Pediatrics Module 2: The Neonate

Introduction to Pediatrics and Adolescent Medicine - Module 2: The Neonate

• The history taking of pediatric patients differs from adults due to the involvement of parents as historians.

Neonatal History

• A significant part of neonatal history relies heavily on maternal and family history.
• Key elements include: maternal history, family and genetic history, previous pregnancies and outcomes, labor and delivery details, general neonatal history from birth, and general maternal history since delivery.

Components of Neonatal Evaluation

• Apgar score
• Vitals
• Age, length and weight
• Sex
• Physical examination

Apgar Scoring

• Apgar scores are used to assess the health of a newborn immediately after birth.
• They are taken at 1-minute and 5-minutes after birth.
• The score ranges from 0 to 10 and assesses: appearance, pulse rate, grimace, activity, and respiration.
• A score of 8-10 is normal, 5-7 indicates some CNS depression and 0-4 indicates severe depression, requiring resuscitation.

Newborn Vital Signs

• Heart rate: 100-165 beats/min (awake), 90-160 beats/min (sleeping), up to 180 beats/min (crying)
• Respiratory rate: 40-60 breaths/min
• Blood pressure (BP): 67-84 mmHg (systolic), 35-53 mmHg (diastolic)
• Temperature

Infant Growth

• Full-term infants typically weigh 3.5-6 kg (7lb 9oz - 13 lb)
• Weight loss of up to 5-10% is common in the first week and should be regained within 7-10 days.
• Average length at birth is 51cm or 20 inches
• Infants typically gain 10 inches during their first year and average 2 inches per year until puberty.
• Brain weight doubles by four to six months and triples by one year of age.
• Average head circumference is 35cm at birth; it typically increases by 1cm per month in the first year.

Classification by Gestational Age and Weight

• Premature infants are categorized by gestational age (<37 weeks); 37-42 weeks are considered full-term, and >42 weeks are post-term
• Infants are classified by weight categories: <1000 grams, <1500 grams, <2500 grams, and ≥2500 grams
• Furthermore, infants are categorized as small for gestational age (<10th percentile), appropriate for gestational age (10-90th percentile), and large for gestational age ( >90th percentile).

Newborn Screening

• New Mexico screens for over 45 disorders
• The 5 main categories include Amino Acid, Endocrine, Fatty Acid Oxidation, Hemoglobin and an "Other" category including Organic Acid and Bilirubin.

Common Newborn Problems

• Jaundice
• Hypoglycemia
• Murmurs
• Respiratory Distress
• Birth Trauma
• Maternal Drug Use
• Prematurity
• Multiple Births

Premature Infants' Challenges

• Physiological issues due to immaturity of tissues, organs and development (e.g., inability to maintain body temperature, breathing difficulties, poor feeding ability, risk of infections)

Newborn Examination and Reflexes

• A thorough examination in newborns assesses all vital signs, general appearance, size according to gestational age. Further assessment includes detailed inspection and palpation of the head, neck, clavicles, chest, eyes, ears, nose, throat, mouth, genitalia, anus, spine, and extremities. Newborn reflexes are also evaluated.
• 3 basic primitive reflexes are assessed.
• Additional maneuvers such as the Barlow and Ortolani tests help evaluate hip development and potential disorders.

Normal Newborn Features

• Fontanelles (soft spots on the skull)
• Bruising

Abnormal Newborn Features

• Cleft lip/palate
• Ambiguous genitalia
• Closed rectum
• Polydactyly
• Sacral dimple
• Broken clavicles
• Low-set/deformed ears
• Tongue-tie

Normal Thorax and Retractions

• Visual assessment of the thorax (chest) is critical.

Other Normal Features of Neonatal features

• Mongolian spots
• Congenital dermal melanocytosis