Maternal and Child Health (Ch 24)
Terms
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- Acrocyanosis
- Cyanosis in both hands and feet that is common in newborns. Feet may be cold as well. This is caused by sluggish peripheral circulation as the newborn makes the transition from fetalnewborn circulation (the first 24hrs of life)
- Caput Succedanum
- Edema of the scalp at the presenting part of the head. It may involve wide areas of the head, or it may be the size of a large egg. The edema, which crosses the suture lines, is gradually absorbed and disappears at about the 3rd day of life. Needs no tx.
- Cavernous Hamangioma
- Dilated vascular spaces, usually raised and resemble a strawberry hemangioma in appearance. However, will not disappear with time. Tx- Subcu infusions of interferon-alfa-2a can be used to reduce these lesions in size or they can be surgically removed. Children who have this as a skin lesion may have additional ones on internal organs. Blows to the abdomen, such as from games, can cause bleeding. Crit levels or monitored at health maintenance visits to watch for internal blood loss
- Central Cyanosis
- Cyanosis of the trunk. **Cause for concern- Indicates decreased oxygenation and may be the result of a temporary respiratory obstruction or an underlying disease. Sx of the mucus membranes may relieve the problem. Always sx the mouth before the nose as sx of the nose first may trigger a reflex gasp, which may lead to aspiration if there is mucus in the posterior throat. The nose is the chief conduit of air in the newborn
- Cephalhematoma
- A collection of blood under the periosteum of the skull bone. As the bruising heals and the RBC’s are hemolyzed, additional indirect bilirubin is released (jaundice).
- Conduction
- The transfer of body heat to a cooler, solid object in contact with the baby (cold counter). Covering surfaces with a warmed blanket or towel helps to minimized conduction heat loss.
- 7. Convection
- Flow of heat from the newborn’s body surface to cooler surrounding air. The effectiveness of convection depends on the velocity of air flow (a current of air moves faster than nonmoving air). Eliminating draft (window, AC) reduces convection heat loss.
- 8. Erythema Toxicum
- Newborn rash, appears in the 1st-4th day of life, may appear up to 2 weeks of age. It begins with a papule, increases in severity to become erythema by the 2nd day, and then disappears by the 3rd day. Sometimes called a “flea-bite rash†(lesions are miniscule). No pattern, occurs sporadically and unpredictably, lasting hours or days. Caused by a newborns eosinophils reaching to the environment as the immune system matures. No tx.
- 9. Evaporation
- Loss of heat thru conversion of liquid to a vapor. Newborns are wet, and they lose a great deal of heat as the amniotic fluid on their skin evaporates. Dry the baby as quickly as possible, especially the head and face, wrap him quickly and cover the head with a cap.
- 10. Hemangioma
- Vascular tumors of the skin.
- 11. Jaundice
- Hyper bilirubinemia
- 12. Kangaroo Care
- Placing a newborn against the mother’s skin and then covering the newborn helps to transfer heat from the mother to the newborn
- 13. Kernicterus
- Permanent cell damage resulting from indirect bilirubin (about 20mg/100mL) leaves the bloodstream, causing interference with the chemical synthesis of brain cells.
- 14. Lanugo
- Fine, downy hair that covers a newborn’s shoulders, back, and upper arms, even the ears and forehead. It is rubbed away by the friction of the bedding and clothes against the newborn’s skin and disappears by age 2 weeks.
- 15. Meconium
- A sticky, tar-like, blackish-green odorless material formed from mucus, vernix, lanugo, hormones, and carbohydrates that accumulated during intrauterine life. **If a newborn does not pass a meconium stool within the 1st 24-48hrs of life, there may be a possibility of a meconium ileus, imperforated anus, or bowel obstruction should be suspected.
- 16. Millia
- Immature sebaceous glands may cause a pinpoint white papule on the cheek or across the bridge of the nose. They disappear by age 2 weeks. **Teach parents to avoid squeezing, or scratching the papules to prevent secondary infection.
- 17. Mongolian Spot
- Collection of pigment cells (melanocytes) that appear as slate-gray patches across the sacrum or buttocks and possibly on the arms and legs. Tend to occur in children of Asian, Southern European, or African extraction). Disappear by school age with no tx. **Make sure that parents understand that these are not bruises because they make think that their baby sustained an injury during the birth.
