Medical Archive

C113.1 History in Neonatal Pediatrics

C113.2 Physical Examination of the Newborn Infant

Healthy neonates normally lose up to 7% of their birth weight in the first 5 days.
The number of wet diapers should equal age in days for the first week of life.
Birth weight should be regained by age 10-14 days.

General appearance

• Central cyanosis
  • Hyperoxia test
    • Administering 100% O2
    • Pulmonaray disease – improves with oxygen
    • CHD – persistent cyanosis

Skin

Skull

Face

• ???? ?? (nasolacrimal duct obstruction)
  • ??? ??? ??
  • ??? ???? ??? ???? ?? ?? (dacrocystostomy?)

Neck

Chest

• Maternal estrogen effect
  • Breast hypertrophy (boys & girls)
  • Galactorrhea “Witch’s milk”
    • In 5% of newborns
  • Resolve spontaneously within 2 weeks (but up to 1 year)

Lungs

Heart

• Hypertrophic cardiomyopathy in infants of diabetic mothers
  • ?Glycogen & fat deposition in intraventricular septum ? dynamic LVOT obstruction
  • Often asymptomatic, but may have respiratory distress and/or hypotension
  • Systolic ejection murmur
  • DDx) hypo plastic left heart syndrome (HLHS)
    • Isolated hypertrophy of the interventricular septum is not expected.
    • Cyanosis is always present.
  • Management
    • IV fluids & BB to increase LV blood volume
    • Spontaneous regression by age 1 d/t normalization of insulin levels.

Abdomen

• ??? ????
  • ?? ??? ?? ???? ???? ?? ?? ??? ????.
  • ??? ??? ??? ????
  • ?? ??? ??? ??? ??? ??? ??.

Genitals

Physiologic leukorrhea (whitish vaginal discharge), swollen labia
? Maternal estrogen effect

Anus

Extremities

Neurologic examination

See Chapter 21.

C113.3 Routine Newborn Care

1. 1-minute Apgar score
   • ?Cry ? oropharyngeal suctioning to clear the airway.
2. Dry and stimulate
   • Placed on mother’s chest for skin-to-skin care.
   • Helps to initiate breastfeeding
3. Routine newborn care
   • eg, Vitamin K, HBV vaccine, erythromycin eye ointment
   • Can be postponed for an hour to allow for skin-to-skin time.
4. A sponge bath with soapy water
   • Typically performed after 24 hours of life.

CBC

• Hb: ??? 14-20g/dL, ?? 2? – 18-22g/dL, ?? 3?? – 10.5-11.5 g/dL
• WBC: 10,000~20,000m3
• Platelet: ?? ??? ??

Other exams

• RR: 30-40/m, PR: 120-140/m
• ??: ?? 24?? ??. 48??? ??? ???? ?? ??
• ??: 4.5%?? undescended. (?????? 30%)

Maintenance of body heat

Antiseptic skin and cord care

Newborn prophylaxis and screening

• Preventive
  • IM vitamin K
  • Erythromycin eye ointment
  • Hepatitis B vaccine
• Screening
  • Newborn screen (metabolic/genetic disorders)
  • Hyperbilirubinemia
  • Hearing screen
  • Pulse oximetry
    • For early detection of critical CHD
    • Pre-ductal (right arm) & post-ductal (either leg)
    • Echocardiogram is indicated for a positive screen (<90% in either extremity, <95% in both upper and lower extremities, or >3% difference between upper and lower extremities)
  • Hypoglycemia (select populations)

C113.4 Circumcision

Health benefits

• Significant decrease (~10-fold) in UTIs in the first year of life
• Prevention of pathologic phimosis
• Modest reduction in the risk of penile cancer.
• Reduction in certain penile inflammatory disorders (eg, balanitis)
• Reduction in the risk of acquiring some STIs (eg, HPV) and HIV through penile-vaginal sex, especially in countries where HIV is endemic.

C113.5 Parent-Infant Bonding

Rooming-in and Breastfeeding