Normal Newborn

127
NORMAL NEWBORN Prof. RODOLFO C. NG, MD, FPPS, FSPCCMP, FPSCCM, MAEd 1

Transcript of Normal Newborn

Page 1: Normal Newborn

NORMAL NEWBORN

Prof. RODOLFO C. NG, MD, FPPS, FSPCCMP, FPSCCM, MAEd

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Pattern of Successful Transition from Intrauterine to Extrauterine Life…..

Expansion of lungs following initiation of first several breaths which clear the fetal lung fluid and termination of right-to-left shunting

Elevation of P02 in both the alveoli and the arterial circulation (50-70 mm Hg)

Decrease in pulmonary vascular resistance

Conversion from fetal to neonatal circulation

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Transitional Period:The First 6 Hours of Adaptation From Intrauterine to Extrauterine Life

Patterns of Activity A. First 15 to 30 minutes 1. immediate tachycardia to 160-180

beats/min, gradual drop to 100-120 beats/min.

2. irregular respirations, tachypnea to 60-80/min, brief apnea.

3. moist-sounding lung fields, transient grunting and retraction.

4. awake, moving, alert, easily startled, crying, transient tremors.

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Next 60 to 90 minutes…..

1. sleepy, or sleeping, somewhat unresponsive.

2. Heart rate 100-120 beats/min, transient tachycardia.

3. RR 50-60/min, transient tachypnea4. Usually, passage of meconium.

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The next 10 min to several hours…

Again, awake, alert, easily startled, crying, easily stimulated, and reactive

At last, behaving like a baby, “Over” being born, eager for

feeding and the world, and eager at times for sleep.

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Routine Newborn Care…..

Thermoregulation: > First temperature reading – rectal*

route; succeeding readings-axillary route. > whenever possible, a digital

thermometer is preferred over a mercurial thermometer

> delivery room temp. should be at 250 to 280C w/o drafts

> Keep baby temperature between 36.50 to 37.50C

*not affected by the environment

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Thermoregulation…..

Kangaroo Mother Care - skin to skin contact specific for low

birth weight babies

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Latching on…..

Initiating breastfeeding within 1 hour after birth

Check for signs of the baby’s readiness to breastfeed (e.g., baby looking around/moving, mouth open, searching)

Neonatal risk of death increased by delayed initiation of breastfeeding

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Neonatal Risk of Death…..

Breastfeeding RR of DeathWithin 1hr 1Day 2 4Day 3 5After day 3 11

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Cord care…..

Initial cord care should include an iodophor solution for its bactericidal properties, followed by 70% alcohol.

Thereafter, 70% alcohol may be continued as an antiseptic agent to minimize microbial colonization

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Eye care…..

Erythromycin 0.5% or tetracycline 1% eye ointment should be applied soon after birth to prevent gonococcal or chlamydia opthalmia.

Bathing: between 1-4 hours after birth. Immediate bathing is indicated for babies born to mothers with infection like HIV.

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Vitamin K…..

Natural vitamin K1 oxide (phyto nadione) 1 mg IM for term; 0.5 mg IM for prematures to prevent Hemorrhagic Disease of the Newborn.

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Other preventive care…..

BCG Hepatitis B vaccination Newborn Screening

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Danger signs to watch out for…..

Deepening jaundice up to palms and soles or persistent jaundice beyond two weeks of life

Decreased sucking reflex or refusal to feed

Unusual sleepiness No urine output for > 8 hours Temperature instability Unusual movements Fast breathing w/ or w/o cyanosis or pallor

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The Newborn Behavioral Observations System (NBO)…..

Provides a formal measure of an infant’s neurodevelopmental competencies, including state control, autonomic reactivity, reflexes, habituation, and orientation toward auditory and visual stimuli.

Used to demonstrate to parents an infant’s capabilities and vulnerabilities.

Used to support the development of positive early parent-infant relationships

Served as therapeutic alliance with the caregiver

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The First 3 Months of Life….

A period of rapid developmental transition First Month: - dominate face to face interactionso Second Month: - show a wide range of facial expressions

and emotional responses, from interest to concentration to astonishment and pleasure

o Third Month: - duration of smiles and cooing increased

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Basic Developmental Tasks…..

1. To organize his autonomic or physiologic behavior. It involves the tasks of stabilizing breathing, reducing the number of startles and tremors and maintaining temperature control.

2. To regulate or control motor behavior. This means gaining control over and inhibiting random motor movements, developing well-modulated muscle tone, and reducing excessive motor activity.

