Q&A COUNT: 26*
NORMAL NEWBORN:
NORMAL NEWBORN:
What is Transitional stool?
At birth, stool is black.
It becomes green and then yellow by the end of first week.
Upto first week, stools will be loose. Such greenish-yellow loose stools showing transition in colour from black towards yellow - are called Transitional stools.
This is a NORMAL newborn feature
Stools after 1st week - called as Mature breastfeeding stools
Common Complaints by Parents about Newborn, which are NORMAL in nature:
1. Weight loss in first week (lose 8-10% of birth weight, regained by 7-10 days)
2. Crying before mirturition (due to full bladder)
3. Regurgitate small amount of milk after feeding (this is normal as long as baby gains weight normally and passes urine 8-10 times a day)
4. Frequent stools (due to transitional stools)
5. Breast engorgement (due to transplacentally acquired maternal hormone)
6. Rashes (erythema toxicum or skin peeling)
At birth, stool is black.
It becomes green and then yellow by the end of first week.
Upto first week, stools will be loose. Such greenish-yellow loose stools showing transition in colour from black towards yellow - are called Transitional stools.
This is a NORMAL newborn feature
Stools after 1st week - called as Mature breastfeeding stools
Common Complaints by Parents about Newborn, which are NORMAL in nature:
1. Weight loss in first week (lose 8-10% of birth weight, regained by 7-10 days)
2. Crying before mirturition (due to full bladder)
3. Regurgitate small amount of milk after feeding (this is normal as long as baby gains weight normally and passes urine 8-10 times a day)
4. Frequent stools (due to transitional stools)
5. Breast engorgement (due to transplacentally acquired maternal hormone)
6. Rashes (erythema toxicum or skin peeling)
Know to draw cross section of Umbilical cord. How to differentiate artery and vein?
Arteries wall - thick
Vein wall - collapse
If you draw a face - the two eyes will be 2 umbilical arteries and one mouth will be 1 umbilical vein
Rest of the face will be Wharton's Jelly
If you draw a face - the two eyes will be 2 umbilical arteries and one mouth will be 1 umbilical vein
Rest of the face will be Wharton's Jelly
Inference of single umbilical artery?
Presence of Congenital anomalies in the baby
Cause for Delayed fall of umbilicus:
LAD - Leukocyte adhesion defect*
Palpable organs in newborn:
- Liver upto 2 cm
- Spleen tip
- Kidney lower pole
What are Epstein pearls?
Retention cysts that look like teeth , present normally in a newborn along the roof of oral cavity (palate)
Normal finding*
Retention cysts that look like teeth , present normally in a newborn along the roof of oral cavity (palate)
Normal finding*
What are Mongolian spots?
Bluish coloured, well demarcated areas of pigmentation over the buttocks
Found in normal newborns*
Other name: Dermal melanosis
Bluish coloured, well demarcated areas of pigmentation over the buttocks
Found in normal newborns*
Other name: Dermal melanosis
What is erythema toxicum?
Benign rash in newborn occuring within 2-5 days.
These are eosinophil laden sterile crystals
Resolves spontaneously.
Occurs due to hypersensitivity reaction to detergents, bedsheet
What is Harlequin colour change?
Transient pale colour over one half of the body from forehead to pubis - due to autonomic instability
Normal finding*
What is Vernix caseosa?
Greasy substance secreted by foetal sebaceous glands - disappears in a few days or removed by bathing. Normal finding*
Absent in preterm babies
These are eosinophil laden sterile crystals
Resolves spontaneously.
Occurs due to hypersensitivity reaction to detergents, bedsheet
What is Harlequin colour change?
Transient pale colour over one half of the body from forehead to pubis - due to autonomic instability
Normal finding*
What is Vernix caseosa?
Greasy substance secreted by foetal sebaceous glands - disappears in a few days or removed by bathing. Normal finding*
Absent in preterm babies
Fontanelles - age of closure?
AF by 7-19 months
PF by 2 months
Method of measuring Anterior Fontanelle
Normally it would be around 2 x 2 cm approximately
AF by 7-19 months
PF by 2 months
Method of measuring Anterior Fontanelle
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How to differentiate Caput succenadeum and Cephalhematoma?
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| This picture is taken from OP Ghai textbook of Paediatrics |
What is DELIVERY POINT SCREENING? Its uses?
Screening newborn from head to toe (clinical examination)
Done 3 times (at birth, 24 hrs, time of discharge which is 3rd day)
Uses:
1. To see whether transition from fetal to external environment is successful or not
2. To find any abnormalities
Done 3 times (at birth, 24 hrs, time of discharge which is 3rd day)
Uses:
1. To see whether transition from fetal to external environment is successful or not
2. To find any abnormalities
INJECTIONS at Delivery Room
- Vitamin K - 1 mg (>1 kg) or 0.5 mg (<1 kg baby)
- HBV
Normal weight loss in Newborn?
