Newborn Assessment Terms
Posted by Laura on February 17, 2010
Reading the various items we are to observe, measure or palpate when doing a newborn assessment, I realized I needed to add a few more words to my vocabulary and understand what they mean. Here is a list of these words. Most of the definitions came from MedicinePlus http://www.nlm.nih.gov/medlineplus/medlineplus.html
caput succedaneum –It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery. A caput succedaneum is swelling that occurs in the scalp of a newborn. This means that bruising occurs in the thin layer of tissue between the hair and the skull itself. This typically appears as a puffy spot on the baby’s head, but it can even be so large as to cover the whole top portion of the skull, making the newborn’s head look misshapen. A caput can also cause molding of the head.
cephalohematoma – Slightly similar to a caput, a cephalohematoma can result from a forceful delivery. As the baby’s body is forced forwards either during a natural birth or a specialized extraction process, the scalp sticks to the interior of the birth canal. This results in the tearing of blood vessels connecting the periosteum to the scalp and skull. A cephalohematoma is a collection of blood under this material. While a caput succedaneum typically disappears in a few days, a hematoma of the periosteum can last longer.
subconjunctival hemorrhage (eye) – Subconjunctival hemorrhage is a bright red patch appearing in the white of the eye. This condition is also called red eye. This occurs when blood leaks under the covering of the eyeball due to the trauma of delivery. It’s a harmless condition similar to a skin bruise that goes away after several days, and it generally doesn’t indicate that there has been any damage to the infant’s eyes.
pupil opacity – white spot on the pupil, congenital corneal opacities – cataracts, glaucoma,
epstein’s pearls – Epstein pearls are whitish-yellow cysts that form on the gums and roof of the mouth in a newborn baby. Epstein pearls occur only in the newborn and are very common. They are seen in approximately 80% of newborns. The pearls are protein-filled cysts. The condition is harmless, although it sometimes worries new mothers.
supernumerary nipples – Supernumerary nipples is the presence of extra nipples. Considerations: Supernumerary nipples are fairly common. They are generally unrelated to other conditions or syndromes. The extra nipples usually occur in a line below the normal nipples. They are usually not recognized as extra nipples because they tend to be small and not well formed. Causes: Variation of normal development. Some rare genetic syndromes may be associated with supernumerary nipples. Usually no treatment is needed. The extra nipples do NOT develop into breasts at puberty.
hymenal tag – Sometimes, a small piece of pink tissue may protrude between the labia — this is a hymenal tag and it’s of no significance; it will eventually recede into the labia as the genitals grow
epispadias – Epispadias is a rare congenital (present from birth) defect in the location of the opening of the urethra. Causes: The causes of epispadias are unknown at this time. It is believed to be related to improper development of the pubic bone. In boys with epispadias, the urethra generally opens on the top or side of the penis rather than the tip. However, it is possible for the urethra to be open the entire length of the penis. In girls, the opening is usually between the clitoris and the labia, but may be in the belly area. Epispadias can be associated with bladder exstrophy, an uncommon birth defect in which the bladder is exposed, inside out, and sticks through the abdominal wall. However, epispadias can also occur alone or with defects.
hypospadias – is a somewhat common birth (congenital) defect in which the opening of the urethra is on the underside, rather than at the end, of the penis. Causes: Hypospadias affects up to 4 in 1,000 newborn boys. Some cases are passed down through families. In other cases the cause is unknown. Symptoms: The condition varies in severity. In most cases, the opening of the urethra is located near the tip of the penis on the underside. More severe forms of hypospadias occur when the opening is at the midshaft or base of the penis. Occasionally, the opening is located in or behind the scrotum. Males with this condition often have a downward curve (chordee) of the penis during an erection. (Erections are common with infant boys.)
polydactyly – Polydactyly is a condition in which a person has more than five fingers per hand or five toes per foot. Considerations: Having an abnormal number of digits (6 or more) can occur on its own, without any other symptoms or disease. Polydactyly may be passed down (inherited) in families. This trait involves only one gene that can cause several variations. African Americans, more than other ethnic groups, can inherit a 6th finger. In most cases, this is not caused by a genetic disease. Polydactyly can also occur with some genetic diseases. Extra digits may be poorly developed and attached by a small stalk (generally on the little finger side of the hand). Or, they may be well-formed and may even function. Poorly formed digits are usually removed. Simply tying a tight string around the stalk can cause it to fall off in time if there are no bones in the digit. Larger digits may need surgery to be removed. The doctor should ask the parents whether there was polydactyly at birth, because a person may
syndactyly – Syndactyly is the most common congenital malformation of the limbs, with an incidence of 1 in 2000-3000 live births.1,2 Syndactyly can be classified as simple when it involves soft tissues only and classified as complex when it involves the bone or nail of adjacent fingers. It is a shared feature of more than 28 syndromes, including Poland, Apert, and Holt-Oram syndromes. Syndactyly is a failure of differentiation in which the fingers fail to separate into individual appendages. This separation usually occurs during the sixth and eighth weeks of embryologic development. The root words of the term syndactyly are derived from the Greek words syn, meaning together, and dactyly, meaning fingers or digits.
