April 28, 2008

• Nurserying a Grudge

  At long last my week in nursery is done.

  Babies. Cute to play with, boring as all get out to examine. Although doing Ballard Scores was mildly amusing for the first day or two. Ballard scores are basically an assessment of the babies gestational age that is done on every newborn before it leaves the hospital. The scores are assessed in both neurological and physical fields.

  Or as I like to call them, “baby aerobics” because the physical half basically involves shifting the babies limbs every which way. The scarf sign is how far across to the midline or across the babies arm can be shifted. If it can go all the way to the neck like a scarf, that’s not good. The square window tests flexion of the wrist, while the popliteal angle and the heel to ear test check range of motion on the legs. The scoring is fairly subjective, but the basic idea is the more flexible the baby, the more premature by developmental gestational age it is

  Now before my new mommy readers start panicking, just because a baby receives low ballard scores does NOT mean it is actually premature. Babies can be born at full term but simply still have development remaining to go through. In other words, they simply need more womb.

  As for the other half of the ballard, well that is checking for things like lanugo, downy hair seen primarily on babies fresh out the mama, and anorexics. Also looked for are foot creases, cracked peeling skin with visible veins (baby sitting in a bathtub for 9 months is gonna peel, yo) and two other things that are good to look for and ideal for an immature person like me to carry out

  the first is ear recoil. Well developed babies, good stiff cartilage in the ears. So you flick them. Bend the ear down and watch it flick back. I could flick baby ears all day.

  The other is checking for breast buds, or the “baby nipple pinch” See, since baby has been bathing in moms hormones for 40 weeks, some of that maternal estrogen crosses the placenta and newly born babies will often have slightly elevated breast buds. We basically feel for these which in a full term developed baby are usually between 1-4 mm in height. They fade away within about a month as mom’s hormones disperse.

  So my week in nursery and that was pretty much what i saw. Oh except for my little viejo and my circus baby.

  The little viejo was a baby who i took one look at and he appeared like an old man, ready to scream from his crib, hey you kids, get off my lawn! When i was joking with the resident and PA student about it, the attending overheard and informed me that appearing like an old man was a sign of a SGA (small for gestational age) baby. Their extra skin makes them appear a little wrinkly which combined with small size gives them an old appearance.

  Look at that…i am learning to observe important things without even realizing i am doing it.

  As for my circus baby while doing a routine physical and ballard I was again joking with the PA student…”time to do a baby exam…hmm ten fingers ten toes, looks good let’s go” When as i was checking the fingers i noticed there were 12. This baby had polydactyly, something which is apparently much more common in babies than i had thought, especially so among the black population. Now these fingers were pure cartilage without bone, so the standard procedure is to tie a string around them very tight, cutting off the blood supply and within a couple weeks the offending additional appendages go all necrotic and fall off.

  I know i would be all pissed too, except that the kid would get no practical use out of these extra fingers even if we let him grow up with them. Aside from having a great way to start a conversation.

  Now I am back in the clinics, on my last week of pediatrics, which has been by far my favorite of the 6 week rotations. Possibly one or two more peds stories this week, and then next week I start two weeks of ophthalmology, one of my final two choices for what i want to be when i grow up. (the other being internal med)

  p.s. OH yeah, and greek easter, was awesome pics to follow within the week

  p.p.s. I have joined twitter because internet is my crack…follow me on rveblade if you are a member!

  • 7:56 pm
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