1 / 32

Newborn infants Classification, History, physical examination and common issues

Newborn infants Classification, History, physical examination and common issues. 4 th year rotation. Course description by day1&2. Day 1:introduction to history related to newborn care PROM, oligo/poly hydramnios, vaginal delivery..etc Apgar score Resuscitation HR, Respiration, Color

jola
Download Presentation

Newborn infants Classification, History, physical examination and common issues

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

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

  2. Course description by day1&2 • Day 1:introduction to • history related to newborn care • PROM, oligo/poly hydramnios, vaginal delivery..etc • Apgar score • Resuscitation • HR, Respiration, Color • Day 2,3:Examination 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 day3,4&5 • 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: <2500gm • VLBW: <1500gm • ELBW: <1000gm • Term :completed 37 weeks gestation till 42 week • Premature; less than 37 weeks gestation

  5. Other Classification • SGA <10th centile • LGA>90th 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; babysucking 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 • Erb’s 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

More Related