SIGNS OF HEALTHY NEONATE-WPS Office.docx

SIGNS OF HEALTHY NEONATE-WPS Office.docx

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  SIGNS OF HEALTHYNEONATE The newborn must be examined thoroughly within 24 hours of birth. . Maternal history (age, parity, medical disorders, etc.), Pregnancy prob- lems-present and past (drugs, IUFD, pre-eclampsia, IUGR, prematurity), Labor and delivery history (duration, anesth- esia, duration of PROM, Apgar score) should be obtained. Assess- ment of gestational age is done . •Examination of vital signs- 1Temperature is recorded and the site (eg. rectal, oral or axillary) is mentioned. 2Respiration: Normal, 30-60 breaths/min. May need screening with pulse oximetry (>95% and 53% difference between right hand and foot). 3. Pulse: Normal, 100-160 beats per min (bpm) and when asleep, it is around 70-80 bpm. 4Blood pressure: Normal range 45-60/25-40 mm Hg. BP is directly related to gestational age and birth weight of the infant •General examination: Skin color: It is the single most important parameter of cardiorespiratory function. a. Pallor may be due to anemia, birth asphyxia, or shock b. Cyanosis: Central cyanosis (bluish skin, including the tongue and lips lis caused by low oxygen satura tion. It may be due to congenital heart or lung disease. Desaturation of hemoglobin should be>3-5 g/dL Peripheral cyanosis (bluish skin with pink lips and tongue) may be due to drugs (nitrates or nitrites) or hereditary. It is often associated with methemoglobinemia (hemoglobin oxidizes from ferrous to ferric form). Acrocyanosis (bluish hands and feet only) may be normal immediately following birth. It may be due to cold stress. Plethora is commonly seen in infants with polycy themia. It may be seen in an overheated or over xygenated infant. Hematocrit value may be done. Jaundice: Bilirubin level >5 mg/dL . Extensive bruising may be due to difficult or traumatic delivery
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  Skin rashes: a. Miliaseen on the nose, cheeks and forehead are due to plugged sweat glands. b. Mongolian spots are bluish, often large, commonly seen on the back, buttocks or thighs. Usually present in Blacks and Asians (90%). They disappear by 4 years of age c. Erythema toxicum: These are papular lesions with an erythematous base. Commonly seen after 48 hours of birth. They resolve spontaneously. d Diaper rash usually the skinfolds are involved. It appears as erythematous plaques and the edges are well demarcated. It is a form of irritant contact dermatitis. It may be infected with Candida albicans. •Heads - Fontanels Large fontanels are associated with hypothyroi dism osteogenesis imperfecta or chromosonal anomalies (Down syndrome) Bulging fontanel may be due to increased intracranial pressure, meningitis be hydrocephalus. Depressed fontanels are seen of the dehydration A small fontanel may be due to hyperthyroidism, microcephaly or craniosynostosis . Caput succedaneum should be Calerentiated from cephalhematoma . Molding seen with prolonged labor Usually molding subsides within 5 days. Cephalhematoma is due to subperiosteal hemorrhage resulting from a traumatic delivery.. It never extends beyond the suture line. X ray and CT scans should be taken to exclude skul fracture Hematocrit and bilirubin levels should be estimated. Aspiration of hematoma is rarely needed as they often resolve in 4-6 weeks' time. Raised intracranial pressure is diagnosed by the following signs (1) Bulging anterior fontanel, () Separation of suture lines, (iii) Paralysis of upward gaze; (iv) Prominent veins of the scalp. Craniosynostosis is the premature closure of one or more of sutures of the skull On palpation, a bony ridge is felt over the suture line and the cranial bones cannot be moved X-ray studies of the skull should be done . Neck : It is checked for movements, goiter, thyroglossal cysts, stermomastoid hematoma (sternomastoid tumor) or short neck, webbed neck (Turner's syndrome) Face and mouth:
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  Face is lookedfor hypertelorism (eyes widely separated) or low-set ears (trisomy 9 18, triploidy) or facial nerve injury. Mouth is checked for clefts (palate, lips), natal teeth, lingual frenulum (tongue tie), macroglossia (Beckwith syndrome) or oral thrush. Thrush is treated with nystatin suspension. Eyes are examined for congenital cataract, Brushfield's spots in the iris (Down's syndrome) or subconjunctival hemorrhage (traumatic delivery) and conjunctivitis Chest is examined for any asymmetry (tension pneu mothorax), tachypnea, grunting, intercostal retrac tions (respiratory distress), pectus excavatum and the breath sounds. The newborn's breasts may be enlarged (normal 1 cm in diameter) due to maternal estrogen The white discharge from nipple is common knewn as "Witch's milk" Heart is Heart is examined for rate (normal 120-160 bpm) thythm, the quality of heart sounds and presence of PD murmur, Murmurs may be associated with VSD PDA. ASD, transposition of great vessels, tetralog of Fallot, coarctation of aorta and others. Fetal echocardiography at 18-20 the antenatal diagnosis in utero. Fetal cardiac intervention in utero is a new and promising method of treatment. Abdomen is examined for any defect, e g. omphalocele ,hepatomegaly (sepsis), splenomegaly (CMV, rubella infection) or any other mass. A scap hoid abdomen may be due to diaphragmatic hernia. Umbilicus is examined for any discharge, redness or infection. A greenish-yellow colored cord suggests meconium staining (fetal distress). Single umbilical artery (more in twin births) indicates genetic (trisomy 18) and congenital anomalies (40%), and FGR. Genitalia should be examined carefully before gen der assignment. Male is examined for penis (normal kn >2 cm), testes within the scrotum, any hydrocele or hypospadias. Prepuce is normally long and phimo sis is present. Female is examined for any clitorial enlargement (maternal drug), fused labia with clito rial enlargement (adrenal hyperplasia). Blood stained vaginal discharge may be due to maternal estrogen withdrawal. Normally labia majora cover the labia minora and clitoris. Anus and rectum are checked to rule out imper ke foration and their position Meconium should be passed within 48 hours of birth. Extremities, spine and joints are examined for syn- dactyly (fusion of digits), polydactyly, Simian crease (Down's syndrome), talipes equinovarus, hip disloca tion (Ortolani and Barlow maneuvers). Nervous system is examined for any Irritability abno rmal muscle tone, reflexes, cranial and peripheral ti nerves (Erb's paralysis, see p. 455). Neurological devel- opment is dependent on gestational age. The reflexes Including Moro reflex are present at birth. REFLEX BEHAVIORS: (A) Muscle tone: Hypotonia (flop piness) or hypertonia (increased resistance) is examined B) Reflexes:
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  Rooting reflex -directionand open her mouth. Glabellar reflex: To tap gently over the forehead and the eyes will blink Grasp reflex (Palmar grasp): Place a finger in the open palm of the infant's hand and the infant will grasp the finger. Moro reflex: The infant is supported from behind the upper back with one hand and then the baby is allowed to drop back ≥1 cm but not on the mattress. The baby will symmetrically abduct, extend the arms and fingers This is followed by flexion and adduction of the arms. Asymmetry may signify a fractured clavicle, hemiparesis or brachial plexus injury. An absent Moro reflex may Signify CNS pathology. Sucking and swallowing reflexes: A normal infant starts sucking when something( nipple and the areola ) touches the palate.Baby swallows when the mouth is filled with milk .