Pediatrics
NEW BORN
Normal human gestational period is 280 days or
40 weeks calculated from the first day of the
mother’s last menstrual cycle
•Stillbirth - fetus born with no signs of life ≥24
weeks of pregnancy
•Perinatal mortality rate - stillbirths + deaths
within the first week per 1000 live births and
stillbirths
•Neonatal mortality rate - deaths of live-born
infants within the first 4 weeks of age per 1000
live births
•Neonate - infant ≤28 days old
•Preterm - gestation <37 weeks of pregnancy
Term - 37-41 weeks of pregnancy
•Post-term - gestation >42 weeks of pregnancy
•Low birthweight (LBW) - <2500 g
•Very low birthweight (VLBW) - <1500g
•Extremely low birthweight (ELBW) - <1000 g
•Small for gestational age - birthweight <10th
centile for gestational age
•Large for gestational age - birthweight >90th
centile for gestational age.
The first 28 days of life are usually considered the
newborn period (neonatal period); practically extended
in a case of a sick or premature infant
Evaluation of the Newborn Infant History:
Taking the history in newborn medicine involves three
key areas:
(1) the medical history of the mother and father,
including a relevant genetic history;
(2) the history of the mother's previous pregnancies; and
(3) the history of the current pregnancy, including
antepartum and intrapartum events
New Ballard Score for Assessment of Fetal Maturation of
Newly Born Infants
Neuromuscular Maturity
Physical Maturity
Ballard scoring system
Physical maturity
-1 0 1 2 3 4 5
Skin
Lanugo
Plantar
creases
Physical maturity (contd…)
-1 0 1 2 3 4
Breast
Eye &
Ear
Genitals,
Male
Genitals,
female
Maturity rating
Maturity Score –10 –5 0 5 10 15 20 25 30 35 40 45 50
Rating Weeks 20 22 24 26 28 30 32 34 36 38 40 42 44
new Ballard Score =
= SUM (points for each parameter)
Interpretation:
• minimum score: -13
• maximum score: 54
Posture
Square
window
(wrist)
Arm
recoil
Popliteal
angle
Scarf
sign
Heel to
Ear
Recall of the date of the last menstrual period is
the best indicator of gestational age
Other obstetric observations, such as fundal
height and early ultrasound examination, provide
supporting information
Postnatal examination can also be used
Birth weight and gestational age must be plotted
on an appropriate standard to determine if the
infant's weight is
appropriate for gestational age (AGA),
small for gestational age (SGA),
intrauterine growth restricted (IUGR), or
large for gestational age (LGA)
Birth Weight for Gestational Age (GA)
Birth Weight for Gestational Age (GA)
Causes of Variations in Neonatal Size in Relation to
Gestational Age:
Infants large for gestational age
Infant of a diabetic mother
Infants small for gestational age
Asymmetrical
Placental insufficiency secondary to pregnancy-induced
hypertension or other maternal vascular disease
Maternal age > 35 years
Poor weight gain during pregnancy
Multiple gestation
Symmetrical
Maternal drug use
Narcotics
Cocaine
Alcohol
Chromosomal abnormalities
LGA babies are at risk for
birth trauma,
hypoglycemia,
polycythemia,
congenital anomalies,
cardiomyopathy,
hyperbilirubinemia, and
hypocalcemia.
SGA babies are at risk for
fetal distress during labor and delivery,
polycythemia,
hypoglycemia, and
hypocalcemia.
In the delivery room, the examination consists
largely of
observation plus auscultation of the chest and
inspection for congenital anomalies and birth
trauma
A useful tool for immediate assessment of the newborn
Helps to identify infants requiring resuscitation
Scores given at 1 and 5 min after birth ; may be given every
5 min afterwards
A score of less than 5 indicates a need for assisted
ventilation & possible cardiac support
A score of 5-7 indicates a need for stimulation supplemental
Oxygen
Score of 8-10 reflects good oxygenation and ventilation
The Apgar Score
or
sneeze
motion
,crying
Start with observation, then auscultation of the chest,
and then palpation of the abdomen
Examination of the eyes, ears, throat, and hips should
be done last, since these maneuvers are most disturbing
to the infant.
