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Newborn infants Classification, History, physical examination and common issues

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Fontanell, reflexes, DDH, dysmorphism and gross abnormalities, red reflex, ... Circumcision. Day5: newborn screening : Thyroid, PKU ... – PowerPoint PPT presentation

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Title: Newborn infants Classification, History, physical examination and common issues


1
Newborn infantsClassification, History, physical
examination and common issues
  • 4th year rotation

2
Course description by day12
  • Day 1introduction to
  • history related to newborn care
  • PROM, oligo/poly hydramnios, vaginal
    delivery..etc
  • Apgar score
  • Resuscitation
  • HR, Respiration, Color
  • Day 2,3Examination of newborn with unique
    component and demonistration
  • Fontanell, reflexes, DDH, dysmorphism and gross
    abnormalities, red reflex, femoral pulses see
    next
  • Performing examination independently

3
Course description by day3,45
  • Day 4
  • nutritional issues and breast feeding and
    counseling mother about
  • common issues of newborn like
  • Physiologic Jaundice
  • Umbilical care
  • Circumcision
  • Day5
  • newborn screening Thyroid, PKU
  • Screening for DDH, G6PD,, neonatal cataract by
    red reflex
  • Give write up of complete history, exam and
    counseling regarding above mentioned issues
  • Follow up visit after dicharge
  • Weight gain
  • Feeding, stooling, urination, sleeping,
    activities
  • education

4
Classification of newborn by weight and
gestational age
  • Help in predict potential problems
  • LBW
  • VLBW
  • ELBW
  • Term completed 37 weeks gestation till 42 week
  • Premature less than 37 weeks gestation

5
Other Classification
  • SGA
  • LGA90th centile
  • AGA 10-90th centiles
  • IUGR describe less than optimal pattern of
    growth over a period of time intrauterine. It is
    possible to be IUGR not SGA

6
SGA / IUGR problems
  • Stillbirth
  • More RDS
  • High mortality
  • Hpoglycemia
  • Hypocalcemia
  • Polycythemia
  • Depression needing resuscitation at birth
  • Low Apgar score

7
LGA
  • Associated with maternal diabetes
  • High fetal insulin even in absence of maternal
    diabetes
  • Morbidity
  • Birth trauma
  • Hypoglycemia
  • Polycythemia
  • Congenital heart disease TGA
  • High cesarean delivery
  • Sacral agenisis

8
Important History points in caring of newborn
  • Maternal diabetes
  • Metabolic and congenital defect
  • Polyhydramnios
  • Swallowing defect, GI obstruction
  • Oligohydramnios
  • Renal disease, pulmonary hypoplasia
  • Maternal age
  • Old age and chromosomal
  • Breach presentation
  • IUGR
  • Consanguinity, family history

9
  • Rupture of membrane
  • sepsis
  • Delivery type
  • c/s and TTN
  • Prenatal care
  • Maternal blood group
  • ABO, Rh disease
  • Infection risk
  • Maternal Hepatitis carrier
  • Maternal GBS colonization

10
Examination precaution
  • Hand washing
  • Thermal environment
  • Light and noise
  • 5-10 minutes examination time

11
Cardiopulmonary stability
  • Apgar score
  • Heart rate
  • Respiratory effort
  • Color
  • Tone
  • Reflex irritability

12
Physical Eamination
  • Vital signs
  • RR 40-60
  • HR 120-160
  • Temperature axilary 35.5-37.5
  • Over bundling
  • Heater

13
Physical Examination
  • skin
  • Pink is normal
  • Acro cyanosis is normal
  • Cyanosis
  • Bruised part look blue
  • Jaunduce
  • 1st 24 hours
  • Cephalopedal distribution
  • Pale and grayish color in anemia and acidosis
    respectively
  • Common skin rash
  • Erythema toxicum, mongolian spot,

14
General inspection
  • Flexion of upper and lower extremities
  • Cortical thumb
  • Asymetric movement
  • Brachial plexus and fractured humerous
  • Ventral, vertical suspension and head control for
    tone assessment

