Newborn infant

newborn infant is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...

1. -DR. AKIF A.B

2. 1)Length : 45-55cm

2)Head circumference : 34cm

3)Chest circumference :31cm

4)Upper to lower segment ratio : 1.7 to 1.9

5)Heart rate : 120-140 per minute

6)Respiratory rate :35-40/min

7)Attitude : flexion

8)Urine and meconium is passed within 24hrs

3. -Systolic murmur may be present

- Peripheral cyanosis(acrocyanosis) may be present.
Note: Peripheral cyanosis is normal but not central cyanosis.

Central cyanosis is always pathological

4. -There are few clinical problems which occur in newborn which are absolutely
- normal and gets compensated with time and doesn’t require any treatment
1)Milia

2)Erythema toxicum

3)Mongolian spots

4)Peeling of skin

5)Subconjunctival haemorrhage

6)Breast engorgement
7) Epstein pearl

8) Vaginal bleed

9) Hymenal tags

5. -Milia are tiny white bumps that appear across a baby's nose, chin or cheeks.

-Milia are common in newborns but can occur at any age.

-You can't prevent milia.

-no treatment is needed because they usually disappear on their own in a few weeks or
months.

7. -Mongolian spots are very common in any part of the body of dark-skinned babies
most commonly at presacral region

- They are flat, gray-blue in color (almost looking like a bruise), and can be small or large.

- They are caused by some pigment that didn't make it to the top layer when
baby's skin was being formed.

- Disappears spontaneously before 1
st
bday

8. -Seen on 3
rd
to 7
th
day of life

- due to withdrawal of maternal hormones

11. 1)Rooting Reflex/suckling/swallowing reflex

2)Moro’s reflex

3)Palmar grasp

4)Crossed extensor reflex

5)Asymmetric tonic neck reflexes

6)Parachute reflex

7)Landau reflex

8)symmetric tonic neck reflexes


Appears after birth
Present since birth

14. -Moro reflex is present since birth

- disappears by 6
th
month

- Unilateral Moro reflex : 1) erb’s palsy

2) fracture of humerus / clavicle

3) shoulder dislocation

4) Spastic Hemiplegia

- Exaggarated moro reflex : Brain damage

16. Watch video of asymmetric tonic neck reflex by clicking on this link
https://www.youtube.com/watch?v=UWqafotPxTg

17. Appears at 4-6months and disappears at 8-12 months

21. Rooting reflex appears at 32 wks of gestation

23. -Parachute reflex appears at around 9
th
month and persists throughout life.

-

25. Landau reflex appaears at 10
th
month and disappears by 24 months

27. Infant's larynx is positioned high in the neck opposite
C3 or C4 (vocal cord level ) at rest and reaches C1 or
C2 during swallowing.
This high posit ion allows the
epiglottis to meet soft palate and make a nasopharyngeal
channel for nasal breathing during suckling. The
milk feed passes separately over the dorsum of tongue
and the side of epiglottis, thus allowing breathing and
feeding to go on simultaneously.

29. 1)MC type = Subtle Seizures

2)Best prognosis = clonic type

3)Worst prognosis = Myoclonic type

4)Etiology wise , best prognosis = Hypocalcemia

5)MC cause of Neonatal Seiures = Hypoxic Ischemic Encephalopathy ( Bad Prognosis)

6)MC cause of day 2 Seizure = Sub arachnoid Haemorrhage

7)Hypoglycemia can lead to seizures more commonly during Day 1 of Life

8)Hypocalcemia can lead to Seizures more commonly during day 2

30. -Macrosomic baby

- prone to Respiratory distress Syndrome since Insulin decreases Surfactant levels

- prolongs neonatal jaundice

- leads to Polycythaemia – sluggish flow – Renal Vein thrombosis

- MC congenital defect = VSD > Anencephaly

- Most specific = Sacral agenesis

- MC complication during delivery = Shoulder Dystocia

33. -Shiverring mechanism is absent in Newborns

- Newborns are more prone for hypothermia because of large surface area

- Heat generation is by : 1) peripheral vasoconstriction

2) Non shivering thermogenesis in brown fat by adrenaline

-Brown fat is located at : 1) Nape of neck

2) interscapullary region

3) around adrenal gland & Kidney

4) axillary region

34. 8. Not ass. With neonatal jaundice 8. Prolongs neonatal jaundice since it
contains blood

9. Edematous swelling of scalp 9. Subperiosteal swelling

37. 1)Symptoms doesn’t appear at birth

2)Symptoms appear at 3
rd
week of life

3)Non bilious vomiting since obstruction is above the opening of common bile duct
at 2
nd
part of duodenum

4) Usage of erythromycin during neonatal phase is associated with CHPS

5) Hypochloremic hypokalemic metabolic alkalosis

6) Investigation of choice : USG

7) Radiological diagnosis : pyloric thickness >4mm and pyloric length >14mm

8) Barium study : string sign /double tract sign

9) Rx: Ramstedt’s myomectomy operation

41. -Single most important risk factor = Prematurity

- Bell’s Staging

42. To make it easy refer next slide

43. Stage 1a : systemic features + GI Symptoms + Occult blood in stools = Rx : NPO + Antibiotics*3days

Stage 1b : systemic features + GI Symptoms + Gross blood in stool = Rx : NPO + Antibiotics*3days

Stage 2a : same as 1b + absent bowel sounds + Pneumatosis intestinalis = Rx : NPO + Antibiotics*7-10days

Stage 2b: same as 2b but increase in severity + x-ray showing Portal venous air = Rx : NPO + Antibiotics*10-14days

Stage 3a: same as above but increase severity + Peritonitis+X-Ray showing Ascites = Rx : NPO + Antibiotics+
supportive

Stage 3b: same as above + Pneumoperitoneum = Surgery

45. You must be thinking answer as Surgery since it is mentioned 3b type NEC

BUT you should see that baby is on ventilator and is hence unfit for Surgery,

Hence, best management is Lavage