Examination of Newborn Baby PDF

EXAMINATION OF NEWBORN BABY Children’s new clinic 2024 Perinatal, Neonatal, and Infancy Periods Defined: 1. Perinatal Period: Definition: The period from the 28th week of gestation through the 7th day after birth. Importance: This period encompasses the time surrounding birth, dur...

EXAMINATION OF NEWBORN BABY Children’s new clinic 2024 Perinatal, Neonatal, and Infancy Periods Defined: 1. Perinatal Period: Definition: The period from the 28th week of gestation through the 7th day after birth. Importance: This period encompasses the time surrounding birth, during which the risk of mortality is significantly high for both fetuses and neonates. 2.Neonatal Period: Definition: The first 28 days after birth. Subdivisions: Very Early Neonatal Period: Birth to less than 24 hours after birth. Early Neonatal Period: Birth to less than 7 days after birth. Late Neonatal Period: 7 days to less than 28 days after birth. Infancy: Definition: The first year after birth. The initial examination of a newborn infant should be performed as soon as possible after delivery Purpouses: To determine the normalcy of different body system for healthy adaptation to extra uterine life To detect significant medical problem for immediate assessment To detect any congenital malformations To assess the need for resuscitation. Any disorder which may affect the well being of the baby. Steps Immediate assessment with APGAR score The transitional assessment during period of reactivity. The Apgar score is a practical method of systematically evaluating infants immediately after birth and is assessed at 1 and 5 min of life. Most healthy infants who appear to be in satisfactory condition may remain in skin-toskin contact with their mothers for immediate bonding and nursing. At 60 sec after complete birth of the infant (disregarding the cord and placenta), the 5 objective signs listed here are evaluated, and each is given a score of 0, 1, or 2. A total score of 10 indicates an infant in the best possible condition. An infant with a score of 0-3 requires immediate resuscitation. After a stable delivery room course, a second and more detailed examination should be performed within 24 hr of birth General appearance Skin; skull Face, ears, nose, mouth Neck Chest lungs heart Abdomen Genitals ; anus extremities Posture and movements Supine position with partial flexion of arms, legs and hands commonly turned a little to one side. Hip joints are partially abducted. Movement is most evident in face and limbs. Unusual movement or lack of movements and asymmetry should be noted and reported. Examination of the Skin Color : Acrocyanosis- appear due to immature peripheral circulation. This is a normal phenomenon in the first 24 to 48 hour after birth. Cyanosis- indicates decreased oxygenation. Pallor - caused by anemia, asphyxia, shock, or edema. Early recognition of anemia may lead to a diagnosis of fetomaternal blood transfusion, erythroblastosis fetalis, subcapsular hematoma of the liver or spleen, subdural hemorrhage, or fetal-maternal or twin-twin transfusion. Mottling - a mottled appearance known as cutis marmorata, a benign condition that will disappear. Th is condition may develop in older children when they are cold. Cavernous hemangiomas are much less common than strawberry hemangiomas, have a less predictable course. These collections of larger blood vessels are often sizable. Th ey may initially appear as bluish masses under the skin, or they may be above and below the skin, or they may be present completely under the skin, occupying an organ such as the liver In many neonates, small, white papules on an erythematous base develop 1-3 days after birth. This benign rash, erythema toxicum , persists for as long as 1 wk, contains eosinophils, and is usually distributed on the face, trunk, and extremities.  Skull A newborn’s head appears disproportionaly large because it is one fourth of the total length. Fontanelles. Eyes To visualize the retinal or red light reflex in the newborn or early infancy, hold the infant upright, cradling the head, and gently rock the infant. As the head is lowered to the exam table, the eyes usually will open. Newborn’s usually cry tearlessly because of the lachrymal ducts are nor fully mature until about 3 months of age Eyes should appear clear without any redness or purulent discharge. Examination of both eyes for the presence of a pupillary red reflex is necessary. An ophthalmoscope is used, setting the lens at zero, standing at a distance of 12 in to 18 in, and shining the light fi rst at one pupil and then at the other. A red refl ection should be present bilaterally; Mouth Should be observed for cleft lip, cleft palate and tongue-tie. On the hard palate on either side of the raphe, there may be temporary accumulations of epithelial cells called Epstein pearls. Sometimes in some newborns one or two natal teeth may have erupted. Neck The neck appears relatively short. Abnormalities are not common but include goiter, cystic hygroma, branchial cleft cysts, teratoma, hemangioma, and lesions of the sternocleidomastoid muscle that are presumably traumatic or caused by a fixed positioning in utero that produces either a hematoma or fibrosis, respectively. Pediatric Pearl: A sunken or scaphoid abdomen is always a cause for concern. Where are the intestines? Is the flat abdomen due to a diaphragmatic hernia? Is it due to poor muscle tone from a neurologic insult or fl accid musculature? In any case, it is a cause for alarm. Abdominal distention at birth or shortly afterward suggests either obstruction or perforation of the gastrointestinal tract, often as a result of meconium ileus; later distention suggests lower bowel obstruction, sepsis, or Examination of the Genitalia Female - The labia majora and labia minora appear full and puffy. The vaginal opening can be seen, as can the hymen. Some newborns have a mucous vaginal secretion, which is sometimes blood tinged, called pseudomenstuarion.  Examination of the Genitalia Male- Examination of the male genitalia involves checking for the presence of both testes in the scrotum, the shape and size of the penis, the presence of a normal-appearing foreskin, and the position of the urethral meatal opening Anus Physical examination is usually sufficient for diagnosis of imperforate anus , if the anal opening is absent or incorrectly located. However, if there is a fistula to the skin, urethra or vagina, a newborn can pass meconium; in such cases, unless a careful exam is done, imperforate anus may not be suspected. Imperforate anus with rectopenile fistula; a A catheter was inserted into the orifice of the fistula. b Fistulography showed the fistula and the end of the rectum  Extremities Careful inspection of the fingers and toes with regard to number, size, and shape is necessary. Parents focus on these areas, and if the examiner fails to find an abnormality that is present, no matter how minor, credibility with the parents is lost. Extra partial digits, connected to a finger, usually the fifth by a pedicle of skin, are not uncommon.