 0.8 cm (1⁄4 inch) difference. Standing height measures less than recumbent length
– Breastfedreferencepopulationtoaprimarilyformula-fedreference population
– Weight-for-lengthcharttoBMI-for-agechart
– Onesetofcutoffvaluestoanother |
|
|
Term
|
Definition
• TheWHOchartsdescribegrowthofhealthy children in optimal conditions.
• TheCDCgrowthchartsareagrowthreference, not a standard, and describe how certain children grew in a particular place and time. The CDC charts describe the growth of children in the United States during a span of approximately 30 years (1963–1994). |
|
|
Term
|
Definition
• General guidelines regarding weight gain during infancy and childhood for infants with growth parameters that were appropriate for gestational age at birth include the following:
– Termneonatesmayloseupto10percentoftheirbirthweightinthefirst few days of life and typically regain their birth weight by 10 to 14 days.
– Newbornsgainapproximately30gperday(1ozperday)untilthree months of age.
– Infantsgainapproximately20gperday(0.67ozperday)between3 and 6 months of age and approximately 10 g per day between 6 and 12 months.
– Infantsdoubletheirbirthweightby4monthsofageandtripletheirbirth weight by 1 year.
– Childrengain2kgperyear(4.4lbsperyear)between2years and puberty. |
|
|
Term
| Boys: Development of External Genitalia |
|
Definition
Stage 1: Prepubertal
Stage 2: Enlargement of testes and scrotum; scrotal skin reddens and changes in texture
Stage 3: Enlargement of penis (length at first); further growth of testes
Stage 4: Increased size of penis with growth in breadth and development of glans; testes and scrotum larger, scrotal skin darker
Stage 5: Adult genitalia |
|
|
Term
| Girls: Breast Development |
|
Definition
Stage 1: Prepubertal
Stage 2: Breast bud stage with elevation of breast and papilla; enlargement of areola
Stage 3: Further enlargement of breast and areola; no separation of their contour
Stage 4: Areola and papilla form a secondary mound above level of breast
Stage 5: Mature stage: Projection of papilla only, related to recession of areola |
|
|
Term
| Boys and Girls: Pubic Hair |
|
Definition
Stage 1: Prepubertal (the pubic area may have vellus hair, similar to that of forearms)
Stage 2: Sparse growth of long, slightly pigmented hair, straight or curled, at base of penis or along labia
Stage 3: Darker, coarser, and more curled hair, spreading sparsely over junction of pubes
Stage 4: Hair adult in type, but covering smaller area than in adult; no spread to medial surface of thighs
Stage 5: Adult in type and quantity, with horizontal upper border |
|
|
Term
| Cranial Nerves for infants |
|
Definition
• CN 1: difficult to assess
• CN 2, 3: response to light, baby in sitting position, use a light and check for optic blink reflex and pupillary response
• CN3,4,6:EOM,movetoywithno
sound, look for tracking and facial response
• CN 5: sucking and rooting reflex, pacifier
• CN 7: (facial movement) observe symmetry of face and forehead, crying, smiling
• CN8:(hearing);snappingandtracking,acoustic blink reflex
• CN9,10:(sensoryandmotorfunctionofthe palate, pharynx, larynx) observe coordination during swallowing with a bottle (gag)
• CN11:(SCM,uppertrapezoids)symmetryof infant’s shoulders
• CN12:(motorfunctionoftongue)observe coordination of swallowing, sucking, and tongue thrusting |
|
|
Term
|
Definition
• Neonate’ssleep:~16hours a day
• 14hby6months
• 13hby2years
• 12hat4years
• Commonsleepproblems:nightterrors(4–7 years), nightmares (8–10 years), sleep walking (5–10 years), sleep onset delay, night awakening, daytime sleepiness. |
|
|
Term
|
Definition
• Congenitalhypothyroidism screening
• Hearinglossscreening
• Oculargonorrheainfection, preventive medication
• Phenylketonuriascreening
• Sicklecelldiseasescreening |
|
|
Term
| Children 6 Months and Older screening |
|
Definition
| • Fluoridesupplementationinareaswherethe primary water source is deficient in fluoride |
|
|
Term
| Children 3–5 Years screening |
|
Definition
| • Visual impairment screening |
|
|
Term
| School-Aged Children screening |
|
Definition
| • Tobacco use, counseling to prevent initiation |
|
|
Term
| Children 6 Years and Older screening |
|
Definition
|
|
Term
| Children 10 Years and Older screening |
|
Definition
| • Skincancer,counselingto reduce risk |
|
|
Term
| Children 12 Years and Older screening |
|
Definition
|
|
