Appearance of a Newborn

Presented by the Group 4

Paclibar, Jonie Rey Aquino, Jhan Ivy
Castillo, Divine Catama, Babylyn
Estandarte, Kevin Mikhail Lorenzo, Trixia
Robillos, Eriluz San Miguel, Jhon Khan
Saw, Jemarlyn
 SKIN
Color - ruddy complexion because of the increased
concentration of red blood cells in blood vessels and
a decrease in the amount of subcutaneous fat, w/c
makes the blood vessels more visible.

Cyanosis – the generalized mottling of the skin

common among newborns that makes the skin in the
lips, hands and feet to appear blue due to the
immature peripheral circulation.
Acrocyanosis - or the
blueness of the hands
and feet, is a normal
phenomenon in the 24
to 48 hours after birth.

Central cyanosis - or the

cyanosis of the trunk, is
a cause concern as this
indicates decreased
oxygenation.
Hyperbilirubinemia - leads to
jaundice or the yellowing of
the skin.
- Usually occurs on the 2nd or
3rd day of life in about 50%
of all newborns.
- Skin and sclera of the eyes
appear noticeably yellow.
- This happens because of the
high red blood cell count
built up in utero is
destroyed, and heme and
globin are released.
globin - a protein component that is reused by the
body and is not a factor in the development of
jaundice.
heme - further broken down into iron and protophyrin.
iron - reused and is not involved in the jaundice.
protophyrin - further broken down into indirect
bilirubin.
indirect bilirubin - fat soluble and cannot be excreted
through the kidneys.
glucuronyl transferase - a liver enzyme that converts
indirect bilirubin into direct bilirubin.
direct bilirubin - water soluble and is incorporated into
stool and then excreted in feces.
Causes of hyperbilirubinemia:
• Immature liver function
• Cephalhematoma
• Intestinal obstruction

Kernicterus - above normal indirect bilirubin level (20

mg/100 ml) are potentially dangerous as it can
interfere with the chemical synthesis of brain cells
and result in permanent cell damage.

phototherapy - exposure of infants to light (UV) to

initiate maturation of liver enzymes.
Pallor - usually the result of anemia.
Caused by:
a)Excessive blood loss when cord was cut
b)Inadequate flow of blood from the cord into
the infant at birth
c) Feta-maternal transfusion
d)Blood incompatibility in w/c a large number of
RBC were hemolyzed in utero
e)Internal bleeding
Harlequin sign - reddening
of the lower half of the
laterally recumbent
body and blanching of
the upper half, due to
temporary vasomotor
disturbance in newborn
infants.
- fades immediately if the
infant’s position is
changed, kicks or cries
vigorously.
Birthmarks

Hemangiomas - vascular tumors of the skin.

Three types:
a. Nevus flammeus
b. Strawberry hemangioma
c. Cavernous hemangioma
 Nevus flammeus

A macular purple or
dark-red lesion that is
present at birth w/c
typically appear on the
face, although they are
often found in the thighs
as well.
Also often called as Portwine stains.
Can occur as lighter, pink patches at the nape of the neck,
known as stork’s beak marks or telangiectasia. Do not
fade and occur more often in females.
Strawberry hemangioma
Elevated areas formed by immature
capillaries and endothelial cells.
Most are present at birth in the term
neonates, although they may
appear up to 2 weeks after birth.
Typically not present in preterm
infant because of the immaturity
of the epidermis.
They may continue to enlarge from
their original sizeup to 1 year of
age and they tend to be absorbed
or shrink in size after the 1st year.
Formation is associated w/ high
estrogen levels during pregnancy.
Cavernous hemangioma
Are dilated vascular spaces w/c
are usually raised and
resemble a strawberry
hemangioma in appearance.
Do not disappear w/ time as do
strawberry hemangiomas.
Children w/ this lesion may
have additional ones on
internal organs w/c
predispose them to internal
bleeding from blows in the
abdomen while playing
actively.
Mongolian spots
- collections of
melanocytes that
appear as slate-gray
patches across the
sacrum or buttocks
and sometimes on
legs and arms.
- tend to occur in
children of Asian,
southern European,
or African ethnicity.
- disappear by school
age w/o treatment.
Vernix caseosa
White, cream cheese-like
substance that serves as a
lubricant in utero usually
noticeable on a term
newborn’s skin.