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Basic Developmental Tasks…..

3. State regulation or organization of state. This is the ability to develop robust and predictable sleep and wake states called sleep protection, or the ability to screen out negative stimuli while asleep. State control means that the infant is able to deal with stress either through self-regulation strategies like hand-to-mouth maneuvers or through communication with the caregiver by crying.

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Basic Developmental Tasks…..

4. Regulation of attentional-interactive, or social, behavior. This involves the capacity to maintain prolonged alert periods, the ability to attend to visual and auditory stimuli within his range, and the ability to seek out and engage in social interaction with the caregiver.

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First Months of Life…..

Constitute a major transition stage in the development of the parent-infant relationship.

Affective attunement between the parent and infant is taking shape.

NBO identifies where the infant needs support and how they can provide this support such as concerns about sleep and crying of the infant

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Neonatal Behavioral States of Arousal…

Deep sleep state: regular, shallow breathing, eyes closed, no spontaneous movement, and no rapid eye movement; startles or jerky movements appear at regular intervals (every 5 minutes)

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Light sleep state…..

Eyes closed, irregular respirations in depth and rate and more modulated or low motor activity; rapid eye movement is present along with facial expressions, even half-smiles, and sucking.

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Drowsy or semi-alert state…..

Eyes may be half-open or open and closed; eyelids fluttering; activity levels are variable with occasional mild startle.

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Quiet alert state…..

Bright look, focused attention on source of stimulation and minimal motor activity.

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Active alert state…..

Eyes open; considerable motor activity with thrusting movements of the extremities;fussing may or may not be present.

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Crying state…..

intense crying; require helps to stop crying.

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Organization of Autonomic or Physiological Behavior: Response to Stress (Color Change)

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Response to Stress: Startle

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Regulating or Controlling Motor Behavior: Rooting Response

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Sucking Response…..

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Hand grasp…..

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Crawling Response…..

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State Regulation or Organization of State: Habituation to Light (Flashlight)

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Habituation to Sound (Rattle)…..

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Crying…..

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Soothability…..

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Regulation of Attentional-Interactive, or Social Behavior: Response to Face and Voice

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Visual Response to Face

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Orientation to Voice and to Sound (Rattle)

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Visual Tracking (Red Ball)

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NBO Sequence

A – Autonomic: color changes, tremors, and startles

M – Motor/Reflexes: muscle tone, rooting, sucking, hand grasp, crawling response, crying, and soothability.

O – Organization of state: Habituation to flashlight/rattle

R – Responsivity: response to face and voice, visual response to face, orientation of voice/sound, visual tracking.

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Profile Elicited from NBO

Infant’s competencies Infant’s individuality Parent-child relationship Supporting strategies

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Mongolian Blue Spot

Gray or bluish pigmentation usually in the lumbo-sacral region, but maybe seen anywhere on the trunk or limbs

Common among asian newborns Occurs as a result of infiltration of

melanocytes deep in the dermis May be mistaken for bruising among

inexperienced medical personnels or MD Rx: none; disappears gradually as infant

grows older (2-4 years old)

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Erythema Toxicum (Toxic erythema; Urticaria of NB; Eosinophil rash)

Erythematous maculo-papular rashes seen anytime during 1-3 weeks of life. Not seen in preterm infants (represent an inflammatory reaction in mature skin)

Matbe mistaken for septic spots Cause unknown; suspect allergic or

immediate hypersensitivity reactions Disappear spontaneously (6 days to 2

weeks) with no treatment needed

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Vernix Caseosa

Slowy, ointment-like white substance covering the skin anywhere

Amount correlates well with age of gestation (plenty among preterm while scanty term

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Milia

Hypertrophic sebaceous glands appear as fine white spots seen on the nose and cheeks, forehead, chin

Mistaken for infection Resolves spontaneously within few

weeks after birth No treatment required

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Epithelial Pearls (Epstein pearls)

Epiderma cysts which appear as clusters of white spots in the mouth at the junction of the soft and hard palate in the midline. Less commonly on the alveolar margin or on the prepuce

Mistaken for infection Disappear spontaneously with no

treatment

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Ranula

Mucous retention cyst in the anterior part of the floor of the mouth

Often disappear spontaneously. However, if the cyst is large which can interfere with feedings, then require surgery (Marsupialization)

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Natal Teeth

Uncommon; often with positive family history of similar teeth (autosomal dominant)

