The

Newborn
Infant
by Dianne Jean Rubia
Group 6
Outline
01 02
History and Physical Routine
Examination Newborn Care

03 04
Circumcision Parent-Infant
Bonding
01
History and
Physical
Examination
History in Neonatal Pediatrics
● Demographic and social data
● Maternal medical conditions
○ Diabetic mothers- newborns screened for severe
hypoglycemia within the 1st 24 hours of life
● Past medical illnesses
● Previous maternal reproductive problems
● Events of current pregnancy
● Description of the labor
 Physical Examination
Initial examination
● performed as soon as possible after delivery
● Monitor vital signs, color, signs of respiratory
distress, tone, activity, and level of
consciousness until stabilization
Second examination
● more detailed
● performed within 24 hours
 Physical Examination
Infants >48 hours
● Repeat assessment
● Discharge examination within 24 hours of
discharge

For healthy infants

● Mother should be present during PE
● Determine BP if neonate is ill or has a heart
murmur
 Assessment

Pulse Rate Respiratory Rate Temperature

120-160 beats/min 30-60 cycles/min 36.5-37.5℃

Length Head
Weight
circumference
10-90th percentile →AGA Proper position: legs from glabella to occiput
<10th percentile→ SGA straight, head and feet
>95th percentile →LGA flat against the board
<5th percentile→ IUGR
General Appearance
● active and passive muscle tone and
any unusual posture
● coarse, tremulous movements with
ankle and jaw myoclonus are common
● convulsive twitching
● edema
○ generalized vs. localized
 SKIN

Acrocyanosis
● deep redness and purple lividity
● due to vasomotor instability and
peripheral circulatory sluggishness
● harmless cyanosis
SKIN

Mottling
● General circulatory instability
● Associated with serious illness or
related to transient fluctuation in
skin temperature
SKIN

Jaundice
● Pathologic: Jaundice that appears
within 24 hours after birth; must be
evaluated
● Physiologic: Jaundice that appears
after 24 hours
SKIN

Jaundice
SKIN

Harlequin Color Change

● Extraordinary division of the body

into red and pale halves
○ Forehead to pubis
● Transient and harmless
SKIN

Pallor
● Caused by anemia, asphyxia, shock,
or edema
SKIN

Polycythemia Vera

● ruddy appearance of plethora

SKIN

Mongolian Spots
● Slate-blue, well-demarcated areas of
pigmentation
● Seen over the buttocks and back
● No anthropologic significance
● Disappear within the first year
 Skin
Premature Extremely
Infants Premature Infants

Thin and delicate Gelatinous and translucent

SKIN

Lanugo
● fine, soft, immature hair
● frequently covers the scalp and brow
and may also cover the face of
immature infants
SKIN

Tufts of Hair
● Over the lumbosacral spine
● Suggest an underlying abnormality
○ Occult spina bifida
○ A sinus tract
○ A tumor
SKIN Erythema toxicum Pustular melanosis
characteristics small, white papule on an
vesicopustular eruption
erythematous base

duration develops 1-3 days after birth; present at birth;

resolves after 1 week resolves after 2-3 days

distribution chin, neck, back, soles and palms of

face, trunk, and extremities
soles of extremities

contains eosinophils contains neutrophils

SKULL
Subgaleal
Caput succedaneum Cephalohematoma
hemorrhage

Circular boggy area of edema

Well-circumscribed fluid-filled Larger, more diffuse; may
characteristics due to scalp pressure from the
mass result to hypovolemic shock
uterus, cervix or pelvis

distribution indistinct borders Does not cross suture lines can cross suture lines

development develops over the first few

present at birth
hours of life
SKULL

Microcephaly Megalencephaly
excessively small head excessively large head

hydrocephaly, storage disease,

Underlying genetic disorder, congenital achondroplasia, cerebral gigantism,
infection, intrauterine drug exposure neurocutaneous syndromes, inborn
errors of metabolism
FACE
Dysmorphic features