Its color follows that of the

amniotic fluid, green
vernix means that the
amniotic fluid is
meconium stained and
yellow vernix implies
presence of bilirubin in
the amniotic fluid.
Lanugo
Are fine, downy hair that covers a newborn’s shoulders,
back, and upper arms but can also be found on the
forehead and ears.
Postmature infants rarely have lanugo.
Disappear by the 2nd week of life.
Milia
Are white papules that
can be found on the
cheek or across the
bridge of the nose
of almost every
newborn. Papules
are plugged or
unopened
sebaceous lands.
Disappear by 2 to 4
weeks of age as the
sebaceous glands
mature and drain.
 Erythema toxicum

Newborn rash that usually appear in the 1st to 4th

day of life but may appear up to 2 weeks of age.
Begins w/ a papule, increases in severity by the 2nd
day and then disappears by the 3rd day.
Sometimes called flea-bite rash.
Lacks pattern and occur sporadically and
unpredictably.
Caused by newborns’ eosinophils reacting to the
environment as the immune system matures.
Erythema toxicum
Forceps marks
Forceps may leave a
circular or linear
contusion matching
the rims of the blade
forceps on the
infant’s cheek.
Disappear in 1 to 2
days, along w/ the
edema that
accompanies it.
Can cause potential
facial nerve
compression.
Skin turgor
Newborn skin should feel resilient if the underlying tissue
is hydrated.
Skin should feel elastic when a fold of the skin is grasped
between the thumb and fingers. Should fall back when
released, forming smooth surface.
Skin will not smooth out again but will remain in an
elevated ridge if severe dehydration is present.
Poor skin turgor is seen in newborns:
1. who suffered malnutrition in utero,
2. who have difficulty sucking at birth, or
3. who have certain metabolic disorders such as
adrenocortical insufficiency.
 HEAD
• Appears disproportionately large
because it is about ¼ of the total
body length.
• Forehead is large and prominent.
• Chins appear to be receding and
quivers easily when infant cries
or is startled.
• Well-nourished newborns have
full-bodied hair while poorly
nourished and preterm infants
have thin, life-less hair.
Fontanelles
The spaces or openings where skull bones join.
• Anterior fontanelle – located at the junction of the 2
parietal bones and the 2 fused frontal bones. It is
diamond-shaped and measures 2-3 cm in width and 2-4
cm in length. Normally closes at 12-18 months of age.
• It can be felt as a soft spot and should not appear
indented or bulging when the infant is held upright. The
anterior fontanelle may bulge if the newborn strains to
pass a stool or cries vigorously or is lying supine.
• Posterior fontanelle – located at the junction of the
parietal bones and occipital bone. Triangular in shape
and measures about 1 cm in length. Closes by the end of
the 2nd month.
Sutures
The separating lines of the skull that may override at birth
because of the extreme pressure exerted on the head
during passage through the birth canal. The overriding
subsides in 24-48 hours.
Should never appear widely separated in newborns w/c
may suggest increased intracranial pressure because of
abnormal brain formation, abnormal accumulation of CSF
in the cranium, or an accumulation of blood from birth
injury such as subdural hemorrhage. Fused suture lines
are also abnormal as they will prevent the head from
expanding w/ brain growth.
Molding
The part of the infant’s head that
engaged the cervix molds to fit
the cervix contours during
labor. Molding causes the
newborn’s head to become
prominent and asymmetrical
after birth.
Extreme molding usually occurs
in babies of primiparous
mothers.
The shape of the head will
normalize w/in a few days
after birth.
Caput succedaneum
The edema of the scalp at the presenting part of the head.
The edema, w/c crosses the suture lines, is gradually
absorbed and disappears at about the 3rd day of life.
Cephalhemangioma
A collection of blood between the periosteum of the skull
bone and the bone itself, caused by rupture of the
periosteal capillary because of the pressure of birth.
Blood loss is small but the swelling w/c appears in 24 hours
is usually severe and is well-outlined as an egg shape.
May be discolored (black or blue) because of coagulated
blood.
Suture lines confine cephalhematomas to individual bones,
so swelling stops at these suture lines.
It often takes weeks for cephalhematoma to be absorbed.
Craniotabes
Localized softening of the cranial bones that is probably
caused by pressure of the fetal skull against the mother’s
pelvic bone in utero.
More common among first born infants because of the
lower position of the fetal head in the pelvis during the
last 2 weeks of pregnancy in primiparous women.
Once the pressure is removed, the bones return to its
normal contour after a few months as the infant takes in