15
General inspection
  • Symmetry of the mouth and face
  • Facial nerve
  • Vigorous cry is assuring
  • Weak cry
  • sepsis, asphyxia,metabolic, narcotic use
  • Hoarseness
  • Hypocalcemia, airway injury
  • High pitch cry
  • CNS causes, kernicterus

16
Congenital anomalies
  • Facial gestalt overall look of facial features
    that give impression of diagnosis ie Down
    syndrome
  • Minor anomaly common and no effect on organ
    function such as simian crease or ear tag
  • Major anomaly less common and involve main organ
    dysfunction like neural tube defect, multicystic
    dysplastic, kidney

17
Head
  • Forceps and vaccum marks
  • Caput succedaneum
  • Boggy edema in presenting part of head
  • Cross suture lines
  • Disapear in few days
  • Cephalhematoma
  • Subperiosteal
  • Weeks to resolve
  • Dose not cross sutures

18
head
  • Head cicumference
  • Molding
  • Brachycephaly flat occiput
  • Widening of suture
  • Fontanelles
  • Head auscultation bruits

19
Ears, Nose, Mouth
  • Low set ears?,Preauricular pits, External meatus
    tie
  • Natal teath
  • Choanal atresia
  • Epstein pearls
  • Cleft, submucosal

20
Neck and clavicle
  • Webbing turner syndrome
  • Excess skin at base of neck posterior in Down
    syndrome
  • Goiter
  • Fracture in clavicle
  • Asymmetric moro reflex

21
Respiratory
  • Tachypnea
  • Nasal flaring
  • Respiratory effort
  • Mild retraction
  • Grunting
  • asymetric chest rise
  • supra-sternal, intercostal, subcostal retraction

22
Chest, back
  • Pectus excavatum
  • Pectus carinatum
  • Suprmammary nipple
  • Breast hpertrophy
  • Milk production
  • No redness
  • Back
  • abnormal curvature
  • Sinus trsct, tuft of hair, MMC

23
Respiratory
  • Inspection is the key
  • No grunting, flaring. Retraction
  • Auscultate
  • Air entry, symmetry
  • Early crepitation sound is transmitted upper
    sound
  • Late inspiratory crepitation

24
cardiovascular
  • HR 100-160 beats/min
  • Color, perfusion
  • Central cyanosis
  • Single S1
  • Splited S2
  • No split single ventricle, pulmonary hypertension

25
Abdomen
  • Inspection
  • Scaphoid
  • Distention
  • Abdominal wall defect (gastroschisis)
  • Palpation baby sucking and use warm hands
  • Kidneys are normaly palpable
  • Liver 2-3 cm
  • Spleen palpable
  • Umblical vessels
  • 2 artery, one vein
  • Hernias umbilical and inguinal

26
Genitalia and anus
  • Penile size
  • Hypospadias, epispadias
  • Testes
  • 2 crypoorchid
  • Hydrocele
  • Premature
  • Prminent clitoris and minora
  • Vaginal skin tag
  • Vaginal discharge /blood
  • Labial fusion

27
Extremities
  • Erbs palsy extended arm and internal rotation
    with limited movement
  • Humerous fracture
  • Digital abnormality
  • Syndactaly, brachdactaly, polydactaly
  • Single palmar crease
  • Hip dislocation
  • Female, breach

28
Anus
  • Patency
  • location

29
CNS
  • Awakenes and alertness
  • moving extremities
  • Flexed body posture
  • Minimal Head lag
  • Ventral suspension
  • Vertical suspension
  • Moro reflex

30
Postnatal assessment of gestational age( leave
nect 3 slids to NICU week)
  • Accuracy within 1-2 weeks
  • New Ballard Score
  • Neurologic characterstic
  • Physical characterstic
  • Part of general examination

31
Neuromuscular Maturity
  • Posture
  • Square window
  • Arm recoil
  • Poplitteal angle
  • Scarf sign
  • Heel to ear

32
Physical Maturity, with maturity
  • Skin thicker , less translucent, dry, peeling
  • Lanugo
  • fine non pigmented hair all over 27-28 wks
  • disappears gradually
  • Plantar surface presence or absence of creases
  • Breast areola development
  • Ear cartilage
  • Eyelid opening
  • External genitalia
  • Rugation, desend
  • Prominent labia majora
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