Introduction to

neonatology
Nicu-2 15/1/2015
#classification of
newborn
#examination of

#preterm baby are more liable to

get intracranial Hge

CLASSIFICATION OF
NEWBORN
1.Acc to gestational age
2.Acc to the weight of baby
3.Acc to the wt for age (growth
wt classification)

1. According to
gestational age
Full term: 37w 41w 6/7days
Post date: >42w
Preterm :
- late preterm: 34w-37w
- early preterm: less than
34w

How to asses gestational age?

1.Inaccurate method ie asking the
mother the last day 0f menstrual
period
2.Physical character baased on
modified ballard score. Which
include physical and
neuromuscular development.
3.Most accurate b y
ultrasonography

2. According to weight of
baby
Normal: 2.5-4kg
Low bith weight: 1.5-2.5kg
Very low birth weight: 11.5kg
Extremely birth weight: less
than 1kg
Macrosomic baby: >4kg

3. According to weight for age

(growth rate classification)

Based on graft. Upper limit or

upper percentile and lower
limit ie lower percentile.
In between upper and lower
is normal.

IUGR (intrauterine growth

retardation)
The birth wt are not appropriate to
gestational age.
Either symmetrical or assymmetrical
Symmetrical the proportion bet the head
and body is balanced. HC is abnormal.
Insult occur early in pregnancy
Assymetrical is proportion between the
head and the body are not balanced. HC
is normal. Insult occur late in pregnancy.

Causes of IUGR
Placental insufficiency
causes: SLE, smoking, high
altitude, chromosomal disease,
congenital infection by TORCH,
congenital malformation,
IUGR liable for
- hypothermia and hypoglycemia
due to their thin skin and low SC
fat.

MACROSOMIC BABY
Wt more than 4kg
Have abdominal organomegaly
Causes: infant of diabetic
mother, constitutional obesity ,
post date baby.
Complications: congenital
anomalies, birth injuries,
hypertophic cardiomyopathy,
hypoglycemia due to sudden

HISTORY TAKING IN NEW

BORN

Maternal disease: DM, HTN, anemia, SLE

Polyhydraminous: detected by US. Due to
GI obstruction.
Oligohydraminous: due to renal disease
Maternal age: old liable for chromosomal
disease while young age liable for
premature baby
Premature rupture of membrane: beyond
18hrs liable fro ascending infection
Type of delivery: if CS- delayed in
clearance of lung

Precaution during
examination

Hand washing
Thermal environment
No light
Brief examination time

I: GENERAL
EXAMINATION

1.WEIGHT/LENGTH

2.VITAL SIGN:
-. pulse: 120- up to 180
beats/min
-. RR: less than 60 beats/min
-. Temperature: 36.5-37.5
degree celsius

3. General looks
Conscious level
Distress or not: distressgrunting, acting ala nasi,
subcostal retraction, cyanosed
Abnormal color
skin

Cause is unknown
No significant
pathological
condition
Resolve alone by
10days
DD. Impetigo
neonatum in which
skin have vesicles,
pus and bullous
and by swab
reveals
polymorphs and it
is treated by
antibiotics.
In erythema
toxicum, when we

MONGOLIAN SPOT
-Collections of
melanocytes
-Site esp at
lumbosacral
region
-Not elevated
DD: bruiseselevated and
tender

Benign pustular melanosis of

newborn

esolve within 3-4m

MILIA
small pearly
white lesion
On the face
Retention
cyst

evus flammeus

If large sturge waber syndro

Neonatal acne
At the
cheek
Due to
sensitivity of
newborn
sebaceous
gland to the
maternal
hormone
Resolve
after 1m

Milian/miliary rubra
Give
prick
sensation
Sweat
rash

Caput succedaneum
-Birth injury
-Swelling at the
head
-Just
subcutaneous
hematoma
-Extraperiosteum
lesion
-Will not be
restricted to
suture line
-Associated with
moulding of
overlying skull

Cephalhematoma

Accumulation of
blood under
periosteum
Restricted to suture
lines
With instrumental
delivery
Usually benign
Do not do any
incision or drainage
When the condition
resolve it will go to
the normal pathway
and thus increase
bilirubin and thus
baby will be
jaundice

