Slide 1

NEWBORN INFANT-DR. AKIF A.B

NORMAL NEWBORNLength : 45-55cm

Head circumference : 34cm

Chest circumference :31cm

Upper to lower segment ratio : 1.7 to 1.9

Heart rate : 120-140 per minute

Respiratory rate :35-40/min

Attitude : flexion

Urine and meconium is passed within 24hrs

NORMAL NEWBORNSystolic murmur may be present - Peripheral cyanosis(acrocyanosis) may be present.

Note: Peripheral cyanosis is normal but not central cyanosis. Central cyanosis is always pathological

Normal Clinical ProblemsIn NewbornThere are few clinical problems which occur in newborn which are absolutely normal and gets compensated with time and doesnt require any treatmentMilia

Erythema toxicum

Mongolian spots

Peeling of skin

Subconjunctival haemorrhage

Breast engorgement7) Epstein pearl

8) Vaginal bleed

9) Hymenal tags

MILIA

Miliaare tiny white bumps that appear across ababy'snose, chin or cheeks.

Milia are common innewbornsbut can occur at any age.

You can't preventmilia.

no treatment is needed because they usually disappear on their own in a few weeks or months.

ERYTHEMA TOXICUM

Mongolian SpotsMongolian spotsare very common in any part of the body of dark-skinnedbabies most commonly at presacral region - They are flat, gray-blue in color (almost looking like a bruise), and can be small or large.

- They are caused by some pigment that didn't make it to the top layer when baby'sskin was being formed.

- Disappears spontaneously before 1st bday

Breast engorgement & Vaginal bleedingSeen on 3rd to 7th day of life

due to withdrawal of maternal hormones

SKIN PEELING

Epstein Pearls

NEONATAL REFLEXESRooting Reflex/suckling/swallowing reflex

Moros reflex

Palmar grasp

Crossed extensor reflex

Asymmetric tonic neck reflexes

Parachute reflex

Landau reflex

symmetric tonic neck reflexes

Appears after birthPresent since birth

Rooting/suckling/swallowing reflex

Moro Reflex

Moro reflex is present since birth

disappears by 6th month

Unilateral Moro reflex : 1) erbs palsy

2) fracture of humerus / clavicle

3) shoulder dislocation

4) Spastic Hemiplegia

- Exaggarated moro reflex : Brain damage

Watch video of asymmetric tonic neck reflex by clicking on this link https://www.youtube.com/watch?v=UWqafotPxTg

Appears at 4-6months and disappears at 8-12 months

PARACHUTE REFLEX

NEWBORN INFANT

Q. Earliest reflex to appear

Ans. Rooting ReflexRooting reflex appears at 32 wks of gestation

Q. Reflex which persists throughout life ??

Ans. Parachute ReflexParachute reflex appears at around 9th month and persists throughout life.

Q. Last reflex to appear ??

Ans. Landau ReflexLandau reflex appaears at 10th month and disappears by 24 months

Q. Newborn babies are able to breath and suck at the same time because of ??

Ans. High placed Larynx Infant's larynx is positioned high in the neck oppositeC3 or C4 (vocal cord level ) at rest and reaches C1 orC2 during swallowing. This high posit ion allows theepiglottis to meet soft palate and make a nasopharyngealchannel for nasal breathing during suckling. Themilk feed passes separately over the dorsum of tongueand the side of epiglottis, thus allowing breathing andfeeding to go on simultaneously.

Neonatal SeizuresMC type= Subtle Seizures

Best prognosis = clonic type

Worst prognosis = Myoclonic type

Etiology wise , best prognosis = Hypocalcemia

MC cause of Neonatal Seiures = Hypoxic Ischemic Encephalopathy ( Bad Prognosis)

MC cause of day 2 Seizure= Sub arachnoid Haemorrhage

Hypoglycemia can lead to seizures more commonly during Day 1 of Life

Hypocalcemia can lead to Seizures more commonly during day 2

Infant of Diabetic MotherMacrosomic baby

prone to Respiratory distress Syndrome since Insulin decreases Surfactant levels

prolongs neonatal jaundice

leads to Polycythaemia sluggish flow Renal Vein thrombosis

MC congenital defect = VSD > Anencephaly

Most specific = Sacral agenesis

MC complication during delivery = Shoulder Dystocia

Q. Reflex which never reappears ??

Ans. Moro Reflex

Hypothermia in neonatesShiverring mechanism is absent in Newborns

Newborns are more prone for hypothermia because of large surface area

Heat generation is by : 1) peripheral vasoconstriction

2) Non shivering thermogenesis in brown fat by adrenaline

Brown fat is located at : 1) Nape of neck

2) interscapullary region

3) around adrenal gland & Kidney

4) axillary region

Neonatal Seizures

8. Not ass. With neonatal jaundice 8. Prolongs neonatal jaundice since it contains blood

9. Edematous swelling of scalp 9. Subperiosteal swelling

Neonatal Head Injury

Neonatal Seizures

Congenital hypertrophic pyloric stenosisSymptoms doesnt appear at birth

Symptoms appear at 3rd week of life

Non bilious vomiting since obstruction is above the opening of common bile duct at 2nd part of duodenum

4) Usage of erythromycin during neonatal phase is associated with CHPS

5) Hypochloremic hypokalemic metabolic alkalosis

6) Investigation of choice : USG

7) Radiological diagnosis : pyloric thickness >4mm and pyloric length >14mm

8) Barium study : string sign /double tract sign

9) Rx: Ramstedts myomectomy operation

Congenital hypertrophic pyloric stenosis

Congenital hypertrophic pyloric stenosis

Congenital hypertrophic pyloric stenosis

Necrotising EnterocolitisSingle most important risk factor = Prematurity

Bells Staging

Neonatal Seizures

Very ImportantTo make it easy refer next slide

NECStage 1a : systemic features + GI Symptoms + Occult blood in stools = Rx : NPO + Antibiotics*3days

Stage 1b : systemic features + GI Symptoms + Gross blood in stool= Rx : NPO + Antibiotics*3days

Stage 2a : same as 1b + absent bowel sounds + Pneumatosis intestinalis = Rx : NPO + Antibiotics*7-10days

Stage 2b: same as 2b but increase in severity + x-ray showing Portal venous air = Rx : NPO + Antibiotics*10-14days

Stage 3a: same as above but increase severity + Peritonitis+X-Ray showing Ascites = Rx : NPO + Antibiotics+ supportive

Stage 3b: same as above + Pneumoperitoneum= Surgery

Q. 30wks,1.2kg,3b NEC on ventilator, TOC ??

Ans. Peritoneal Lavage You must be thinking answer as Surgery since it is mentioned 3b type NEC

BUT you should see that baby is on ventilator and is hence unfit for Surgery,

Hence, best management is Lavage

NEC

PneumoperitoneumPneumatosis intestinalis

Neonatal Seizures