Physical characteristic of Newborn عمل الطالبات : اسماء جادالله فاطمة الحشاش ختام الكفارنة نعمة مصلح اية المملوك صابرين سلامة

Physical examination  1 st examination in delivery room or as soon as possible after delivery  2 nd and more detailed examination after 24 h of life  Discharge examination with 24 h of discharge from hospital

Examination precaution Hand washing Hand washing Thermal environment Thermal environment Light and noise Light and noise Brief examination time Brief examination time

APGAR Score Score012 Heart RateAbsent<100bpm>100bpm Respiratory effortAbsent, irregularSlow, cryingGood Muscle toneLimpSome flexion of extremities Active motion Reflex irritability (nose suction) No responseGrimaceCough or sneeze ColorBlue, paleAcrocyanosisCompletely pink

General Measurements:  Birth weight: g.  Head Circumference: cm, about 2-3 cm larger than chest circumference.  Chest Circumference: cm.  Head to heel length: 48-53cm.

Head Circumference Head circumference is measured by wrapping the paper tape over the eyebrows and the around the occipital

1.Temperature  Temperature should be taken axillary  The normal temperature for infant is 36.2 – C.  Axillary temp.is c lower than rectal

Axillary temperature measurement. The thermometer should remain in place for 3 minutes.

Physical Examination

17. Skin: General description: At birth: Color: bright red. Texture: soft and has good elasticity. Edema: is seen around eye, face, and scrotum or labia. Cyanosis: of hands & feet (acrocyanosis)

18 General description of the skin

19 Acrocyanosis

20 1.Vernix Caseosa: Soft yellowish cream layer that may thickly cover the skin of the newborn, or it may be found only in the body creases and between the labia. The debate of wash it off or to keep it.

21 Vernix Caseosa

22 2. Lanugo hair: - Distribution: The more premature baby is, the heavier the presence of lanugo is. - It disappears during the first weeks of life

23 3. Mongolian spots: Black coloration on the lower back, buttocks, anterior trunk, & around the wrist or ankle. They are not bruise marks or a sign of mental retardation, they usually disappear during preschool years without any treatment.

24 Mongolian spots

25 Mongolian spots

26 4. Physiological Jaundice: will discussed later in details. 5. Milia: - Small white or yellow pinpoint spots. - Common on the nose, forehead, & chin of the newborn infants due to accumulations of secretions from the sweat & sebaceous glands that have not yet drain normally. They will disappear within 1-2 weeks, they should not expressed.

27 Physiological Jaundice

28 Milia

29 6. Head: The Anterior fontanel: is diamond in shape, located at the junction of 2 parietal & frontal bones. It is 2-3 cm in width & 3-4 cm in length. It closes between months of age. The posterior fontanel: is triangular in shape, located between the parietal & occipital bones. It closes by the 2 nd month of age.

30 Fontanels should be flat, soft, & firm. It bulge when the baby cries or if there is increased in ICP. Two conditions may appear in the head: Caput succedaneum & Cephalhematoma

31 Caput succedaneum An edematous swelling on the presenting portion of the scalp of an infant during birth, caused by the pressure of the presenting part against the dilating cervix. The effusion overlies the periosteum with poorly defined margins. Caput succedaneum extends across the midline and over suture lines. Caput succedaneum does not usually cause complications and usually resolves over the first few days. Management consists of observation only.

32

33 Caput succedaneum

34 Cephalhematoma: Cephalhematoma is a subperiosteal collection of blood secondary to rupture of blood vessels between the skull and the periosteum, in which bleeding is limited by suture lines (never cross the suture lines).

35 Cephalhematoma

36 7. Eyes: - Usually edematous eye lids - Gray in color. True color is not determined until the age of 3-6 months. - Pupil: React to light - Absence of tears - Blinking reflex is present in response to touch - Can not follow an object (simple fixation on objects).

