ADCON

1. ADCON April 23,2010

2. DISCUSSION

3. PHYSICAL EXAMINATION OF THE NEWBORN • General appearance • Posture, skin color, physical activity, muscle tone, edema, gross congenital abnormalities, distress • Vital signs • PR, RR, BP, Temperature • Anthropometric measures • Head circumference • Weight and percentile • Length and percentile

4. PHYSICAL EXAMINATION OF THE NEWBORN • Assessment of Gestational Age • New Ballard Score • Skin • cyanosis, pallor Vernixcaseosa, hemangioma Mongolian spots, jaundice, mottling, hair tufts, rashes, plethora, erythematoxicum, portwine stain, skin turgor • Head • Macro/microcephaly, ant. and post. fontanels, Caput succedaneum, synostosis, cephalhematoma, molding, anencephaly • Face • Mobius syndrome, asymmetric appearance

5. PHYSICAL EXAMINATION OF THE NEWBORN • Eyes • exophthalmos, cyclopia, pupillary reflex, leukocoria, brushfield spots • Ears • Microtia, preauricular pits, ear tags • Nose • Choanalatresia • Mouth • Epstein pearls, macroglossia, cleft lip and palate, ranula, precocious dentition • Neck • Clavicular fracture, cystic hygroma, congenital torticollis

6. PHYSICAL EXAMINATION OF THE NEWBORN • Chest • retractions, supernumerary nipples, breath sounds • Heart • Flow murmurs, persistent murmurs, precordial activity • Abdomen • Omphalocoele, gastroschisis, scaphoid abdomen • Hips • Ortolani’s and Barlow’s sign, hip displacement • Genitalia • Hydrocoele, hymenal tag, phimosis, undescended testis, ambiguous genitalia

7. PHYSICAL EXAMINATION OF THE NEWBORN • Extremities • Syndactyly, polydactyly, Simian crease, talipesequinovarus • Trunk and spine • Spina bifida, scoliosis • Anus and rectum • Rectal patency, imperforate anus • Nervous system • Muscular activity

8. MAINTAIN BODY HEAT • Decrease the incidence for metabolic acidosis, reduce cold stress • Skin to skin contact • Radiant heat source

9. CORD CARE • Reduce bacterial colonization • Alcohol swab = EtOH 70% used in the ward

10. EYE CARE • 1% silver nitrate drops – best proven therapy to protect gonorrheal infection • 0.5% erythromycin ointment and 1.0% tetracycline ointment – alternative measures against chlamydialconjuntivitis • 2.5% povidone iodine – may also be used

11. EYE CARE • Procedure may be delayed during initial short alert period following birth to promote bonding • Once applied, should not be rinsed out

12. WHY GIVE VITAMIN K? • IM injection of 1 mg of water- soluble VitaminK– prevents hemorrhagic disease of the newborn • mod decrease of factors II, VII, IX and X • 48- 72 hours after birth • Gradual return to birth levels by 7-10 days • Transient deficiency due to: • Lack of free Vit K in mother • Absence of bacterial intestinal flora

13. NEONATAL SCREENING • Cost-effective when timely identification and prompt therapy lessen morbidity • Performed on infant heel puncture blood samples

14. NEONATAL SCREENING 1. Congenital hypothyroidism 2. Congenital adrenal hyperplasia 3. Galactosemia 4. Phenylketonuria 5. G6PD Deficiency

15. BREAST FEEDING • Nursing at least 5 min at each breast • allows baby to obtain most of the available breast contents • Provide effective stimulation for increasing milk supply • Can be extended according to comfort and desire of mother

16. Sacral Dimpling • Common • May occur as an isolated finding or as part of multiple syndromessuch as spina bifida occulta • Spinal Dysgraphism • Large size (>5mm) • Increased distance from the anus (>2.5 cm) • Association with a mass or hair, aplasia cutis and hemangioma

17. Ultrasound during 1st 3 mo of life before ossification of the posterior elements of the lower spine • costeffective, noninvasive method • Assessment of any associated lumbosacral spine abnormalities