The heart rate should range from 120–160 beats/min,
and the respiratory rate from 30–60 breaths/min
Systolic blood pressure on day 1 ranges from 50–70 mm
Hg and increases steadily during the first week of life
Skin
Head
Face
Eyes
Nose
Ears
Mouth
Neck
Chest & Lungs
Heart
Abdomen
Genitalia & Anus
Skeleton
Neurologic Examination
Skeletal examination immediately after delivery serves
two purposes:
(1)to detect any obvious congenital anomalies, and
(2)to detect signs of birth trauma, particularly in LGA
infants or those born after a protracted second stage of
labor—in whom a fractured clavicle or humerus might be
found
The umbilical cord should be examined for the number
of vessels. Normally, there are two arteries and one vein
Skin
Skin color is a useful indicator of cardiac output
Normally there is a high blood flow to the skin
Any stress that triggers a catecholamine
response redirects cardiac output away from the
skin to preserve oxygen delivery to more critical
organs
Cyanosis and pallor are thus two signs reflecting
inadequate skin oxygenation and cardiac output.
Mangolian spots:
Flat-blue or gray lesions with well-defined
margins that generally disappear in the first
few years of life
Most common over the presacral area
Secondary to melanin-containing
melanocytes found in the dermal layer
Salmon patch:
A flat vascular lesion that disappears with time
(except in nuchal area); seen over the eyelids,
glabella, nuchal area
Capillary (strawberry) hemangiomas: Macular lesion
in first few months; quickly grow in the first year of life
Nevus sebaceus: yellow-orange hairless plaques
Café-au-lait spots: tan or light brown flat lesions
Erythema toxicum:
Small papules or pustules on an erythematous base
Appear after the first day of life ;may last several weeks;
full of eosinophils if scraped
Milia: small inclusion cysts; pearly white
Cutis marmorata: vasomotor response to cold stress
Neonatal acne: can occur due to circulating androgenic
hormones
Cephalohematoma: A subperiosteal bleed; does not
cross suture lines
Caput succedaneum: A swelling of the scalp;
crosses the suture lines
Subcutaneous fat necrosis: Rubbery, firm nodules
palpated on the cheeks or buttocks, back,
extremities
Facial palsy
Clavicular fracture
Subconjunctival hemorrhage
Brachial injury:
Occurs in large infants, secondary to traction
on the head during delivery
Erb-Duchenne paralysis : injuries of upper
brachial plexus or its nerve roots (C5-C6); arm
adducted , pronated and internally rotated
Klumpke paralysis: injuries of lower brachial
plexus or its nerve roots (C7,8;T1); produces
paralysis of the hand
Infant with Erb’s palsy
•Muscles of shoulder
and upper arm chiefly
affected;
•elbow extended and
wrist flexed;
•grasp normal
Young girl with Klumpke’s palsy
•Muscles of forearm and
hand chiefly affected;
•Grasp weak and affected
limb small;
•Horner’s syndrome present
due to interruption of fibres
to cervical sympathetic trunk
Eyes:
Colobama: a defect in the lid, ranging from a small
notch to a large defect
Aniridia: absence of the iris
Ears: pre-aruicular skin tags, pre-auricular pits and
malformed ears
Neck:
Brachial cleft cysts
Congenital torticollis
Chest:
Breast hypertrophy
Supernumerary nipples
Poland syndrome: amastia, pectoralis
muscle aplasia, rib deformities; webbed
fingers, radial nerve aplasia
Pectus excavatum (funnel)
Pectus carinatum (pigeon)
Abdomen:
Masses: Hyedronephrosis, Multicystic/polycystic
kidney disease
Umbilical hernias
Omphalocele: Herniation of peritoneum and
abdominal contents into the base of umbilical cord
Gastroschisis: Herniation without sac, through an
abdominal wall defect to the side of the umbilicus
Genitourinary:
Epispadias: urethral opening located on the dorsum
of the shaft of the penis
Hypospadias: urethral opening located on the
ventral side of the shaft of the penis
Undescended testes: usually in the inguinal canal
Hydrocele: collection of fluid in the scrotum,specially
the tunica vaginalis
Hernias; usually inguinal, (usually indirect)