club feet – Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which your baby’s foot is twisted out of shape or position. The term “clubfoot” refers to the way the foot is positioned at a sharp angle to the ankle, like the head of a golf club. Clubfoot is a common birth defect and is usually an isolated problem for an otherwise healthy newborn. Clubfoot can be mild or severe, affecting one or both feet. Clubfoot won’t hinder your child’s development drastically until it’s time for your child to walk. At that stage, the awkward positioning of the foot may force your child to walk on the outside edge of his or her feet.
simian crease – simian crease is a single line that runs across the palm of the hand. People normally have three creases in their palms. The term “simian crease” is not used much anymore since it tends to have a negative meaning (it refers to monkey or ape). The crease is usually just referred to as a single palmar crease.
Considerations: Strong lines (called palmar flexion creases) appear on the palms of the hands and soles of the feet. The palm normally has three of these creases. But sometimes, the horizontal creases join together to form a single one. Palmar creases develop while the baby is growing in the womb, usually by the 12th week of gestation.
A single palmar crease appears in approximately 1 out of 30 people. Males are twice as likely as females to have this condition. Some palmar creases indicate problems with development and are associated with disorders like Down syndrome.
desquamation – Shedding of the epidermis. The peeling of skin characteristic of post-mature infants.
milia – Milia are benign, self-limited lesions that manifest as tiny white bumps on the forehead, nose, upper lip, and cheeks of the newborn. Also seen in the baby’s mouth as Epstein’s pearls. Some dermatologist consider them the continuing formation of secretion glands. Do not remove, let them complete on their own.
erythema toxicum – The main symptom is a rash of small, yellow-to-white colored papules surrounded by red skin. There may be a few or several papules. They usually appear on the face and middle of the body, but may also be seen on the upper arms and thighs. The rash can change rapidly, appearing and disappearing in different areas over hours to days. The large red splotches typically disappear without any treatment or changes in skin care.
hemangiomas – A hemangioma is an abnormal buildup of blood vessels in the skin or internal organs. About 30% of hemangiomas are present at birth. The rest appear in the first several months of life. Most hemangiomas are on the face and neck.
The hemangioma may be:
- In the top skin layers (capillary hemangioma)
- Deeper in the skin (cavernous hemangioma)
- A mixture of both
- A red to reddish-purple, raised sore (lesion) on the skin
- A massive, raised tumor with blood vessels
telangiectatic nevi – a common skin condition of neonates, characterized by flat, deep-pink localized areas of capillary dilation that occur predominantly on the back of the neck, lower occiput, upper eyelids, upper lip, and bridge of the nose. The areas disappear permanently by about 2 years of age. Also called capillary flames or stork bite.
mongolian spots – is a benign flat congenital birthmark with wavy borders and irregular shape, most common among East Asians and named after Mongolians by Erwin Bälz. It is also extremely prevalent among East Africans, Polynesians, and Native Americans. It normally disappears three to five years after birth and almost always by puberty. The most common color is blue, although they can be blue-gray, blue-black or even deep brown.
Moro’s Reflex – Moro reflex is type of involuntary response that is present at birth. It normally disappears after 3 or 4 months. Considerations: The Moro reflex may be demonstrated by placing the infant face up on a soft, padded surface. The head is gently lifted with enough support to just begin to remove the body weight from the pad. (Note: The infant’s body should not be lifted off the pad, only the weight removed.) The head is then released suddenly, allowed to fall backward momentarily, but quickly supported again (not allowed to bang on the padding). The infant may have a “startled” look, and the arms fling out sideways with the palms up and the thumbs flexed. As the reflex ends, the infant draws its arms back to the body; elbows flexed, and then relax. Causes: This is a normal reflex present in newborn infants. Absence of the Moro reflex in an infant is abnormal. Presence of a Moro reflex in an older infant, child, or adult is also abnormal. Two-sided absence of the Moro reflex suggests damage to the brain or spinal cord. One-sided absence of the Moro reflex suggests the possibility of a broken shoulder bone or injury to the group of nerves that run from the lower neck and upper shoulder area. Conditions associated with such nerve injury include Erb’s palsy and Erb-Duchenne paralysis. Loss of muscle function on one side of the body may also produce an asymmetrical Moro reflex.
Babinski reflex – occurs when the big toe moves toward the top of the foot and the other toes fan out after the sole of the foot has been firmly stroked. This reflex, or sign, is normal in younger children, but abnormal after the age of 2. Considerations: Reflexes are specific, predictable, involuntary responses to a particular type of stimulation. Babinski’s reflex is one of the infantile reflexes. It is normal in children up to 2 years old, but it disappears as the child ages and the nervous system becomes more developed. It may disappear as early as 12 months. The presence of a Babinski’s reflex after age 2 is a sign of damage to the nerve paths connecting the spinal cord and the brain (the corticospinal tract). This tract runs down both sides of the spinal cord, therefore a Babinski’s reflex can occur on one side or on both sides.
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