This is the first part of my Neonatology Powerpoint series. It comprises an illustrative demonstrations of:- Introduction to neonatology. The APGAR score General are of the newborn. Neonatal examination & assessment.

13. 1.Transient weight loss Up to 10% of the birth weight within 3-5 days.
Birth weight usually regained by the 7th day.
2.Transient erythema **first 3-7 days.
Capillary reaction for skin receptors stimulation
with different external irritants.
3.Transient changes
of heat balance
Transient hypo or hyperthermia.
4.Neonatal transient
non-hemolytic hyperbilirubinemia
Doesn’t exceed
12-15 mg/dL
50% of neonates 2nd-3rd days of life
----end of 2nd week
5.Sexual (hormonal) crisis Maternal hormonal withdrawal.
3rd – 4th days
6.The transient stool of the
newborn (meconium)
Sticky black substance,
excreted during the first few days after birth.
7.Transient dysbacteriosis Frequent watery greenish stool.
Bacterial contamination of the sterile intestine by the new milk food.

14. Clinical Hints
• A Newborn weight might be decreased in the 1st week of
life by 10% from the initial birth weight due to :
Excess extravascular fluid.
Limited Nutritional intake.

15. Sexual (hormonal) crisis
Symmetrical breast engorgement (physiological masteopathy)
Nipple discharge White transparent fluid
Desquamative vulvovaginitis Mucous vaginal discharge during the
first 3 days of life.
Pseudomenstruation 5-10 % of girls
On the 5th-8th day of life
Lasts for 1-2 days or more

17. Evaluation of the functional status & grade of maturity
APGAR score
Ability to maintain stable temperature.
Newborn reflexes.
Movement, activity & emotional reflexes.
Special tables & clinical features.
Don’t discharge
the baby!
 Birth asphyxia
 Significant congenital anomalies as:-
Cleft lip or palate, cardiac disease, chromosomal
abnormalities, hydrocephalus, meningomyelocele…
 Diagnostic work-up in progress.
 Medical /surgical problems requiring further care
as:- congenital infections, apnea episodes, drug withdrawal,
poor feeding, anemia, paralysis, blindness, abnormal
neurological function…

18. Hydrocephalus

19. Common life threatening congenital
anomalies of the newborn
Bilateral Choanal atresia Unable to pass NGT through
the nostril.
Pierre Robin syndrome Micrognathia
Airway
RD
Tracheoesophageal fistula Excessive salivation
Unable to pass NGT into
stomach
Duct-dependent congenital cyanotic heart disease
Diaphragmatic hernia scaphoid abdomen,
Bowel sounds in the chest
RD
Gastroschisis & omphalocele
Intestinal Obstruction Duodenal atresia
(anal atresia)
Neural tube defects; Meningomyelocele

20. Pierre Robin Syndrome

21. Neonatal
examination

22. Head Skin
Neck Spine
Eyes Umbilical cord
Nose Reflexes
Mouth Predictable behaviors
Ears Daily weight, feeding, voids.
Clavicle “Done once”
Chest Sleep states.
Awake states.Abdomen
Kidneys Assessment of maturity
Anus & rectum
Extremities

23. Reflexes
Sucking reflex Place finger in mouth  infant sucks right away.
Moro reflex
“Startle reflex”
Loud noise  infant extends arms & legs suddenly.
Rooting reflex Touch cheek turns head in direction of touch.
Grasping reflex Place finger in newborn’s hand  grabs & holds Klumbke's
palsy
Babiniski reflex ! Stroke sole of foot from top to bottom  toes fan out.