Commonly occur in the central lower incisor region in pairs, loosely attached

Increased incidence of cleft lip/palate Others advocate early removal to prevent

aspiration and ulceration of the tongue Dental x-ray is always indicated to

differentiate premature eruption of deciduous teeth from supernummerary teeth (for extraction)

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Sucking Pad

Appear as dry thick mucous membrane of the lips to form a pad or callous

Cause unknown Resolve spontaneously with no

therapy

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Simple Nevus

are capillary hamangioma seen on the eyelids, bridge of nose, upper lip and nape

Grow in size for 3-7 mos, stabilizing and then involute completely over 1-5 years

Does not blanch on pressure Sturge-Weber Syndrome: nevus flammeus

of the forehead and upper lip; glaucoma and contralateral Jacksonian seizures

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Neonatal Gynecomastia/Vaginal Bleeding

Gynecomastia can occur in both sexes; gradual involution takes some months to disappear

Probably due to placental transfer of maternal estrogen, progesterone and prolactin

Breast enlargement with lactation (witch’s milk); mastitis

No treatment except antibiotic for mastitis

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Sacral Pits/Dimples

May have associated abnormalities like hemangiomata, hairy nevi, or lipomas and assocaited with tethering (tieing) of the cauda equina (diastatomyelia)

r/o fistula, require X-Ray Frequent cause of recurrent

meningitis

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Vulval tag

A long and pedunculated tag of membrane in the posterior vulval region of female NB

Resolves spontaneously

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Umbilical Cord

Normally, 2 arteries and 1 vein Average length at term 50-60 cm Greenish-yellow staining of umbilicus: rH

blood incompatibilities or with fetal distress

2 vessels (1A1V) indicates congenital renal malformations or genetic problem like Trisomy 18

Usually falls off w/in 7-10 days after birth

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Stools

Meconium stools are sticky, tarry, greenish-black stools within 48 hrs after birth

Failure to pass after 48 hrs: intestinal obstruction and Hirschprung disease

Pass before birth: fetal distress Transitional stools are softer, greenish

with mucus and occur at the time of onset of feeding

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Stools

Breastfed baby’s stools: mustard yellow or greenish yellow; soft or semi-formed and occasional liquid, faint sweet odor and pass frequently after or during feeding

Bottle-fed baby’s stool: firmer, browner, and passed less frequently; odor vary accordingly to the milk formula

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Neonatal Jaundice

Very common; 50% full term and 80% preterm infants visibly jaundiced by 3-5 days of life

Clinical jaundice once the serum bilirubin reaches 5 mg/dl

Physiologic jaundice noted after 24-48 hr of life: Term peak 3th-4th day and disappear 7th-10th

day Preterm peak 5th day and ends at 2 wk old Reasons: increase red cell mass ( high hct) and

short RBC life span ( 70-90 days which normally, 120 days

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Neonatal Jaundice

Pathologic jaundice:1. Occurs on the 1st 24 hr of life2. Bilirubin increase >0.5 mg/dl/hr3. Peak bilirubin >12 mg/dl term and >15

mg/dl preterm during the 1st wk of life4. Associated with hepatosplenomegaly5. Clinical jaundice persisting > 1 wk term

and > 2 week preterm

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Breastfeeding Jaundice

Early onset of jaundice within the first 3-4 days of life

Also called exaggerated physiologic jaundice; lack of breast milk jaundice

Factors: oral water or glucose intake; inadequate nursing and decrease stool output

Rx: continue breastfeeding; no complementary feeding

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Breast Milk Jaundice

Late-onset jaundice toward the end of 1st wk of life and persists to 3 wks to 3 mo

Etiology: unknown constituent in BM but exact mechanism unknown

Diagnosis by exclusion Rx: Bilirubin levels < 20 mg/dl : no

intervention > 20 mg/dl: stop BM X 1-2 days; resume

BM if jaundice decreases; otherwise, phototherapy

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Primitive Reflexes

Generally assesses the extent of CNS maturational development

Does not localize a particular pathological or anatomical lesion in the brain

Delayed disappearance of primitive reflexes may be an early sign of cerebral palsy

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Primitive Reflexes

Moro reflex: appear at birth and disappear at 4-5 mo

Assymetric moro reflex: fracture of humerus or clavicle; brachial plexus palsy

Grasp reflex: plantar disappear 9 mo while palmar gone 4 mo

Sucking/rooting reflexes Automatic walking reflex gone 2-3 mo Assymetric tonic reflex disappear 6 mo

(prerequisite for sitting)