8-10% of birth weight in 1st week
Regained by 7-10 days
The reflex involves 3 COMPONENTS
1. Opening of hands* and
2. Sudden abduction and extension of arms*
3. This is followed by - anterior flexion at shoulder joint
Moro reflex disappears by 3-6 months*
Gestational Age of appearance of 3 components of Moro reflex and its importance
Hand opening - 28 weeks
Extension and abduction - 32 weeks
Anterior flexion - 37 weeks
Significance:
3rd component of Moro reflex is absent in Preterm, due to weak antigravity muscles
List of Immature Newborn reflexes
Regained by 7-10 days
How to prevent Hypothermia in newborn?
- Temperature of labour room 28-30°C
- Keep warmer ready (if baby stable - put on mother's breast or if unstable or <34 wks - NICU radiant warmers)
- Two towel technique
- Wrap baby by Polythene wrap or Cling wrap
- Put socks, cap for a preterm with "hypothermia" under warmers
Cranial nerve examination in Newborn
CN 1 - Rarely tested, baby turns towards smell of breast milk without touch
CN 2 - Momentary fixation of eyes at light, Pupillary reflex, Photic sneeze reflex (bright light shown on eyes can cause reflex sneezing)
CN 3,4,6 - Check for Doll's eye movement/reflex (given below) + also pupillary reflex and ptosis for CN3
CN 5 - Sucking and swallowing reflex, Corneal reflex and Jaw jerk
CN 7 - Asymmetry of face on crying, deviation of angle of mouth
CN 8 - Startle reflex (blinking eyes and alteration in heart rate in response to sound), Acoustic blink reflex (strong blink in response to sound which decreases on repeated stimulation)
CN 9,10 - Sucking and swallowing co-ordination, Gag reflex
CN 11 - Palpate Sternocleidomastoid and feel its contraction on passive flexion and rotation of head
CN 12 - Symmetry of tongue, movements of tongue during sucking
*Doll's eye movement:
Turn the head on both sides slowly. Baby should not cry and should be awake. Eyes show spontaneous movements in all directions, until visual fixation develops.
CN 2 - Momentary fixation of eyes at light, Pupillary reflex, Photic sneeze reflex (bright light shown on eyes can cause reflex sneezing)
CN 3,4,6 - Check for Doll's eye movement/reflex (given below) + also pupillary reflex and ptosis for CN3
CN 5 - Sucking and swallowing reflex, Corneal reflex and Jaw jerk
CN 7 - Asymmetry of face on crying, deviation of angle of mouth
CN 8 - Startle reflex (blinking eyes and alteration in heart rate in response to sound), Acoustic blink reflex (strong blink in response to sound which decreases on repeated stimulation)
CN 9,10 - Sucking and swallowing co-ordination, Gag reflex
CN 11 - Palpate Sternocleidomastoid and feel its contraction on passive flexion and rotation of head
CN 12 - Symmetry of tongue, movements of tongue during sucking
*Doll's eye movement:
Turn the head on both sides slowly. Baby should not cry and should be awake. Eyes show spontaneous movements in all directions, until visual fixation develops.
How to do Moro reflex? (or) What are the 3 components of Moro reflex?
With baby supported in supine position, head is allowed to fall backward for a few centimetres.The reflex involves 3 COMPONENTS
1. Opening of hands* and
2. Sudden abduction and extension of arms*
3. This is followed by - anterior flexion at shoulder joint
Moro reflex disappears by 3-6 months*
Gestational Age of appearance of 3 components of Moro reflex and its importance
Hand opening - 28 weeks
Extension and abduction - 32 weeks
Anterior flexion - 37 weeks
Significance:
3rd component of Moro reflex is absent in Preterm, due to weak antigravity muscles
List of Immature Newborn reflexes
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| This picture is taken from Aruchamy textbook of Paediatrics |
New born resuscitation algorithm:
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| This picture is taken from OP Ghai textbook of Paediatrics |
BALLARD SCORING (to differentiate between preterm and term baby)
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| This picture is taken from Aruchamy textbook of Paediatrics |
How to assess Neuromuscular maturity in newborn? (Tell 6 parameters) (these 6 parameters are component of Ballard scoring)
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| This picture is taken from Aruchamy textbook of Paediatrics |
ADMISSION CRITERIA TO NICU (IN RSRM hospital, Chennai)
"Prevent ALL MISBIRTHS"
P - Preterm, PROM/PPROM/ MRO >18 Hours, Perinatal Depression, Precious Baby
A - Anomalies (congenital)
L - Low Birth Weight (<1.8 kg)
L - Large for Gestational Age (LGA)
M - Meconium Stained Amniotic fluid (MSAF)
I - Intrauterine Growth Retardation (IUGR)
S - Sepsis Screening
B - Birth asphyxia, Bad Obstetric history (BOH)
I - IDM (Infant of Diabetic Mother)
R - Respiratory Distress (RD)
T - Twins (Discordant Terms)
H - HbsAg Positive
S - SGA (Small for Gestational Age) & LGA