1. 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

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

3. 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.

4. 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)

7. 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

8. 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 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

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

10. Mila

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

12. Cradle cap

13. Newborn Acne

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

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

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

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

18. Head
Craniosynostosis
Positional Plagiocephaly

20. Positional Plagiocephaly

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

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

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

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

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

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

27. Pulmonary
Cyanosis
Decreased breath sounds
Stridor
Wheezing
Hypoxia

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

29. Pulmonary
Bronchiolitis
Pneumonia
Upper respiratory infection

30. Gastrointestinal Umbilical hernia Reflux Vomiting Diarrhea
Constipation
Umbilical granuloma

31. Musculoskeletal Hip clicks Breech presentation Shoulder dystocia
Clavicular fracture

32. Neurologic
Sacral dimple
Tuft of hair (sacrum)
Hypertonia
Hypotonia

33. GU
Undescended testicles
Circumcision
Vaginal discharge/bleeding

34. QUESTIONS?

35. THANK YOU!