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Cephalhematoma

Subperiosteal bleeding caused by rupture of small vessels in the periosteum

Often associated with caput succedaenium Not apparent at birth Swelling never crosses the suture (However if

crosses, R/0 fracture) Disappear spontaneously, sometimes accpd by

calcification and takes 2-3 months to disappear Jaundice is a common complication in the first few

week of life

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Facial Palsy

Compression of the facial nerve Caused by pressure from forceps

blade but may occur even after normal delivery

Clinically, decrease forehead wrinkling; increase eye opening; decrease naso-labial fold and flattening of corner of the mouth

Majority resolves spontaneously

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Brachial Plexus Palsy

Stretch injury to brachial plexus Major predisposing factors: shoulder dystocia

(unanticipated or unrecognized) Associated factors: fetal macrosomia; breech

delivery; multiparity; prolonged 2nd stage labor; midforceps delivery

Types: a. Erb’s Palsy: secondary to injury of C5-C6 nerve

roots (90-95%) > clinically, assymetric moro reflex; affected

arm in waiter’s tip position; decraese to absent DTR; R>L; breech-bilateral

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a. Erb’s Palsy…..

Associated findings: asphyxia; facial palsy; fractured clavicle/humerus; cephalhematoma; cervical cord injury; diaphragmatic paralysis (5%)

b. Klumpe’s Palsy: > injury to C7, C8-T1 nerve roots > loss of wrist movement and grasp

reflex > Horner’s syndrome(ptosis; miosis;

anhidrosis)c. Combination

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Brachial Plexus Palsy

Prognosis: 75-90% resolves spontaneously within weeks to 3 mo.

Recovery better for Erb’s than Klumpe’s

(+) Horner’s syndrome is a bad prognostic sign

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Postural Talipes

Breech delivery Affected foot is held in varus

(inturned) position Easily reduced by passive

manipulation or spilnting In contrast to Talipes equinovarus

(fixed flexion) can’t be passively corrected; require surgery

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Strawberry Nevi

Are dilated capillaries commonly seen among preterms

Usually not present at birth;appear w/in 1st few weeks of life

Single or multiple; may occur anywhere on the body

Disappear eventually w/ no rx

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Cavernous Hemangiomata

Bigger size of hemangioma; mixture of veins and capillaries

Majority don’t regress and may actually incraese in size

If present together with thrombocytopenia and microangiopathic changes of rbc : Kasabach-Meritt syndrome

Require surgery

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Neural Tube Defects

Inheritance: polygenic; recurrence risk 1:20 in the next pregnancy

Antenatal dx: increase alpha-fetoprotein in amniotic fluid and maternal serum during the second trimester and ultrasound

Meningocoele; meningomyelocoele; encephalocoele and spina bifida

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Hydrocephalus

Occur as an isolated congenital deformity

Commonly due to aqueductal stenosis or secondary to IVH or meningitis or neural tube defects

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Cleft Lip/ Palate

Inheritance: polygenic Cleft lip repairs first followed by

cleft palate

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Anencephaly

Causes hypopituitarism Incompatible to life (seldom live

beyond 24 hrs)

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Congenital Cataract

Inheritance: autosomal dominant May be seen in rubella or

galactosemia Rule out: retinoblastoma

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Cystic Hygroma

Cystic swelling of the lateral part of neck

Can cause dysphagia or respiratory obstruction if it enlarges rapidly

Rx: surgery

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Congenital Hip Dislocation

Common in girls and in breech presentation

Test: Ortolani test (reduction test) causes

reduction by abduction producing “clunk” (bringing back the femoral head to acetabulum)

*Early dx is crucial because it may affect baby’s crawling or walking potential later on

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Cyanosis

Central cyanosis: bluish skin including tongue and lips

> secondary to decrease 02 saturation to blood > secondary to heart or lung diseases*Peripheral cyanosis: bluish skin with pink lips and

tongue > secondary to methhemoglobinemia • Acrocyanosis: bluish hands and feet only• >normal during the first few hours of life or due to

cold stress• > poor tissue perfusion as in shock

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Down Syndrome (Trisomy 21)

Extra chromosome at 21 Parents should be screened for

translocation because of high probability to recur

Mosaic type has better developmental outcome, less complication

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Ambiguous Genitalia

UGLYS

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Osteogenesis Imperfecta (Brittle Bone Disease)

Autosomal recessive Multiple fractures and callus

formation

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Congenital Hypothyroidism (Cretinism)