24. Vital signs
HR
Femoral, radial & brachial pulses
110-160 bpm
Apical pulse for 1 minute.
Can be palpated
RR 40-60 cycle/min
Initial RR: 80/min
Temperature Initially rectal.
36.2-37.5 C
BP At birth: 80/46 mmHg
By 10th day: 90/50 mmHg

25. Daily Done once
 Weight :2500-3000 g
Compare with the previous day.
5-10% weight loss is acceptable.
 Feeding.
 Voids/stools.
Length 50 cm
Head 35 cm
Chest 30 cm

27. Head
1-Size: ¼ the body.
33-35 cm in circumference.
2-Molding: asymmetry of the skull
3-Cephalhematoma.
4-Caput succedaneum.
5-Fontanelles:
--Depression;  dehydration
--Bulging  hydrocephalus
Neck
Normal: short, chubby,
with creased skin folds.
Head support is necessary.
Inspection for:-
Masses, limitation of movement or webbing.

30. 2-3 cm
3-4cm
0.5 cm
Anterior fontanelle Posterior fontanelle
Junction of Frontal & parietal bone Parietal & occipital bone.
Is hard to feel
Closes at 12-18 months 2 months
Shape

33. Anterior fontanelle

34. Eyes
Colour: *blue or grey.
Permanent colour :3-12 months
Iris: develops colour only at 3-6 months.
Lacrimal glands are not fully mature.
Subconjunctival hge.
Transient strabismus: <6 weeks, unable to focus.
Constant strabismus >6 weeks.
---further assessment..
Pupil: round & equal.
Assess light reflex.
“PERL.”
Subconjunctival
hemorrhage
Strabismus

37.  Normal red reflex of the 2 eyes should be symmetrical.
 Indications for referral to an ophthalmologist:
1) Dark spots in the red reflex,
2) A blunted red reflex on 1 side,
3) Lack of a red reflex,
4) The presence of a white reflex (retinal reflection)

39. Nose
Infants are “Obligatory nose breathers”.
Inspect:-
o The size
o Shape
o Nasal discharge on stuffiness.
o Nasal flaring.
o Choanal atresia.
Clean with bulb syringe; saline drops.

40. Choanal atresia
bulb syringe

41. Ear
Inspect for:-
Position in relation to the eyes.
Pinna normally is fully formed & firm.
Term infant Preterm infant
< 36 weeks
Pinna recoils easily. o Relatively shapeless & flat.
o Little cartilage.
o Slow recoil.
Skin tag: is harmless, but may be associated with renal disease.
Mouth
Examine palate with index finger.
Inspect for:-
o Size & shape of the tongue.
o Length of the frenulum.
o Cleft palate and/or cleft lip.
o Supranumery teeth (natal teeth).
Reflexes:-
Evaluate Sucking & rooting reflexes.

42. Skin tag: is harmless, but may be associated with renal disease.

43. Preterm infant
< 36 weeks
o Relatively shapeless & flat.
o Little cartilage.
o Slow recoil.

44. Evoked potentials
Evoked otoacoustic emission
(EOAE)
ABR
(Auditory Brainstem Response)
An Earphone produces a
sound which evokes an echo or
emission from the ear if
cochlear function is normal.
Computer analysis of EEG
waveforms evoked in response
to series of auditory stimuli.
Hearing tests in the Newborn include :
Hearing tests

46. Clinical Hints
 Early detection and ttt of hearing loss improves the outcome of speech,
language and behaviour.
 Newborn screening for early detection of hearing loss should be encouraged.
 Potential concern for hearing loss is an indication for further assessment .

47. Mouth
Examine palate with index finger.
Inspect for:-
o Size & shape of the tongue.
o Length of the frenulum.
o Cleft palate and/or cleft lip.
o Supranumery teeth (natal teeth).
Reflexes:-
Evaluate Sucking & rooting reflexes.

48. Supranumery teeth (natal teeth).

49.  Reddish in colour, smooth & puffy.
 At 24-36 hrs. of age, skin is flaky, dry & pink in colour.
 Edema around the eyes, feet, genitals.
1-Acrocyanosis
& Central cyanosis.
Lasts for 1-2 days
Due to mucous obstruction……
2-Milia Pinpoint white papules, disappear after 2-4 weeks..
3-Erythema toxicum
neonatorum.
Red blotchy rash like an allergic reaction.
Contain eosinophils.
Trunk ,extremities & face
4-Lanugo --Fine hair covering the upper arms, shoulders & back.
--Decreases as gestational age increases.
5-Vernix caseosa --White, creamy cheese like substance.
--Skin lubricant.
Benign skin lesions found in neonates

50. 6-Stork Bites
(telangiectasia)
--Pink spots found on the nape of the neck, nose,
upper eyelids & upper lip.
--Disappear within 1-2 years.
7-Mottling Generalized red and white skin discolouration .
8-Mongolian spots Collection of melanocytes that appear as patches
across the sacral area & buttocks.
9-Capillary hemangioma Nevus flammeus, Strawberry
& cavernous hemangiomas.

