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1. Term Newborn Abhinaya K Final yr MBBS GMC OGE

2. Demographic details Mrs.Kala , 25yrs old primi from adyar who’s a homemaker belonging to lower social status came to the hospital for safe confinement of pregnancy and delivered a girl baby by normal vaginal delivery. ANTENATAL HISTORY: LMP – 01/02/2020 EDD – 08/11/2020 Pregnancy was confirmed by UPT at home, Booked (Min 4 AN visits, 2 doses Td, IFA Tablets) and Immunized

3. Antenatal History 1 st Trimester : Dating scan – Normal No H/O excessive vomiting No H/O fever with erythematous rashes (TORCH infections) No H/O bleeding per vaginum No H/O radiation exposure/drug intake (ACE Inhibitors, Beta blockers, Furosemide – IUGR/Oligohydramnios) Folic acid tablets taken 2 nd Trimester : Quickening felt at 5 th month IFA tablets taken 2 doses of Td taken at 4 th and 6 th month No H/O breathlessness, Blurring of vision, Headache ( Pre eclampsia ) No H/O bleeding PV Anomaly scan done – Anomalies were ruled out 3 rd Trimester : Normal perception of fetal movements No H/O fever, Sepsis No H/O bleeding/draining PV Growth scan - Normal

4. Natal History Mother was admitted in the hospital on 08/11/2020 at 8AM and delivered a term girl baby of gestational age 40 weeks by normal vaginal delivery ( term : 37 – 42 weeks ) Baby cried immediately after birth Birth weight – 3Kg ( normal – 2.5 – 3.5 kg) Postnatal History Baby was breast fed immediately after birth Meconium passed within 24 hrs ( if not – hypothyroidism , congenital megacolon anal atresia ) and urine passed with 48hrs ( if not – obstructive uropathy ) Previous Obs History - Nil

5. Past H istory No H/O invasive procedure during AN period No H/O blood transfusion No H/O HTN ,DM ,TB ,Epilepsy Family History – Non consanguineous marriage Immunization history : BCG, Hep A, OPV given on day 1

6. General Examination Baby was alert and active Normal cry, Pink in color Attitude – Universal flexion ( preterm – hypotonic and limbs extended) No pallor ( compare baby’s palmar crease with our palmar crease, ) No icterus ( pressure over sternum for a few seconds – look for any yellowish discolorisation , if yes – check limbs palms and soles and grade acc . To Kramer’s scale , physiological icterus is seen only after 24 hrs of birth) No cyanosis ( ACROCYANOSIS (peripheral cyanosis – normal and lasts for first 1- 2 days) No clubbing No generalized lymphadenopathy No pedal edema Vitals: HR – 120 beats/min ( normal – 100 – 160 beats/min) RR – 54 breathes/min ( within 2 months – 60 breathes/ min , 2m -12m – 50 breathes/min, 2-5yrs – 40 breathes/ min , TYPE – ABDOMINAL) CRT – Less than 2 secs ( pressure over sternum – check for rapid refilling) Normothermic ( 36.5 – 37.4 C – AXILLARY TEMP , core body /rectal temp – 36.5 – 37.5 C / 97.7-99.5 F) Anthropometry : HC – 35 cm ( NORMAL – 34 - 36cm) CC – 32 cm ( NORMAL – 2 TO 3 cm less then HC , measured at the level of nipples) Length – 50 cm ( till 2 yrs / till baby stand’s – length term uses and measured in infantiomete r , normal – 47 – 50cm) Weight – 2.8kg ( first 7 – 10 days loses 8 – 10% weight then gains at rate of 30g/day for first three months , baby 10 th day weight = birth weight)

