TERMS: Neonatal Period: Birth --> 28 days of life. Term Infant: weeks of gestation

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Willis Francis
5 years ago
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1 Normal newborn

2 objectives Quickly identify any danger signs Assess the normal adaptations of a newborn after birth Identify conditions requiring special care or follow-up observation. Identify any birth defect or birth trauma; Monitor growth Counsel the mother

TERMS: Neonatal Period: Birth --> 28 days of life Term Infant: 38-42 weeks of gestation

3 TERMS: Neonatal Period: Birth --> 28 days of life Term Infant: weeks of gestation Transition Period: Phases of instability during the first 6-8 hours after birth (?????)

4 Gestational Age & Birth Weights Gestational Age: Pre-term: < 37 weeks Term: /7 weeks Post-term: 42 or more weeks Term Infant (weight classification) LGA: >4000 g AGA: g SGA: <2500 g

5 Gestational Age Classification LGA Pre-term, term, and post term infants must all be plotted to determine if they are SGA, AGA, and LGA with regards to weight, length, and head circumference. AGA SGA X X X

6 danger signs for newborn not feeding well Fast breathing, difficult breathing with severe chest in drawing,grunting,cyanosis Convulsions hypothermia, fever Reduced movement, and jaundice appearing anywhere on the first day or palmer or sole jaundice at any age

7 Newborn examination indications Immediately after birth Before discharge from maternity unit Whenever there is any concern about the infant's progress

8 Examination precaution Hand washing,hand washing,hand washing Thermal environment Light and noise Brief examination time

9 General examination Attention : at initial ex Congenital anomalies Infant has successful transition from fetal life to air breathing Gestational age,delivery medication Any sign of infection or metabolic disease

Newborn first exam APGAR Score Score 0 1 2 Heart Rate Absent <100bpm >100bpm Respiratory effort Absent, irregular Slow, crying Good Muscle tone(activity) Limp

10 Newborn first exam APGAR Score Score Heart Rate Absent <100bpm >100bpm Respiratory effort Absent, irregular Slow, crying Good Muscle tone(activity) Limp Some flexion of extremities Reflex irritability (nose suction) Active motion No response Grimace Cough or sneeze Color Blue, pale Acrocyanosis Completely pink

11 Postnatal assessment of gestational age New Ballard Score Accuracy within 1-2 weeks 2 parts Neurologic characteristic Physical characteristic Part of general examination

13 General(Growth parameters) Weight (Naked) N:( kg) full term,loss of weight is expected by 5-10% in the first few days Length(straight) N:(48-53cm ) full term Head circumference(3 measurements) N:(33-38 cm) full term

14 Vital Sign Heart Rate HR Respiratory Rate RR periodic rather than regular Temperature skin: C rectal : C Blood Pressure

15 General Well, Distress or not? skin Pink is normal Acro cyanosis is normal Cyanosis -- pallor Jaundice Common variants skin rash Erythema toxicum, mongolian spot Vigorous cry is assuring Weak cry sepsis, asphyxia, metabolic, narcotic use High pitch cry CNS causes, kernicterus

16 s 16

are sterile Appear in the first 3-4 days of life

17 Erythematous macules and firm 1-3 mm yellow or white papules Etiology obscure Papule contain eosinophils and are sterile Appear in the first 3-4 days of life Erythema Toxicum Range: Birth to 14 days Benign and self limited

18 Mongolian Spots Slate-gray to blueblack lesions Usually over lumbosacral area and buttocks Accumulation of melanocytes within the dermis Generally fade by age 1year

19 Shape of the head Fontanels? Sutures? Eyes? Nose? Mouth,lips,palate? Ears? Neck? Head and Face

20 Eye 20

21 Forceps and vacuum marks Caput succedaneum Boggy edema in presenting part of head Cross suture lines Disappear in few days Cephalhematoma Subperiosteal Weeks to resolve Dose not cross sutures Head

22 Newborn Scalp Hematomata

23 Chest Distress signs(,tachypnea,nasal flaring,asymetric chest rise,supra-sternal, intercostal, sub costal retraction Grunting ). Deformities(Pectus excavatum, carinatum) Auscultate Air entry, symmetry crepitation Breast hypertrophy Milk production No redness

24 Heart HR beats/min Color, perfusion, Central cyanosis Murmur

25 Abdomen Inspection Scaphoid Distention Abdominal wall defect (gastroschisis) Palpation; baby sucking and use warm hands Liver 2.5 cm Spleen may palpable Umbilical vessels 2 artery, one vein Hernias ; umbilical and inguinal

26 The umbilicus: Which one is normal? Normal vs. Abnormal

27 Penile size Genitalia Hypospadias, epispadias Testes 2% crypoorchid Hydrocele Female: Prominent clitoris and majora Vaginal skin tag Vaginal discharge /blood Labial fusion Anus : Patency and location

$Hip and Extremities Erb s palsy: extended arm and internal rotation with limited movement Humorus fracture,clavicle fracture Digital abnormality$

28 Hip and Extremities Erb s palsy: extended arm and internal rotation with limited movement Humorus fracture,clavicle fracture Digital abnormality Syndactaly, brachdactaly, polydactaly Single palmar crease Hip dislocation Feet deformities Back and spine abnormal curvature Sinus tract, tuft of hair

29 Hip Exam

30 Neonatal reflexes Also known as developmental, primary, or primitive reflexes. They consist of autonomic behaviors that do not require higher level brain functioning. They can provide information about lower motor neurons and muscle tone. They are often protective and disappear as higher level motor functions emerge.

31 Newborn Reflexes Moro reflex Stepping reflex

32 Newborn Reflexes Palmar and plantar grasp Rooting reflex

33 Moro Onset: weeks GA Well-established: 37 weeks GA Disappearance: 4-6 months How to elicit and what is the response? An absent or inadequate Moro response on one side : hemiplegia, brachial plexus palsy, or a fractured clavicle Persistence beyond 6 months of age is : indicate severe neurological defects

34 Please contact me with any questions or concerns.

History. History and Physical Exam of the Pediatric Patient. History of Present Illness. Chief Complaint. Past Medical History. Past Medical History

History. History and Physical Exam of the Pediatric Patient. History of Present Illness. Chief Complaint. Past Medical History. Past Medical History History History and Physical Exam of the Pediatric Patient Colleen A. Kraft, M.D., FAAP Richmond Pediatric Associates, Inc. Source Who is giving the history? Is this the patient s primary caretaker? 1