● Epicanthal folds
● Widely or narrowly spaced eyes
● Microphthalmos
● Asymmetry
● Long philtrum
● Low-set ears
EYES

Eyes
● Open spontaneously when infant is held up
and tipped gently forward and backward
● Retinal hemorrhages are more common with
vacuum or forceps-assisted delivery
○ Bilateral, intraretinal, in the posterior pole
 EYES

Pupillary Light Reflex

● Present after 28-30 weeks of
gestation

Congenital Glaucoma
● Cornea > 1 cm in a term infant
(with photophobia and tearing) or
corneal clouding
 EYES
Red Reflex Leukocoria
● Absence of cataracts and ● “White” pupillary reflex
intraocular pathology ● Suggests cataracts, tumors
chorioretinitis
 Ears
● Preauricular skin tags are common
● Otoscopy
○ Short and straight external auditory
canal
○ Dull and gray tympanic membrane
 MOUTH
Natal vs. Neonatal teeth Cleft palate

Epstein pearls Ankyloglossia Sucking callus

 NECK

● Relatively short
● Congenital torticollis
○ Causes head to turn toward and
the face to turn away from the
affected side
● Clavicles are palpated for fractures
CHEST

Breast hypertrophy
- Milk may be present
○ Should not be expressed
- Supernumerary nipples and
inverted nipples should be noted
 LUNGS

● Normal respiratory rate: 30-60 breaths/minute

○ RR >60 cpm consistently 1 hour after birth →rule
out pulmonary, cardiac or metabolic disease
● Cheyne-Stokes rhythm → periodic breathing
● Breathing is almost entirely diaphragmatic
● Breath sounds are bronchovesicular
LUNGS

● Labored respirations with retractions

● Intermittent groaning
● Whining cry
● Grunting during expiration
○ Resolves 30-60 minutes after
birth →benign
 HEART

● Normal heart rate: 110-140 beats/min at rest

○ 90 beats/min in relaxed sleep
○ 180 beats/min during activity
● Transitory murmurs →closing ductus arteriosus
● Pulse oximetry screening
○ Routine screening for critical CHD
○ Performed between 24-48 hrs of life
○ ≥ 95% R hand or either foot; <3% difference
ABDOMEN

● Liver palpable 2 cm below the rib margin

● GIT gasless at birth
○ Gas seen on rectum by 24 hours old
● Diastasis recti and umbilical hernias
● Unusual masses investigated immediately
○ Renal pathology-most common
● Umbilical cord has 2 arteries 1 vein
 ABDOMEN

● Abdominal distention suggest obstruction or perforation

● Scaphoid abdomen - diaphragmatic hernia
● Abdominal wall defects
○ Gastroschisis- occur lateral to the midline
○ Omphalocoele- occur through the midline
● Omphalitis- acute inflammation of the periumbilical tissue
 GENITALS

● Genitals and mammary glands are enlarged with secretion of breasts

due to transplacentally acquired maternal hormones
● Imperforate hymen or vaginal obstruction → hydrometrocolpos
● Scrotum relatively large at birth; erection is common
● Prepuce and foreskin normally tight and adherent
● Hypospadias vs epispadias
● Most infants will void within 24 hours
ANUS

● Meconium passed within 48 hours of birth

● Assess for imperforate anus
● Bowel movement
○ 95% of preterm infants in 48 hours
○ 99% of term infants in 48 hours
 EXTREMITIES

● A fracture or nerve injury

● Hands and feet examined for:
○ Polydactyly
○ Syndactyly
○ Abnormal dermatoglyphic patterns
NEURO