7. Head to toe examination Head : No visible abnormalities, AF - soft, palpable 2.5cm x 2.5cm, PF not palpable ( AF – quadrangular in shape and closes by 16-18 months of age , PF – triangular in shape and closes at term) Face – Symmetrical ( MONGOLOID FACIES – hypertelorism , epicanthal slant , flat face , depressed nasal bridge , FACIAL ASYMMETRY – seen in facial paralysis ( injury via instrumental forceps delivery) , elfin facies – William syndrome) Eyes – normal ( congenital cataract , hypo/ hypertelorism , micro/ buphthalmos , corneal haziness) Ears – normal elastic recoil Nose – patent ( NASAL FLARING – baby in respiratory distress) Mouth – no cleft lip/palate, Tongue – normal ( small mouth with protruding tongue- DOWN’S) Neck – normal ( web neck with thick pad pf skin in nape of neck – DOWN’S , swelling – thyroglosal cyst / sternocleidomastoid tumour ) Chest – symmetrical ( breast bud of 5mm , wide spaced nipples in TURNER’S SYNDROME) Umbilicus – cord dried, no erythema, no periumbilical redness ( to rule out neonatal sepsis , cord falls in 7-10 days) Genital – normal, labia majora covering labia minora ( in male baby- rugosities present , both testis palpable) Back and spine – normal ( NT defects like spina bifida , meningocele , meningomyelocele ) Extremities – normal, no limb asymmetry, creases present ( congenital hip dysplasia seen in breech delivery , CTEV – congenital club foot managed by serial casting – PONSETTI CASTING) Skin – lanugo hair sparse ( soft immature hair which falls off)

8. Systemic examination CVS – S1, S2 heard, No murmur RS – bilateral air entry present, Normal vesicular breathe sounds, no added sounds ( ABDOMINAL TYPE irrespective of gender) Abdomen – Soft, Hernial orifices free, Umbilicus – Midline, everted, cord dried ( round in shape , LIVER usually palpable) CNS – Cry, Tone and Posture normal PRIMITIVE REFLEXES – moro’s reflex –normal, rooting reflex- normal, grasp reflex-normal , plantar – Babinski positive

9. Primitive reflex Seen In newborn and disappears when cortex develops and has an inhibitory control on these primitive reflexes Rooting reflex- on touching the corner of baby’s mouth , baby will turn its head and open mouth to follow and root in the direction of stroking Sucking reflex – when roof of baby’s mouth is touched , baby will begin to suck . Reflex begins at around 32 weeks and develops by 36 weeks of GA . Premature will have a weak sucking. Moro’s reflex- the head of the baby is allowed to fall backward for few centimeters ,with body supported in supine position. There will be a sudden abduction and extension of arms with opening of hands, followed by slower adduction and flexion at shoulder joint. This reflex disappears by 4-5 months With premature babies – initial abduction and extension is followed by falling back of arms on table during adduction phase due to weakness of antigravity muscles Startle reflex- response same as moro’s reflex , but stimuli being loud sound (clap) Asymmetric tonic neck reflex (fencing position)- baby in supine position , when neck turned to right the limbs in right will be extended , whereas left limbs will be flexed. This reflex disappears by 6-7 months

10. Grasp reflex- on touching the palm , baby will flex the fingers and grasp . Similar with toes too. This reflex disappears in 5-6 months Babinski reflex- when sole firmly stroked , dorsiflexion of great toe with fanning out of all other fingers . This reflex is present till 2yrs of age Stepping (walking reflex)- baby appears to take steps when held upright with feet touching solid surface Glabellar reflex- repetitive tapping of forehead leads to blinking of eyes

11. Diagnosis Term – 3 days old girl baby, AGA, With no complications With adequate breastfeeding and immunized upto age Advice : Exclusive breastfeeding upto 6 months of age Immunization

12. CARE AT BIRTH CLEAN SURFACE CLEAN HANDS CLEAN CORD CLEAN TIE CLEAN BLADE Postnatal room should be warm( 25-28 C) and draught free BABY should be received in warm linen Hypothermia prevented by skin to skin contact and early breastfeeding

13. Care after birth Care of umblical cord – sterile cut Delay the cut by 1 min so that 80ml extra blood enters fetal circulation which contributes 50 mg of iron Cord falls by 7-10 days Quick screening of malformations – examine all orifices NG tube passed to check patency of esophagus and rectum Choanal atresia checked by passing soft catheter Tracheoesophageal fistula – indicated by excessive drooling o f saliva Care of eyes- wipe with a sterile cotton swab from medial to lateral Care of skin- skin cleaned by sponging and should be kept clean and dry . vernix caseosa is greasy substance secreted by fetal sebaceous glands Care of external genitalia – kept clean and dry Inj vit k IM – FOR TERM babies weight more than 2kg – 1 mg , weight less than 2 kg – 0.5mg IMMUNISATION MAINTENANCE OF GROWTH CHART