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Infant of Diabetic Mother

LGA

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Hydrops Fetalis

Gross generalized edema Causes: 1. immune hydrops: Rh

isoimmunization; Rhogam 300 mg IM at 28-32 weeks gestation

2. Non-immune hydrops: TORCH; thalassemia; congenital nephrotic syndrome etc

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Impetigo

Secondary to Staph aureus

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Neonatal Opthalmia

Gonococcal: w/in 48 hrs after birth Chlamydia: 2nd week of life but may

co-exist with gonococcal

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Oral Thrush

Secondary to Candida albicans Common especially after antibiotic

therapy

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Congenital Chickenpox

Maternal history of chickenpox 14-21 days before delivery

Lesions appear by 10 days of life

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Umbilical Hernia

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Umbilical Granuloma

A pedunculated pink mass inside the umbilicus with sero-sanguinous discharge

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Inguinal Hernia

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Hydrocoele

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Hypospadia

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Imperforate Anus

VATER: vertebral abnormalities; anal atresia; TEF and radial and renal dysplasia

VACTERL: same as in VATER plus cardiac and limb abnormalities

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Meconium Staining of Skin and Nails

Sign of fetal distress Passage of meconium in NB < 34

wks gestation UNUSUAL

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pulse (normal, 120–160 beats/min), respiratory rate (normal, 30–60 breaths/min)

Blood pressure is determined if a neonate appears ill or has a heart murmur.

. Such movements tend to occur when an infant is active, whereas convulsive twitching usually occurs in a quiet state

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Edema may produce a superficial appearance of good nutrition

but the skin of the fingers and toes lacks the normal fine wrinkles when filled with fluid.

Edema of the eyelids commonly results from irritation caused by the administration of silver nitrate.

Generalized edema may occur with prematurity, hypoproteinemia secondary to severe erythroblastosis fetalis, nonimmune hydrops, congenital nephrosis, Hurler syndrome, or unknown cause.

Localized edema suggests a congenital malformation of the lymphatic system; when confined to one or more extremities of a female infant, it may be the initial sign of Turner syndrome

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Vasomotor instability and peripheral circulatory sluggishness are revealed by deep redness or purple lividity in a crying infant,

whose color may darken profoundly with closure of the glottis preceding a vigorous cry, and by harmless cyanosis (acrocyanosis) of the hands and feet, especially when they are cool

Mottling, another example of general circulatory instabilityo extraordinary division of the body from the forehead to the

pubis into red and pale halves is known as harlequin color change, a transient and harmless condition

cyanosis may be masked by the pallor of circulatory failure or anemia;

the relatively high hemoglobin content of the 1st few days and the thin skin may combine to produce an appearance of

cyanosis at a higher Pao2 than in older children.

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Pallor may represent asphyxia, anemia, shock, or edema. Early recognition of anemia may lead to a diagnosis of

erythroblastosis fetalis, subcapsular hematoma of the liver or spleen, subdural hemorrhage, or fetal-maternal or twin-twin transfusion.

Without being anemic, postmature infants tend to have paler and thicker skin than term or premature infants do.

The ruddy red appearance of plethora is seen with polycythemia.

Cavernous hemangiomas are deeper, blue masses that if large, may trap platelets and produce disseminated intravascular coagulation or interfere with local organ function

Scattered petechiae , seen on(usually the scalp or face) after difficult delivery

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vernix, skin, and especially the cord may be stained brownish yellow if the amniotic fluid has been colored by the passage of meconium during or before birth.

skin of premature infants is thin and delicate and tends to be deep red; in extremely premature infants, the skin appears almost gelatinous and bleeds and bruises easily

Fine, soft, immature hair, lanugo, frequently covers the scalp and brow and may also cover the face of premature infants. Lanugo has usually been lost or replaced by vellus hair in term infant

Tufts of hair over the lumbosacral spine suggest an underlying abnormality such as occult spina bifida, a sinus tract, or a tumor.

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nails are rudimentary in very premature infants, but they may protrude beyond the fingertips in infants born past term.

Post-term infants have peeling, parchment-like skin, a severe degree of which suggests ichthyosis congenita

Pustular melanosis, a benign lesion seen in black neonates, contains neutrophils and is ; it lasts 2–3 days

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Amniotic bands may disrupt the skin, extremities (amputation, ring constriction, syndactyly), face (clefts), or trunk (abdominal or thoracic wall defects).

Their cause is uncertain but may be related to amniotic membrane rupture or vascular compromise with fibrous band formation.