Subgaleal hematoma
Like cephalhematoma but more extensive
Must be admitted to neonatal ICU
May need surgical drainage

Neonatal cataract
TORCH
screening
Have to
exclude
galactosemia
(MR, cataract,

Subconjunctival
haemorrhage

Ophthalmia neonatorum

Ophthalmia neonatorum

Lid edema
Chemosis
Red eye with lacrimations
Usually in vaginal delivery
Infection by chlamydia, lesteria
monocytogenes, N.gonorrhhea
Treat by antibiotic orally or IV

Cleft palate

Cleft lip

Neonatal teeth

Benign
condition
Associated with
chromosomal
abnormalities
It should be
removed if it
cause abrasion
of the upper lip /
amputated the
tongue
Removed it
with care-need
dentist to do it.
If we removed
it hardly it may

Benign gingival nodules

Bohn
retention
cyst
If in the
midline of
palate and
pearly
white
ebstein
pearls

II: CHEST EXAMINATION

1.DISTRESS SIGN: grunting, acting ala
nasi
2.DEFORMITIES
3.AUSCULTATION- harsh vesicular
breathing normal in infant and child
4.SUPRANUMERY NIPPLE
5.BREAST ENLARGEMENT- sensitivity of
neonate glandular tissue to maternal
hormone. Benign condition and resolve
within 1m. If complicated- secrete pustule
thus we do incision and drainage with

upranumerary nipple

III: CARDIAC
EXAMINATION
HR: 100-160 beats/min
SI and S2
Additional HS
Murmur- eg in VSD
Femoral pulsation. If weak or
absent- coarctation of aorta

IV: ABDOMINAL
EXAMINATION

LIVER: normally felt 2cm below costal margin

SPLEEN: can be felt the lower pole-sometimes
KIDNEY: may be felt
Meconium
Transitional stool
Breastfed stool and formulated milk stool
Any umbilical hernia- if present surgical
correction is done after 2yrs if not corrected by
it own.
Any omphalocele?

cal hernia

omphalocele-UH

trochisis: the whole intestinal are outside

V-GENITALIA

Any inguinal hernia- do surgical

correction as soon as possible

Imperforate anus
Hydrocele?

Male genitalia

Scrotum
Testis present
Rugae of scrotum
Pigmaneted- if excessive thus we
suspect congenital adrenal
hyperplasia: dark pigmentation of
scrotum
Penile length: 2.5cm or more
Any epispadius or hypospadius.
Epispadius usually associated with

Normal male genitalia

Normal female genitalia

Female genitalia
Labia minora- slightly darker.
If excess dark- congenital
adrenal hyperplasia
Labia majora Mon pubis
No pubic hair

VI: EXAMINATION OF THE

BACK
Any hair tuft

Any meningiocele

VII:HIPS AND
EXTREMITIES

Erbs palsy: injury to upper

trunk of brachial plexus.
Associated with respiratory
distress due to phrenic
nerve may be injured as
well. This resolve by
physiotheraphy.
Erb palsy are in form of
adduction of arm. Internal
rotation and pronation of
the arm, extension of elbow
with flexion of the wrist.

FRACTURE CLAVICLE. More common than

humerus fracture. Baby will have asymmetrical
movement and asymmetrical moros reflex.

DIGITAL ABNORMALITIES.
- Polydactaly or syndactaly

Simian
crease
-minor criteria
of trisomy 21
Present in 5%
of normal
population

DDH
-dislocation of hips
Detected by barlows or ortolini test

CONGENITAL
TALIPES EQUINO VARUS

VIII: CNS EXAMINATION

Alert and conscious
Move extremities
Flexed body posture
Sensory intact
Any hypotonia?- either
central or peripheral

Test to detect hypotonia

Hold the baby by abdomen. If
hypotonia there will be inverted U
shaped ventral support
Ventral suspension: hold baby in
straight position and try to make him
stand. If good tone--- stepping reflex
if not slipped between hand.

NEONATAL RELFEXES
PRIMITIVE RELFEXES- will
dissapear with time and if persist
this indicate UMNL
1. SUCKLING- upto 1yrs
2. Rooting- up to 4-6m
3. Grasp reflex- up to 4-5m
4. Tonic neck reflex/ fanning- up to
7m
5. Moros reflex- up to 4-6m