Assessment of the Neonate

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Assessment of the Neonate
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  5/23/2013Copyright 2008 AP Jones 1 Assessment of the Neonate Arthur Jones, EdD, RRT http://rc-edconsultant.com/ Learning objective:  Interpret findings from physical andphysiological assessments of thenewborn.   NeonatalScoring Systems FYI - Click for article on use and abuse of Apgar score http://pediatrics.aappublications.org/cgi/content/abstract/pediatrics;98/1/141 Apgar score  Rated at one and five minutes  Intended only to assess generalcondition  Does not:  define asphyxia  predict future development  influence Ivy League admission  Health premature infants willlikely have low Apgar scores   Apgar scoring system ƒ Observations  Color - skin colorimetry reflectsillness severity  Heart rate  Reflex activity  Activity  Respirations   0 1 2Color centralcyanosisperipheralcyanosispink Apgar scoring system  5/23/2013Copyright 2008 AP Jones 2 0 1 2Color centralcyanosisperipheralcyanosispinkHeart rate nonedetectable<100 >100 Apgar scoring system   0 1 2Color centralcyanosisperipheralcyanosispinkHeart rate nonedetectable<100 >100Respiratoryeffortapnea irregular,shallowcrying Apgar scoring system   0 1 2Color centralcyanosisperipheralcyanosispinkHeart rate nonedetectable<100 >100Respiratoryeffortapnea irregular,shallowcryingReflex none grimace(withdraw)crying Apgar scoring system   0 1 2Color centralcyanosisperipheralcyanosispinkHeart rate nonedetectable<100 >100Respiratoryeffortapnea irregular,shallowcryingReflex none grimace(withdraw)cryingMuscle tone(activity)flaccid someflexionwell-flexed Apgar scoring system   Gestational age estimation  Prenatal  menstrual cycle - 1st day of lastmenstrual period + 280 days  fundal height measurement -mom's abdomen  ultrasound   Gestational age estimation  Postnatal  ultrasound measurement - femur length  Ballard score - AKA Ballard-Dubowitz score  5/23/2013Copyright 2008 AP Jones 3 Ballard score ƒ Estimation of gestational age ƒ Physical signs  Skin  Breast  Lanugo  Eye/ear   Plantar surface  Genitalia FYI - Click to view/bookmark Ballard Score videos http://www.ballardscore.com/Pages/videos.aspx Gestational age/score24-26 wkscore = 035-40 wkscore = 4Skin gelatinous,red, translucentparchment, deepcracks, no visiblevessels Ballard score - physical signs   Gestational age/score24-26 wkscore = 035-40 wkscore = 4Skin gelatinous,red, translucentparchment, deepcracks, no visiblevesselsLanugo none to sparse none to sparse Ballard score - physical signs Gestational age/score24-26 wkscore = 035-40 wkscore = 4Skin gelatinous,red, translucentparchment, deepcracks, no visiblevesselsLanugo sparse mostly baldPlantar surfaceno crease creases over entiresole Ballard score - physical signs Click to see skin scoring http://www.ballardscore.com/Pages/mono_phys_skin.aspx Click to see lanugo scoring http://www.ballardscore.com/Pages/mono_phys_lanugo.aspx Click to see plantar surface scoring http://www.ballardscore.com/Pages/mono_phys_plantar.aspx Gestational age/score24-26 wkscore = 035-40 wkscore = 4Skin gelatinous,red, translucentparchment, deepcracks, no visiblevesselsLanugo sparse mostly baldPlantar surfaceno crease creases over entiresoleBreast barely perceptible full areolae; 5-10 mmbud Ballard score - physical signs Click to see breast scoring http://www.ballardscore.com/Pages/mono_phys_breast.aspx   Gestational age/score24-26 wkscore = 035-40 wkscore = 4Skin gelatinous,red, translucentparchment, deepcracks, no visiblevesselsLanugo sparse mostly baldPlantar surfaceno crease creases over entiresoleBreast barely perceptible full areolae; 5-10 mmbudEye and ear  lids open, pinna flat& stays foldedeyes open, ear thickcartilage, stiff  Ballard score - physical signs Click to see eye & ear scoring http://www.ballardscore.com/Pages/mono_phys_eyear.aspx  5/23/2013Copyright 2008 AP Jones 4 Gestational age/score24-26 wkscore = 035-40 wkscore = 4Genitalia- male scrotum empty,faint rugaetestes pendulousdeep rugaeGenitalia-female prominent clitorissmall labia minoramajora cover clitorisand minora Ballard score - physical signs Click to see male genitalia scoring http://www.ballardscore.com/Pages/mono_phys_male.aspx Click to see female genitalia scoring http://www.ballardscore.com/Pages/mono_phys_female.aspx FYI - Click for pictures of ambiguous genitalia http://lh4.ggpht.com/-u5SwxozUhSk/SR8VWtH-RBI/AAAAAAAAD4I/E6eD7RW7vpQ/DSC00229.JPG   Ballard score - neuromuscular signs ƒ Posture  degree of extremity flexion  greater flexion ==> maturity ƒ Square window  flexion of hand to forearm  greater flexion ==> maturity Click to see posture scoring http://www.ballardscore.com/mono_neuro_posture.htm Click to see square window scoring http://www.ballardscore.com/mono_neuro_squarewindow.htm   Ballard score- neuromuscular signs ƒ Arm recoil  recoil of arm after full extension  full recoil ==> maturity ƒ Popliteal angle  angle of knee, with thigh on chest  lesser angle ==> maturity Click to see arm recoil scoring http://www.ballardscore.com/mono_neuro_armrecoil.htm Click to see popliteal angle scoring http://www.ballardscore.com/mono_neuro_pop.htm   Ballard score- neuromuscular signs ƒ Scarf sign  put hand on opposite shoulder   lesser travel of elbow across midline==> maturity ƒ Heel-to-ear   non-forceful movement of heel to ear   greater distance heel - ear ==>mature Click to see scarf sign scoring http://www.ballardscore.com/mono_neuro_scarf.htm Click to see heel-to-ear scoring http://www.ballardscore.com/mono_neuro_heel.htm   Ballard scoring ƒ Maturity ratings  0 24 weeks  10 28 weeks  20 32 weeks  30 36 weeks  40 40 weeks  50 44 weeks Click to see the Ballard score calculator  http://www.medcalc.com/ballard.html   Acute illness scoring  Purposes  to predict mortality  guide patient management  set standards for research,benchmarking across institutions
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