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NORMAL NEWBORN

Prof. RODOLFO C. NG, MD, FPPS,


FSPCCMP, FPSCCM, MAEd

1
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

2
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.

3
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 tachypnea
4. Usually, passage of meconium.

4
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.

5
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

6
Thermoregulation…..
 Kangaroo Mother Care
- skin to skin contact specific for
low birth weight babies

7
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

8
Neonatal Risk of Death…..

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

9
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

10
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.

11
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.

12
Other preventive care…..
 BCG
 Hepatitis B vaccination
 Newborn Screening

13
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

14
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

15
The First 3 Months of Life….
 A period of rapid developmental transition
 First Month:

- dominate face to face interactions


o 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

16
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.

17
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.

18
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.

19
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

20
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)

21
22
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.

23
24
Drowsy or semi-alert state…..
 Eyes may be half-open or open and
closed; eyelids fluttering; activity
levels are variable with occasional
mild startle.

25
26
Quiet alert state…..
 Bright look, focused attention on
source of stimulation and minimal
motor activity.

27
28
Active alert state…..
 Eyes open; considerable motor
activity with thrusting movements
of the extremities;fussing may or
may not be present.

29
30
Crying state…..
 intense crying; require helps to stop
crying.

31
32
Organization of Autonomic or
Physiological Behavior: Response to
Stress (Color Change)

33
Response to Stress: Startle

34
Regulating or Controlling Motor
Behavior: Rooting Response

35
Sucking Response…..

36
Hand grasp…..

37
Crawling Response…..

38
State Regulation or Organization of
State: Habituation to Light (Flashlight)

39
Habituation to Sound (Rattle)…..

40
Crying…..

41
Soothability…..

42
Regulation of Attentional-Interactive, or
Social Behavior: Response to Face
and Voice

43
Visual Response to Face

44
Orientation to Voice and to Sound
(Rattle)

45
Visual Tracking (Red Ball)

46
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.

47
Profile Elicited from NBO
 Infant’s competencies
 Infant’s individuality
 Parent-child relationship
 Supporting strategies

48
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)

49
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

50
Vernix Caseosa
 Slowy, ointment-like white
substance covering the skin
anywhere
 Amount correlates well with age of
gestation (plenty among preterm
while scanty term

51
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

52
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

53
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)

54
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)

55
Sucking Pad
 Appear as dry thick mucous
membrane of the lips to form a pad
or callous
 Cause unknown
 Resolve spontaneously with no
therapy

56
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

57
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

58
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

59
Vulval tag
 A long and pedunculated tag of
membrane in the posterior vulval
region of female NB
 Resolves spontaneously

60
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

61
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

62
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

63
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

64
Neonatal Jaundice
 Pathologic jaundice:
 Occurs on the 1st 24 hr of life
 Bilirubin increase >0.5 mg/dl/hr
 Peak bilirubin >12 mg/dl term and >15
mg/dl preterm during the 1st wk of life
 Associated with hepatosplenomegaly
 Clinical jaundice persisting > 1 wk term
and > 2 week preterm

65
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

66
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

67
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

68
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)

69
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

70
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

71
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

72
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

73
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

74
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

75
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

76
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

77
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

78
Hydrocephalus
 Occur as an isolated congenital
deformity
 Commonly due to aqueductal
stenosis or secondary to IVH or
meningitis or neural tube defects

79
Cleft Lip/ Palate
 Inheritance: polygenic
 Cleft lip repairs first followed by
cleft palate

80
Anencephaly
 Causes hypopituitarism
 Incompatible to life (seldom live
beyond 24 hrs)

81
Congenital Cataract
 Inheritance: autosomal dominant
 May be seen in rubella or
galactosemia
 Rule out: retinoblastoma

82
Cystic Hygroma
 Cystic swelling of the lateral part of
neck
 Can cause dysphagia or respiratory
obstruction if it enlarges rapidly
 Rx: surgery

83
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

84
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

85
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

86
Ambiguous Genitalia
 UGLYS

87
Osteogenesis Imperfecta (Brittle Bone
Disease)

 Autosomal recessive
 Multiple fractures and callus
formation

88
Congenital Hypothyroidism (Cretinism)

89
Infant of Diabetic Mother
 LGA

90
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

91
Impetigo
 Secondary to Staph aureus

92
Neonatal Opthalmia
 Gonococcal: w/in 48 hrs after birth
 Chlamydia: 2nd week of life but may
co-exist with gonococcal

93
Oral Thrush
 Secondary to Candida albicans
 Common especially after antibiotic
therapy

94
Congenital Chickenpox
 Maternal history of chickenpox 14-
21 days before delivery
 Lesions appear by 10 days of life

95
Umbilical Hernia

96
Umbilical Granuloma
 A pedunculated pink mass inside
the umbilicus with sero-sanguinous
discharge

97
Inguinal Hernia

98
Hydrocoele

99
Hypospadia

100
Imperforate Anus
 VATER: vertebral abnormalities;
anal atresia; TEF and radial and
renal dysplasia
 VACTERL: same as in VATER plus
cardiac and limb abnormalities

101
Meconium Staining of Skin and Nails

 Sign of fetal distress


 Passage of meconium in NB < 34
wks gestation UNUSUAL

102
 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
103
 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
104
 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 instability
o 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.
105
 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
106
face) after difficult delivery
 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.

107
 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

108
 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.

109
 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.

110
 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
111
 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
112
 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

113
 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
114
 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

115
 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.

116
 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

117
 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
120
 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
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detect coarctation of the aorta
 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

124
 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
126
 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.
127