37 Eyelid Edema

38 Dysconjugate Eye Movements

39 Congenital Glaucoma

40 Congenital Cataracts

41 8. Ears: Position: Startle Reflex: Pinna (صيوان الادن) flexible, cartilage present.

42 Normal Ears

43 Ear Tag

44 9. Nose: Nasal Patency: Nasal discharge – thin white mucous Normal Nose

45 Dislocated Nasal Septum

Mouth & Throat: - Intact, high arched palate. - Sucking reflex – strong and coordinated - Rooting reflex - Gag reflex - Minimal salivation

Neck : Short, thick, usually surrounded by skin folds.

48  System assessment of the neonates: 1. Gastrointestinal System: Mouth should be examined for abnormalities such as cleft lip and/or cleft palate. Epstein pearls are brittle, white, shine spots near the center of the hard palate. They mark the fusion of the 2 hollows of the palate. If any; it will disappear in time.

49 Cleft Palate

50 Cleft Lip

51 Cheeks: Have a fat appearance due to development of fatty sucking pads that help to create negative pressure inside the mouth which facilitates sucking.

52 Normal Tongue Ankyloglossia

53 Ankyloglossia

54 Gum: May appear with a quite irregular edge. Sometimes the back of gums contain whitish deciduous teeth that are semi-formed, but not erupted

55 Irregular edges with Natal Teeth

56 Natal Tooth

Heart : Observation : heart rate, rhythm, quality of heart sounds, active precordium Position of heart : may be determined by auscultation Presence of murmur Palpate the pulses (femoral) & define whether its normal, weak or absent. Check for perfusion Signs of congestive heart failure : gallop, tachycardia & abnormal pulses

R ESPIRATIONS. The respirations of a newborn infant are irregular in depth, rate, and rhythm and vary from 30 to 60 beats per minute. Respirations are affected by the infant's activity (that is, crying). Normally, respirations are gentle, quiet, rapid, and shallow. They are most easily observed by watching abdominal movement because the infant's respirations are accomplished mainly by the diaphragm and abdominal muscles. No sound should be audible on inspiration or expiration

Abdomen Cylindrical in Shape

61 Normal Umbilical Cord Bluish white at birth with 2 arteries & one vein.

62 Meconium Stained Umbilical Cord

 Normally, the newborn has urine in his bladder and voids at birth or some hours later. Female genitalia:  Labia and clitoris usually edematous.  Urethral meatus behind clitoris.  Vernix caseosa between labia..

Physical Examination Ambiguous GenitaliaClosed Rectum

 Urethral opening is at tip of glans pens.  Testes palpable in each scrotum.  Scrotum usually large edematous, pendulous and covered with rugae and pigmented

Physical Examination Normal Testes Undescended Testes Male Genitalia

ASSESSMENT.Anus : Check to ensure anus patent Insert rectal temperature into the anus as far as 2.5cm Place baby in lateral position for this procedure

 There are maternal hormones that have crossed through the placenta to the baby. After birth these are withdrawn and cause some normal  such as:

 Swollen breasts: This appears on 3 rd day in both males and females. It lasts for 2-3 weeks and gradually disappears without treatment. Sometimes there is also breast secretion called “Witch’s milk”.  Infantile menstruation: a few spots of blood for 1-2 days can be seen in the diaper.

70 Maternal hormonal withdrawal Female genitalia, normal with vaginal discharge

71 Infantile menstruation

ASSESSMENT.Check baby’s back : Turn baby to the side and ensure baby’s back is straight and flat. Use the fingers and check from neck to sacrum Ensure there is no curves,lumps ‘hair patches’ and spinal bifida.

Neural tube defects

ASSESSMENT.Check feet: Both leg are of same length No fracture and paralysis Both legs have same toes and no decrease number of digits on the toes.

ASSESSMENT.Basic neurological test : Grasp reflex Moro reflex Sucking reflex Rooting reflex

Examination

77 Thank you