Common Newborn Problems on Exam Melissa Knudson-Johnson, MD If This Then That Common Newborn Problems on Exam Melissa Knudson-Johnson, MD April 19, 2018

Disclosure I do not have any relevant financial relationships with any commercial interests to disclose.

Objectives To be able to identify abnormal findings on the newborn exam. To obtain a better understanding of abnormal findings on the newborn exam and then next steps in treating them.

Jaundice If infant presents with jaundice in the first couple of weeks of life obtain neonatal bili Calculate hours of life and plug into the nomogram You can also use bili tool but I do think you have to understand how they get the numbers (nomograms)

Jaundice Term but breastfeeding still falls into the medium risk group as breastfeeding does cause less input in the first 2-5 days. Questions to ask: breast vs formula feeding how many wet diapers how many bowel movements and have they transitioned to yellow seedy has the milk come in if breastfeeding how alert/sleepy the baby is

Fever <2 months Fever is 100.4 or higher These children can turn really quickly so even if they look well and are less than 2 months they need a work-up Recommendations are that every child with temp of 100.4 or greater and that is less than 1 month gets an LP and every child 1-2 months without cause of fever gets an LP At the very least blood cultures/urine culture/ CBC with manual differential should be obtained between 1-2 months

Rashes There are a lot of common rashes in the newborn period the next few slides will review a few of the most common

Mila

Erythema Toxicum neonatorum No fever Usually resolves by day 10 Pustules will show eosinophils if cultured

Cradle cap

Newborn Acne

Thrush Nystatin solution QID for 7-10 days Education on cleaning bottles and pacifiers very important

Needs admission for IV acyclovir immediately Herpes Simplex Virus Needs admission for IV acyclovir immediately

Sutures and Fontanelle Over-riding sutures Prematurity Very large anterior fontanelle Achrondroplasia, down syndrome, hypothyroidism, increased intracranial pressure, and rickets

Bulging anterior fontanelle Increased intracranial pressure, tumors Sucken anterior fontanelle Dehydration

Head Craniosynostosis Positional Plagiocephaly

Positional Plagiocephaly

Eye Exam Absent red reflex Cataracts Eye drainage without injected conjunctiva Blocked tear duct

Eye Microphthalmia Fetal alcohol syndrome, TORCH infections, Trisomy 13, Tiploid syndrome, 13q deletion syndrome, Wolf- Hirschhorn syndrome

Ear Preauricular cysts, pits, and fissures Microtia/anotia 1 in 8,000-10,000 births Can be complication of taking Accutane

Mouth and Nares Mouth Thrush Cleft palate/lip Nares Tracheoesophageal fistula

Cardiac Murmur CHF: increased work of breathing, fatigue with feeding, sweating with feeding or crying Cyanosis Delayed capillary refill Decreased peripheral pulses

Cardiac Innocent murmur PDA Cyanotic heart disease Coarctation of the aorta ASD/VSD

Pulmonary Cyanosis Decreased breath sounds Stridor Wheezing Hypoxia

Pulmonary Chronic lung disease: bronchopulmonary dysplasia Persistent pulmonary hypertension of the newborn Pulmonary sequestration Apnea Tracheomalacia/laryngomalacia

Pulmonary Bronchiolitis Pneumonia Upper respiratory infection

Gastrointestinal Umbilical hernia Reflux Vomiting Diarrhea Constipation Umbilical granuloma

Musculoskeletal Hip clicks Breech presentation Shoulder dystocia Clavicular fracture

Neurologic Sacral dimple Tuft of hair (sacrum) Hypertonia Hypotonia

GU Undescended testicles Circumcision Vaginal discharge/bleeding

QUESTIONS?

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