- 18. Natal Teeth
- One or two teeth may have erupted (not very common). Must be evaluated for stability and removed if loose to prevent aspiration during feeding. Any natal teeth that are not covered by the gum membrane should be removed because they can loosen.
- 19. Neonatal Period
- Birth thru the first 28 days of life
- 20. Neonate
- Growing fetus/newborn
- 21. Nevus Flammeus
- A macular purple or dark-red lesion (port-wine stain). Present at birth and typically appear on the face, although found on the thighs as well. Usually fad but some don’t, may recommend cosmetic surgery. Sometimes can be light pink and on the nape of the neck, usually don’t fade but hair covers it up. More often in females than males.
- 22. Physiologic Jaundice
- Breakdown of fetal RBC’s. The high RBC count built up in utero is destroyed, and heme and globin are released. Globin is a protein component that is reused by the body and is not a factor in the developing jaundice. Heme is further broken down into iron (which is also reused and not involved in jaundice).
- 23. Pseudomenstruation
- Mucus vaginal secretion, which is sometimes blood-tinged, caused by the action of maternal hormones. The discharge disappears as soon as the system has cleared the hormones. The discharge should not be mistake for infection or taken as an indication that trauma has occurred.
- 25. Strawberry Hemangioma
- Elevated areas formed by immature capillaries and endothelial cells. Most are present at birth in the term neonate, but they may appear up to 2 weeks after birth. Usually not present in the preterm newborn because the epidermis is not mature. Formation is associated with high estrogen levels of pregnancy. They may continue to enlarge from their original size up to one year of age. After the 1st year, they tend to be absorbed and shrink in size. Age 7- most of the lesions will have disappeared but some may hang around until age 10. Tx- hydrocortisone ointment (interferes with the binding of estrogen to its receptor sites). **Important to note- Make sure parents understand what this lesion is and that it may increase in size. Parents sometimes confuse this with cancer because an increase in size is one of the 7 danger signals of cancer. Surgical removal is not recommended as secondary infection may occur, resulting in scarring and permanent disfigurement, but laser therapy may be used.
- 26. Subconjunctival Hemorrhage
- Pressure during birth sometimes ruptures a conjunctival capillary of the eye. This appears as a red dot on the sclera, usually on the inner aspect of the eye, or as a red ring around the cornea. The bleeding is slight, no tx, and is completely absorbed within 2-3 weeks. **Parents need to know that these hemorrhages are normal variations so they won’t think that their baby is bleeding from within the eye and that his/her vision will be impacted. ***Edema may be present around the orbit of the eye or on the eyelid; this should subside after the 1st 2-3days once the kidneys are capable of evacuating fluid more efficiently. *** The cornea should appear round and proportionate in size. If a cornea is larger than usual, it may be the result of congenital glaucoma. An irregularly shaped pupil or discolored iris may denote disease. A white pupil suggests the presence of a congenital cataract.
- 27. Thrush
- A Candida (yeast) infection, which usually appears on the tongue and sides of the cheek as white or gray patches. **Sometimes a newborn may have one or two small, round, glistening, well-circumscribed cysts (Epstein’s pearls), a result of the extra load of calcium that was deposited in utero. **Parents need to be reassured that these pearl-like cysts are insignificant, require no tx, and will disappear within 1 week.
- 28. Transitional stool
- 2nd or 3rd day of life: newborn stool changes in color and consistency, becoming green and loose. *Breast-fed babies- ¾ light yellow stool s/day, stool is sweet-smelling (breast milk high in lactic acid which reduces the amount of putrefactive organisms. Formula- 2/3 bright yellow stools a day, more odor.
- 29. Vernix Casseosa
- White cream cheese-like substance that serves as a skin lubricant. Usually noticeable on the term newborn’s skin, in the skin folds, at birth. *Document the color of the vernix because it takes on the color of the amniotic fluid. ** Yellow vernixïƒ yellow amniotic fluid from bilirubin; Green vernixïƒ meconium in the amniotic fluid. **Until the first bath, handle the newborn with gloves to protect yourself, never use harsh rubbing to wash away the vernix. A newborn’s skin is tender, and breaks in the skin caused by too vigorous attempts at removal may open portals of entry for bacteria.
- 24. Radiation
- The transfer of body heat to a cooler solid object not in contact with the baby (window, AC). Moving the baby as far away as possible from the object will help.