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DAVAO DOCTORSHOSPITAL

THE NEWBORN INFANT

Xylia Sahara E. TocaoMedical Clerk

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OVERVIEW

PERINATAL PERIOD

from 28th week of gestation through the 7th dayafter birth

Nelson Textbook of Pediatrics , 19th Edition

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OVERVIEW

NEONATAL PERIOD -1st 28 days after birth

Late7 days to < 28 days

EarlyBirth to

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INFANCY

Ist year after birth

Nelson Textbook of Pediatrics , 19th Edition

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HISTORY IN NEONATAL PEDIATRICS

Nelson Textbook of Pediatrics , 19th Edition

Demographic & Social dataPast medical illnessesPrevious maternal reproductiveproblems

Events in the pregnancyDescription of the labor & delivery

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PHYSICAL EXAMINATION

As soon as possible afterdelivery

Within 24 hours of birth

Within 24 hours of discharge

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GENERAL APPEARANCE

Physical activity

Active & Passive tone

Posture

Edema

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SKIN

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SKULL

CRANIOSYNOSTOSIS

FACE

-should be noted with regard to dysmorphic features

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EYES

PUPILLARY REFLEX- (+) after 28-30 weeks ofgestation

LEUKOCORIA

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EARS

PREAURICULAR SKIN TAGS

NOSE

MOUTH

EPSTEIN PEARLS

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NECK

CONGENITALTORTICOLLIS

CHEST

LUNGSTerm Infants: 30-60 breaths/minPreterm: higher

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HEART

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ABDOMEN

Abdominal distention-obstruction/ perforation

Scaphoid abdomen-diaphragmatic hernia

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ABDOMEN

OMPHALOCELE

GENITALS

Imperforate hymen

Neonates:void by 12 hoursPremature & Term infants : void within 24 hours

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ANUS

Passage of meconium 1st 12 hours after birth

Term & Preterm infants : within 48 hours

Imperforate anus not always visible

EXTREMITIES examined for :

polydactylysyndactyly

abnormal dermatoglyphic patterns ( simian crease)

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NEUROLOGIC EXAMINATION

severe positional deformation and contractureS

Manifestation of neuromuscularDisease:

Breech presentationPolyhydramniosFailure to breathe at birthpulmonary hypoplasiaclubfoot

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ROUTINE DELIVERY ROOM & INITIAL CARE

Low risk infants

Healthy infants: given directly to mothers

APGAR SCORE

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MAINTENANCE OF BODY HEAT

Generation of heat :body weight

Heat loss: surface area

Usual delivery room ( 20-25 OC )

-infants skin temperature falls approximately0.3 oC / min

- deep body temperature decreases

approximately0.1 oC / min-cumulative loss of2-3 oC in deep bodytemperature

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4 MECHANISMS OF HEAT LOSS

convection

conductionheat radiation

evaporation

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ANTISEPTIC SKIN & CORD CARE

to decrease colonization with S. aureus ,umbilical

cord should me treated with bactericidal orantimicrobial agents such as triple dye / bacitracin

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OTHER MEASURES

Eyes: 1 % silver nitrate/0.5 % erythromycin

(gonococcal ophthalmic neonatorum)

Vit. K : 1 mg of water soluble Vit. K (phytonadione)(hemorrhagic disease)

Hepatitis B immunization

Universal hearing screening

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NURSERY CARE

Non high risk- mothers room

Nursery temperature : 22-26 oC

Early discharge :

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NURSERIES & BREAST FEEDING

Hospital practices that encourage successfulbreastfeeding:

Antepartum education & encouragement Immediate postpartum mother-infant contact

Rooming-in arrangements

Inclusion of father in prenatal breastfeedingeducation

Support from experienced women

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DRUGS & BREAST FEEDING

Maternal sedatives

Maternal drugs :

>weak acids

>containing large molecules

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