calcium in milk.
 EYES
Tearless as the lacrimal ducts are still immature.
Irises are gray or blue, sclera may also be blue because of
its thinness. Permanent color appears between 3 and 12
months of age.
Should appear clear and w/o redness or purulent discharge.
Purulent discharge w/in the 1st 24 hours after birth can
be an indication of eye infections such as Chlamydia and
opthalmia neonatorum.
Subconjunctival hemorrhage may result from pressure
during birth w/c causes conjunctival capillaries of the eye
to rupture. Bleeding is slight and requires no treatment.
It is completely absorbed w/in 2-3 weeks.
 EYES
Edema around the orbit or on the eyelids is often present
w/c remains only for about 2-3 days, until the kidneys are
capable of evacuating fluids more effectively.
Cornea should appear round and proportionate in size to
that of an adult eye. A cornea that appears larger than
usual may be the result of congenital glaucoma. An
irregularly shaped pupil or discolored iris may denote
disease such as a coloboma.
Pupil should be dark. A white pupil suggests the presence of
a congenital cataract.
 EARS
Not completely formed
Top part of external ear should be on a line drawn from
the inner canthus to the outer canthus of the eye
and back across the side of the head. Otherwise,
indicates certain chromosomal abnormalities
(trisomy 18 & 13).
Small tag of skin can be found just in front of an ear.
Preauricular dermal sinus may be present directly in
front of the ear.
Visualization of the tympanic membrane is difficult and
usually not attempted.
 NOSE
Tends to appear large for the face.
Test for choanal atresia (blockage at the rear of the
nose).
Milia are present.
 MOUTH
A newborn baby may have small white bumps on his gums.
These bumps are usually (normal) cysts, which are fluid-
filled sacs and will soon go away on their own.
Yellow-white spots may be present on the roof of a
newborn baby's mouth. These spots are known as
"Epstein's pearls" and will also go away without special
care.
Some babies are born with one or more teeth. These teeth
do not have roots and may need to be removed by a
dentist.
 NECK
Short and often chubby, with creased skin folds.
Congenital torticollis – rigidity of the neck caused by
injury to the sternocleidomastoid muscle during
birth.
Not strong enough to support the total weight of the
head but in sitting position, a newborn can make a
momentary effort at head control.
Trachea may be prominent on the front of the neck,
and the thymus may be enlarged because of the
rapid growth of glandular tissue early in life.
 CHEST
A newborn boy or girl may have swollen breasts after
birth. This is caused by hormones passed from
mother to the baby before birth. The baby's breasts
may be swollen for a few weeks. The baby's breasts
may be swollen longer if the mother is breast
feeding.
The baby's breasts may also have a milky discharge
called “witch’s milk”.
 ABDOMEN
A newborn baby's abdomen is usually round.
If the baby is premature (born too early), his or her
abdomen may be small and flat.
Scaphoid or sunken appearance may indicate missing
abdominal content contents or diaphragmatic
hernia.
Bowel sounds should be present w/in 1 hour after
birth.
 ANOGENITAL AREA
Anus should be present, patent and not be covered by a
membrane. Newborn should void w/in the 1st 24 hours
after birth
Female genitalia - Premature baby girls may have a very
prominent clitoris and inner labia. A baby born closer to
full-term has larger outer labia. Girls may have a small
amount of whitish discharge or blood-tinged mucus from
the vagina in the first few weeks. This is a normal
occurrence related to the mother's hormones.
Male genitalia - Premature boys may have a smooth, flat
scrotum with undescended testicles. Boys born later in
pregnancy have ridges in the scrotum with descended
testicles.
 BACK
The spine typically appears flat in the lumbar and sacral
area. Curves appear only after a child is able to sit
and walk.
Pinpoint opening, dimpling, or sinus tact in the skin
suggests a dermal sinus or spina bifida occulta.
Lack in folic acid during pregnancy leads to neural tube
defects in newborns.
Newborns normally assume the position maintained in
utero, w/ the back rounded and the extremities
flexed on the abdomen and chest.
 EXTREMITIES
Newborn babies like to keep their arms and legs tucked
close to their bodies. The lower legs normally curve
in because of how the baby was lying inside the
uterus.
A newborn baby's hands and feet may stay bluish in
color for several days. This is a normal response to a
baby's immature blood circulation.
The newborn babies' fingers and toes are very flexible
(bendable). If something is placed in newborn’s
palm, he or she will probably grasp and hold on to it.
End of Presentation
Evaluation