Primitive
Reflexes
NEURO

● Arthrogryposis- severe positional deformations and

contractures
● Fetal neuromuscular disease:
○ Breech presentation
○ Polyhydramnios
○ Failure to breathe
○ Dislocated hips
○ Undescended testes
 02
Routine
Newborn Care
 Initial Steps
● Provide warmth
● Drying
● Tactile stimulation
● Simultaneously evaluating
○ Respiratory effort
○ Heart rate
○ Color
● Delayed cord clamping (30-60 seconds)
APGAR Score
 Ballard Score
● Assessment of gestational age
a. If scored age is within 2 weeks of gestational age suggested by
maternal dates: dates are accepted
b. If scored age is 2 weeks higher or lower, maternal date are
probably wrong
● Composed of Two Parts:
a. Neuromuscular rating
b. Physical maturity rating
Maintenance of Body Heat
● Body surface area (BSA) of a newborn is 3X that of an
adult
● Body weight = generation of body heat
● BSA = heat loss
● Mechanisms of heat loss:
○ Convection
○ Conduction
○ Heat radiation
○ Evaporation
Antiseptic Skin and Core Care

● Nursery personnel:
○ 2 min hand-to-elbow washing (initial)
○ 15-30 sec wash (subsequent)
● First bath
○ Delayed until 24 hrs of life to allow full
transition to extrauterine life (WHO)
○ Warm water or a mild nonmedicated
soap solution
Antiseptic Skin and Core Care

● Topical chlorhexidine
○ Infants born outside of birthing centers or
hospital setting, low-resource communities
● Dry cord care
○ High resource countries
● Staphylococcus aureus
○ Most frequent bacteria colonizing the cord
Antiseptic Skin and Core Care

● Vernix
○ Spontaneously shed within 2-3 days
● Diaper check before and after feeding and
when the baby cries
● Perineal area cleaned with baby wipes or with
mild soap and water
Newborn Prophylaxis
and Screening
● Vital sign monitoring
● Temperature- axillary
○ 36.5-37.4℃
● Weigh baby at birth and daily
thereafter
● 1 cm ribbon of erythromycin (0.5%)
○ Against gonococcal ophthalmia
neonatorum
● 0.5 - 1 mg of water soluble Vit K
○ Prevent hemorrhagic disease of the
newborn
● Hepatitis B immunization 0.5 ml
○ Irrespective of maternal hepatitis status
● BCG 0.05 ml ID
○ Protects against TB in infants
Newborn Screening
● Detect newborn errors of
metabolism

Hearing Screening
● Serious morbidity affecting speech and
language development
● Universal screening recommended
 Physiologic Changes in a Newborn
○ Physiologic weight loss
■ Weight loss of 10% of birth weight within the first week
○ Physiologic weight gain
■ Weight gain expected beyond 2 weeks: increase of
weight by 30 grams/day
Screening for Congenital Hip Dysplasia
Criteria for
discharge
 Circumcision
Male
- Surgical removal of some or all
foreskin of the penis
- Lower complication rate
- Reduced risk UTI in the 1st year of life,
transmission of HIV and STIs, and
penile cancer
- Health benefits not great enough to
recommend routine male circumcision
 Parent-Infant Bonding

● Attachment process
● Bonding reinforced by the
emotional support of a loving
family
● Initiated before birth
● Sensory and physical contact
 Rooming-in
● Term, healthy infants should continuously remain in
the mother’s room
● Reduce the risk of SIDS (commonly occurs at 3-4
months)
○ Place the infant supine in a bassinet
● Maintain room temperature at 22-26 ℃

Breastfeeding
● Antepartum education and encouragement
● Immediate postpartum mother-to-infant contact with
suckling
● Demand feeding
● Inclusion of maternal partners in breastfeeding
education
● Support from experienced women
 Contraindications to
Breastfeeding
● Infants with galactosemia, MSUD, and PKU
● Maternal HTLV Types 1 and 2
● Active Tuberculosis (until appropriately treated ≥2
wk
● Herpesvirus infection on breast
● Use of or dependence on illicit drugs
● Maternal treatment of radioactive compounds
Unang Yakap
 Resources

● Kliegman, R., Stanton, B., St. Geme, J. W., Schor, N. F., & Behrman, R. E. (2016).
Nelson textbook of pediatrics (Edition 20.). Philadelphia, PA: Elsevier.

● Hoffman. Bates' Guide to Physical Examination and History Taking. Twelfth

edition. Philadelphia: Wolters Kluwer, 2017.
 Thanks
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