51. Milia Pinpoint white papules, disappear after 2-4 weeks..

52. Erythema toxicum neonatorum. Red blotchy rash like an allergic reaction.
The lesions contain eosinophils.
Trunk ,extremities & face

54. Lanugo --Fine hair covering the upper arms, shoulders & back.
--Decreases as gestational age increases.
Vernix caseosa --White, creamy cheese like substance.
--Skin lubricant.

55. nape of the neck

56. Stork Bites --Pink spots found on the nape of the neck, nose,
upper eyelids & upper lip.
--Disappear within 1-2 years.

57. Mottling Generalized red and white skin discolouration .

58. Mongolian spots Collection of melanocytes that appear as patches across
the sacral area & buttocks.

59. Nevus flammeus
Or port-wine Stain

62. Capillary hemangioma

64. Chest
Inspect:-
o Size.
N: 30-33 cm.
o Shape.
Retraction indicates RD.
o Symmetry .
o Respiratory movements:
--Normal RR: 40-60 breaths/min.
--After 4 hours: transition period 40.
o Position.
o Development of nipples & breast tissue.
Breast engorgement ;maternal hormones.
Grunting: Transient hoarse sound.
Due to mucous in the lungs.
 If retractions/ grunting aren’t clear by 4-6 hrs.…~RD.
Transient tachypnea of the newborn (TTN)

65. Chest
Inspect:-
o Size.
N: 30-33 cm.
o Shape.
Retraction indicates RD.
o Symmetry .
o Respiratory movements:
--Normal RR: 40-60 breaths/min.
--After 4 hours: transition period 40.
o Position.
o Development of nipples & breast tissue.
Breast engorgement ;maternal hormones.
Grunting: Transient hoarse sound.
Due to mucous in the lungs.
 If retractions/ grunting aren’t clear by 4-6 hrs.…~RD.
Transient tachypnea of the newborn (TTN)

68. Abdominal
examination
Kidney Anus & rectum
Palpate for
masses or
organs.
Deep palpation. Assess rectal patency with a
lubricated thermometer.
 Imperforate anus.
Umbilical cord
Inspect 3 vessels AVA.
If only 2; artery & vein observe infant closely due
to association with cardiac or renal anomalies.
 Falls off in 7-10 days.
 Let dry.

69. Examination of the umbilical cord

70. If only 2 umbilical vessels; artery & vein,
observe the infant closely due to association
with cardiac or renal anomalies.

71. Extremities
Assess muscle tone.
Note length of the arms/legs, they should be symmetrical.
Limp arms in brachial plexus palsy.
• Simian crease in the palm.
• Sole creases.
Normally: mature infant has 2/3 or full sole creases.
• Syndactyly
• Polydactyly
Spine
Assess for intact spine without masses or openings.
Spina bifida occulta. Small indentation.
Nevus pilosus. Tuft of hair.

78. Predictable behaviours
In the first few hours after delivery.
1st period of reactivity Alert & active..
Awake, crying, sucking…
Sleep phase 4 - 6 hrs.
2nd period of reactivity 2-3 hrs.
Sleep/awake during day..
Awake states
Drowsy, quiet alert.
Best time for breastfeeding
& bonding.
Active alert; crying.
Sleep states
Deep sleep
Light sleep

80. New Ballard assessment scale
1-For assessment of gestational maturity.
2-Assesses physical & neuromuscular maturity.
3--Diff. between SGA infant & miscalculated period.
Where SGA infant is gestationally mature.