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Excessive skin fragility and extensibility with joint hypermobility suggest Ehlers-Danlos syndrome, Marfan syndrome, congenital contractural arachnodactyly, or other disorders of collagen syn

by cesarean section or breech presentation is characterized by its roundness

Premature fusion of sutures (cranial synostosis) is identified by a hard nonmovable ridge over the suture and an abnormally shaped skull.

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small fontanels suggest microcephaly, craniosynostosis, congenital hyperthyroidism, or wormian bones

3rd fontanel suggests trisomy 21 but is seen in preterm infants

Soft areas (craniotabes) are occasionally found in the parietal bones

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common in premature infants and in infants who have been exposed to uterine compression.

Soft areas in the occipital region suggest the irregular calcification and wormian bone formation associated with osteogenesis imperfecta, cleidocranial dysostosis, lacunar skull, cretinism, and, occasionally, Down syndrome

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excessively large head (megalencephaly) suggests hydrocephaly, storage disease, achondroplasia, cerebral gigantism, neurocutaneous syndromes, or inborn errors of metabolism

skull of a premature infant may suggest hydrocephaly

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Atrophic or alopecic scalp areas may represent aplasia cutis congenita

Symmetric facial palsy suggests absence or hypoplasia of the 7th nerve nucleus (Möbius syndrome).

Retinal hemorrhages are more common with vacuum-assisted deliveries resolve in most infants by 2 wk (85%) and in all infants by 4 wk

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cornea larger than 1 cm in diameter in a term infant (with photophobia and tearing) suggests congenital glaucoma

presence of bilateral red reflexes suggests the absence of cataracts and intraocular pathology

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Leukokoria (white pupillary reflex) suggests cataracts, tumor, chorioretinitis, retinopathy of prematurity, or a persistent hyperplastic primary vitreous and warrants

Dislocation of the nasal cartilage from the vomerian groove results in asymmetric nares.

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Anatomic obstruction of the nasal passages secondary to unilateral or bilateral choanal atresia results in respiratory distress.

Neonates do not have active salivation. The tongue appears relatively large

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frenulum may be short, but rarely is shortness (tongue-tied or ankyloglossia

marble-sized buccal mass is usually due to benign idiopathic fat necrosis

throat of a newborn infant is hard to see because of low arch of the palate; viewed because it is easy to miss posterior palatal or uvular clefts. The tonsils are small.

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Congenital torticollis causes the head to turn toward and the face to turn away from the affected side\

Redundant skin or webbing in a female infant suggests intrauterine lymphedema and Turner syndrome

Both clavicles should be palpated for fractures

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rate consistently over 60/min during periods of regular breathing usually indicates pulmonary, cardiac, or metabolic disease (acidosis).

rate consistently over 60/min during periods of regular breathing usually indicates pulmonary, cardiac, or metabolic disease (acidosis

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breathing of newborn infants is almost entirely diaphragmatic, so during inspiration the soft front of the thorax is usually drawn inward while the abdomen protrudes. If the baby is quiet, relaxed, and of good color, this “paradoxical movement”

breath sounds are bronchovesicular

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Transitory murmurs usually represent a closing ductus arteriosus.

Premature infants, whose resting heart rate is usually 140–,150/min, may have a sudden onset of sinus bradycardia

Pulses should be palpated in the upper and lower extremities to detect coarctation of the aorta

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oscillometric method is the easiest and most accurate noninvasive method

Renal pathology is the cause of most neonatal abdominal masses

solid flank mass may be caused by renal vein thrombosis, s/s hematuria, hypertension, and thrombocytopenia.

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Abdominal distention at birth -suggests either obstruction or perforation of GIT

result of meconium ileus; later distention suggests lower bowel obstruction, sepsis, peritonitis.

scaphoid abdomen in a newborn suggests diaphragmatic hernia

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Abdominal wall defects produce an omphalocele when through t umbilicus

gastroschisis when they occur lateral to the midline

Omphaloceles are assd with as Beckwith-Wiedemann, conjoined twins, trisomy 18, meningomyelocele, and imperforate anus

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Omphalitis is an acute local inflammation of the periumbilical tissue LEAD TO PORTAL HYPERTENSION

single umbilical artery suggests an occult renal anomaly.

imperforate hymen may result in hydrometrocolpos and a lower abdominal mass

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SCROTUM increased by the trauma of breech delivery or by a transitory hydrocele

manifestations of fetal neuromuscular disease -breech presentation, polyhydramnios, failure to breathe at birth, pulmonary hypoplasia, dislocated hips, undescended testes, thin ribs, and clubfoot.

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