approach to the newborn

8/10/2019 Approach to the Newborn

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Approach to the Newborn:Hello, baby!

Laura Bruno, M.D.


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Proper Assessment After Birth

Estimates of gestational age: physical andneurological

Size: wt, ht, hc SGA (sym/asym), AGA, LGAArousalPosture and toneMovements: spontaneous and sym.Skin color changesRespiratory distressBirth trauma

Congenital malformations


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Milia

White papules

Sebaceous glands

Commonly on nose


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Mongolian Spot

Gray-blue

Common in dark-skinnedand Asian infants

Buttocks, or back,

shoulders

New overlying skin


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Erythema

Toxicum Maculopapular

Eosinophils

Appear after birth

Benign


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Neonatal Pustular Melanosis

Small vesicles

Pigmented macule: freckle

Polymorphonuclearleukocytes

May be present at birth


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Neonatal Acne

Fetal glandulardevelopment

Hormonal stimulation

Nose and cheeks

6 month resolution


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Strawberry Hemangioma

At birth or days after

30% newborns

Commonly on face

May grow before fading(after 1yo)

Wait and watch: canrecurr


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Port Wine Stain

Red, purple, black

Common on forehead andnape

May grow

Sturge-Weberassoc.:ophthalmic divisionof trigemminal n.


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Caf au Lait Spots

Flat and uniform

Usually benign

Associated with

neurocutaneoussyndromes: check #and size (mm.)


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Herpes Neonatorum

Vesicular

Erythema and ulceration

Via birth canal orascending

C/S mothers with visiblelesions

Isolate, viral cultures,

treatment


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Caput Succedaneum

Prolonged labor

Serosanguinous fluid

Above periosteum

Across suture lines


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Newborn Hematomas

QuickTime and a decompressor

are needed to s ee this picture.


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Cephalohematoma

Subperiostealhemorrhage

Well demarcated

Resorb, calcify

Hyperbilirubinemia?


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Red Reflex

Orange in dark-skinned babies

Indicates normal lens,retina


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Leukocoria

White reflex

Retinoblastoma: 30% b/l

Retinal abnormalities


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Subconjunctival Hemorrhage

Birth trauma: even c/s

Benign

Spontaneous

resolution in days


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Conjunctivitis

Chemical early onset,resolves 2-3 days,esp.silver nitrate

Gonococcal onset at 2-3days of life, intense

Chlamydial onset at 1-2weeks of life, assoc. pneumonia

Gram stain and cx, treat


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Preauricular Skin Tag

Associated with renalagenesis

Urogenitalmalformations

Deafness


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Preauricular Sinus

Failure of fusion ofhillocks arising from

branchial arches

Autosomal dominant

Recurrent infectionsrequire antibiotics


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Epsteins Pearls

White

Epithelialized

Gums = Epsteins,

may also be on roof ofmouth or soft palate


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Cleft Lip

Incomplete embryonicfusion of maxillary andnasal processes

uni- or bi-lateral

Variable severity: nasal,

maxillary, dentalinvolvement

+/- cleft palate inspection and palpation


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Cleft Palate

Failure of fusion of palatine plates

Variable severityConcerns: cosmetic;feeding: suck, milkleaks into nasal cavity-

-infection: recurrentotitis media, sinusinfections; t+ahypertrophy; speech


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Shoulder Dystocia

Can cause clavicularfracture: crepitation orcallus formation on

palpation No tx for fx

Brachial plexus injury:

Erbs palsey

Torticollis


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Erbs Palsy

Damage to 5 th and 6 th cervical roots

Paralysis of shoulderand arm

Internal rotation,ad duction, flexedwrist=waiters tip

Neuro, PT
http://www.fammed.washington.edu/network/sfm/NewbornExam/Erbs%20palsy.jpg


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Polydactyly

Hereditary

Commonly lateral to5th digit

Tag vs. well-formeddigit


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Estrogenization

Breast engorgementf/m

Swollen labiaVaginal d/cSwollen scrotum

Ligamentous laxity


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Coarctation of the Aorta

Justa-ductal narrowingSymptomatic with closureof ductus arteriosus: heartfailure, esp.if complicatedPrompt diagnosis andtreatment: femoral pulses,heart mm, 4- limb BPs Associations: TurnersSyndrome, cardiacanomalies (VSD)


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Transposition of Great

ArteriesAorta and pulmonaryartery arise from wrongventricles

Severe hypoxia, metabolicacidemia, CHFPrompt diagnosis andtreatment--cyanosis, SOB,

poor feedingSurvival depends onmixing of blood: PGs tokeep ductus open


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Congenital Diaphragmatic

Hernia1/2000 live birthsFailure of fetaldevelopmentBowel in thoraxVariable severity at

presentation: resp., bowelobstruction, asympto.(routine CXR)Flat, hollow abdomenABCs, surgery


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Umbilical Hernia

Common, ~70%infants

Usually benign

Resolution by 2 years

Incarceration


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Omphalocele

Periumbilical defect,umbilical cord involvedVariable contents: bowel,liver, spleenCovered by fetal sacPrenatal diagnosisAssociations in 50-70%cases:Trisomy, congenitalheart, GI


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Gastroschisis

Failure of lateral ventralfolds to closeSmall and large intestine

pass through No sac No umbilical cordinvolvement

Stabilize,dress,decompress, fluids,antibiotics, surgeryBetter prognosis


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Inguinal Hernia

0.5-1% term5-10% pretermR>LSoft, NT, reducibleIncreases with pressureComplications:

incarceration,strangulationSurgery


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Hypospadias

Failure of urethral folds tofuse, 1:500 newborns

Variable location: belowand proximal

Contraindication to

circumcision

Urological consult,surgery


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Sacral Dimple

Palpate entire spineWorry about large dimplesabove the anal verge, floornot visible, hair tuft, weaklower extremitiesOccult spina bifida,

bacterial portal to CSF,Meningocele,MeningomyeloceleMRI


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Meningocele

Neural crest defect:meninges +/- spinal cord(meningomyelocele)

Prenatal diagnosis: AFP,sono, amnio

Surgical repair, shunting(meningomyelocele andArnold-Chiari assoc.)

Early maternal folic acid


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Club Foot

Talipes equinovarusAbnormality of both fore-and hindfoot and ankle1-2/1000 live birthsM>FHereditary

Early intervention:manipulation and serialcasts vs. surgery


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Breastfeeding Position

Observation

Infant parallel tomothers body

Tongue below nipple


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Newborn Stool

Meconium

Breastfeeding stools

Variable frequency
http://www.breastfeedingbasics.org/graphics/introduction/adb_nutritional_healthy_stool.jpg


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Discharge Planning:

Bye-bye, baby!


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