Examination of the Newborn - part 6 doc

ABNORMAL FINDINGS AND CONGENITAL ABNORMALITIES 99 100 EXAMINATION OF THE NEWBORN ABNORMAL FINDINGS AND CONGENITAL ABNORMALITIES 101 102 EXAMINATION OF THE NEWBORN ABNORMAL FINDINGS AND CONGENITAL ABNORMALITIES 103 104 EXAMINATION OF THE NEWBORN occurs when the level of circulating bilirubin becomes elevated. This commonly occurs in the newborn baby about 3 days after delivery as a result of increased red cell breakdown and immaturity of the liver. Jaundice occurring earlier than this, and especially within 24 hours of delivery, usually requires investigation, as does jaundice occurring after 10 days of age. It is also worthwhile considering the possibility of abnormal causes of jaundice in a baby who develops it within the period 3–10 days of age. For causes see Table 6.1. Behaviour Abnormal cry In order to appreciate an abnormal cry the practitioner has to be familiar with what a normal cry sounds like. The best way to do this is to spend time on a postnatal ward listening to the crying of babies. An example of an abnormal cry is a high-pitched cry. For causes see Table 6.1. Abnormal posture When a baby is first delivered it usually adopts the posture it had in utero, e.g. an extended breech baby will attempt to lie with its hips flexed and its feet almost up by its ears. Gradually the baby adopts a flexed posture with elbows, knees and hips flexed. For causes of abnormal posture see Table 6.1. Irritability Most babies cry at some time, but they are generally consolable either by picking them up and comforting them, changing their nappy or by feeding them. A baby who cannot be consoled may have an underlying reason for this (see Table 6.1). Sleepy Most babies sleep for most of the day, but they do tend to wake for feeds. Excessive sleepiness is abnormal. For causes see Table 6.1. ABNORMAL FINDINGS AND CONGENITAL ABNORMALITIES 105 JAUNDICE This is a yellow discoloration of the skin and sclera of the eyes. It TABLE 6.2 Observed conditions with suggested investigations in management 106 EXAMINATION OF THE NEWBORN ABNORMAL FINDINGS AND CONGENITAL ABNORMALITIES 107 108 EXAMINATION OF THE NEWBORN [...]... movements of the arms and legs Sometimes the only evidence of a fit is a dusky (slightly cyanosed) baby, resulting from a brief cessation of breathing (an apnoea attack) caused by the fit For causes of fits see Table 6. 1 Treat the fits if they are prolonged or are causing neonatal compromise (apnoea, cyanosis and distress) 112 EXAMINATION OF THE NEWBORN Jittery A‘jitter’ is a rhythmical movement of the. .. broad nasal bridge can often produce an apparent squint 120 EXAMINATION OF THE NEWBORN Few genuine squints are detected in the neonatal period, but if the practitioner is convinced that there is a persistent squint the baby is best referred to an ophthalmologist for an opinion Epicanthic folds These are vertical pleats of skin that overlap the medial angle of the eye (see Figure 5.2) They are common in... consideration should be made whether or not the cyst contains thyroid tissue before it is removed 118 EXAMINATION OF THE NEWBORN Tongue-tie Is a term used to describe a condition in which the frenulum of the tongue is attached too far forward It does not usually interfere with either speech or feeding and intervention is not usually recommended, as division of the frenulum is often associated with considerable... (Table 6. 1) Bile-stained vomit (green or yellow) is abnormal and is likely to indicate an intestinal obstruction Blood-stained vomit may be the result of ingestion of maternal blood, trauma or a coagulation problem (excluded by checking the clotting and the platelet count) Abnormal movement Asymmetry Babies should be capable of moving both sides of their body to the same degree—not necessarily at the. .. necessary to enlist the services of a geneticist to identify a syndrome if one is suspected Birthmarks (see Skin, p 1 26) There are many types of birthmarks, but those occurring most commonly in the neonatal period include the following: Salmon patch naevus Salmon patch naevus does not require intervention Port wine stain Port wine stain in the distribution of the first branch of the trigeminal (third... drainage of fluid from the eye is obstructed so causing a build-up of pressure in the eye The cornea may also appear hazy in association with congenital glaucoma Referral to an ophthalmologist should be made as a matter of urgency Coloboma Coloboma of the iris appears as a sector-shaped gap That gap may extend posteriorly to include the ciliary body and choroid It may be isolated or part of a syndrome Referral... encephaloceles These are usually found at the occiput in the midline They are usually associated with a bony defect of the cranium A ABNORMAL FINDINGS AND CONGENITAL ABNORMALITIES 113 FIGURE 6. 1 Caput succedaneum FIGURE 6. 2 Cephalhaematoma meningocele contains meninges, i.e the layers covering the spinal column, but does not contain any neural tissue An encephalocele contains meninges and neural tissue They... has the potential to obstruct vision in the early years Otherwise, after its rapid growth spurt, it should resolve Cavernous haemangioma This should be referred to a dermatologist 1 16 EXAMINATION OF THE NEWBORN Nose Obstruction Failure of the nasal passages to become patent may cause obstruction (unilateral or bilateral choanal atresia) as may deviation of the nasal septum BILATERAL CHOANAL ATRESIA... They are common in infants and may result in the illusion that there is a squint They are a normal feature in the Mongoloid races and in Down’s syndrome (see p 157) Anophthalmia Absence of an eye can occur spontaneously or as part of a syndrome It is usually associated with a shallow orbit, so for cosmetic reasons, and for examination of the normal eye, the baby should be referred to an ophthalmologist... the same aetiology as cleft lip described above Urgent referral to the ‘cleft lip team’ (plastic surgeon, ENT surgeon, audiologist, orthodontic surgeon, and speech therapist) should be made Cysts Ranulae Are mucus retention cysts and appear as blue lumps beneath the anterior part of the tongue They may be large enough to displace the tongue posteriorly and interfere with respirations In the event of . 99 100 EXAMINATION OF THE NEWBORN ABNORMAL FINDINGS AND CONGENITAL ABNORMALITIES 101 102 EXAMINATION OF THE NEWBORN ABNORMAL FINDINGS AND CONGENITAL ABNORMALITIES 103 104 EXAMINATION OF THE NEWBORN occurs. 105 JAUNDICE This is a yellow discoloration of the skin and sclera of the eyes. It TABLE 6. 2 Observed conditions with suggested investigations in management 1 06 EXAMINATION OF THE NEWBORN ABNORMAL FINDINGS AND. beneath the anterior part of the tongue. They may be large enough to displace the tongue posteriorly and interfere with respirations. In the event of this happening, they can be aspirated, but they