Newborn: Grade 1

LGA – infants’ wt is in the 90th% for neonates same  Lag on respirations

gestational age, may be pre, post, or full term.  Just visible
LGA – does not mean post term.  Just visible
 Minimal
LGA – most common cause: maternal diabetes.  Stethoscope only
LGA – infant at risk: birth injuries, hypoglycaemia,
Grade 2
and polycythemia – macrosomia.
 See-saw
 Markes
SGA – infants whose wt is at or below 10th%  Marked
SGA – results from failure to thrive  Marked
 Naked ear
SGA – is a high risk condition

SGA – does not mean premature

Meconium Aspiration Syndrome
SGA – causes: anything restricting utero-placental
blood flow, smoking, DM, PIH (Pregnancy Induced - Occurs most often among post term
Hypertension), Infections.
infants, decreased amniotic fluid/cord
SGA – complications: hypoglycemia, meconium compression.
aspiration, hypothermia, polycthemia
Neonatal Sepsis (Sepsis Neonatorum)

- A type of neonatal infection and specifically

Respiratory Distress Syndrome (RSD) refers to the presence in a newborn baby of a
RSD – also known as Hyaline Membrane Disease bacterial blood stream infection (BSI) (such as
meningitis, pneumonia, pyelonephritis, or
RSD – cause: prematurity, C/S, diabetic mother, gastroenteritis) in the setting fever.
birth asphyxia – interfere with surfactant

RSD – s&s: T R N C G S A  Early-Onset sepsis (EOS) – first 72 hours of

life
Silverman-Andersen Index measures:
- Neonatal sepsis is the single most common
 Upper chest
cause of neonatal death in hospital as well as
 Lower chest
community in developing country.
 Xiphoid retractions
 Nares dilation - (Heart rate above 160) … tachycardia can
 Expiratory grunt present up to 24 hours before the onset of
other signs.

Grade 0 - One risk for Group B Streptococcal Infection

(GBS) is Preterm Premature Rupture of
 Synchronized Membranes (PPROM). Screening women for
 No retractions GBS (via vaginal and rectal swabbing) and
 None treating culture positive women with
 None intrapartum chemoprophylaxis is reducing the
 None number of neonatal sepsis caused by GBS.
NS Treatment: Infant:

Frequently treated with antibiotics empirically until Intussusception – is a medical condition in which
cultures are sufficiently proven to be negative. a part of the intestine folds into section next to it.

In addition to fluid resuscitation and supportive Risk factors:

care, a common antibiotic regimen in infants with
suspected sepsis is a beta-lactam antibiotic - Certain infection
(usually ampicillin) in combination with an - Disease like cystic fibrosis
aminoglycoside (usually gentamicin). - Intestinal polyps

Hyperbilirubinemia Failure to Thrive (FTT) – defined in term of weight,

and can be evaluated either by a low weight for
Phototherapy – bilirubin on skin changes into the child’s age, or by a low rate of increase in
water-soluble excreted in bile & urine. the weight.

 “Bili” light placed inside warmer, need patches

over eyes, infant wearing only diaper or fiber-
optic phototherapy blanket against skin Endogenous (Organic)
 Side effects: frequent, loos, green stools, skin Problems with the gastrointestinal system such
changes as excessive gas and acid reflux are painful
 Can be used at home conditions which may make the child unwilling to
take in sufficient nutrition.

Other Interventions:
Exogenous (Non-organic) – sleepy baby syndrome
• Exchange transfusions – if lights not working

• Maintain neutral thermal environment – not too … conflicting setting and protracted emergencies,
hot or too cold exogenous faltering may be caused by chronic
food insecurity, lack of nutritional awareness,
• Provide optimal nutrition – hydrate and other factors beyond the caregiver control.
• Protecting the eyes from retinal damage

• Enhance therapy by exposing as much skin as

Mixed
possible to light, remove all clothing except diaper,
Child: act content
turn frequently
Caregiver: do not offer feedings of sufficient
frequency or volume
Child: with severe acid reflux, be in pain while
Others: eating
Caregiver: hesitant to offer sufficient feeding
A. Infant of a Diabetic Mother

 Macrosomia: face round, red, body obese, Wasting – weight-for-height

poor muscle tone, irritable, tremors
Stunting – height-for-age
 Most frequent symptom: jitteriness or
tremors
What is Sudden Infant Death Syndrome (SIDS)? Cause of DS:

− Major cause of death in infants after 1st month of − Trisomy 21 is caused by a failure of the 21st
life chromosome to separate during egg or sperm
− Sudden & silent in an apparently healthy infant development (nondisjunction).
− Unpredictable & unpreventable
− Quick death with no signs of suffering - usually − As a result, a sperm or egg cell is produced with
during sleep an extra copy of chromosome 21; this cell thus has
24 chromosomes.

Environment Assessment: − When combined with a normal cell from the other
parent, the baby has 47 chromosomes, with three
− Location of infant copies of chromosome 21.
− Presence of objects in area infant found
− Unusual conditions  88% mother
- High room temperature  8% father
- Odors  3% after the egg and sperm have merged
- Anything out of ordinary

Cleft Lip and Cleft Palate

Colic
Cause:
Baby Colic, also known as Infantile Colic, is defined
as episodes of crying for more than three hours a - Frontonasal Prominence (1) – from the top of the
day, for more than three days a week, for three head down towards the future upper lip;
weeks in an otherwise healthy child between the
ages of two weeks and four months. - Maxillar Prominence (2) – from the cheeks, which
meet the first lobe to form the upper lip; and
Colic is diagnosed after other potential causes of
crying are excluded. - Mandibular Prominence (2) – just below,
additional lobes grow from each side, which form
the chin and lower lip.
Treatment:

− Calming measures may be used and include: Clefts can also affect other parts of the face, such
- Swaddling with the legs flexed as the eyes, ears, nose, cheeks, and forehead.
- Holding the baby on its side or stomach
- Swinging the baby side to side or back and
forth while supporting the head
Treatment:
- Making a shushing sound, and breast
feeding. Rule of 10s – Wilhelmmesen and Musgrave in 1969
− Eye contact, talking, and holding the infant are
also reasonable measures, although it is not ✓ is at least 10 weeks of age;
entirely clear if these actions have any effect
beyond placebo. ✓ weighs at least 10 pounds, and

✓ has at least 10g haemoglobin

Trisomy 21/ Down Syndrome (DS) - typically
associated with physical growth delays, mild to
moderate intellectual disability, and characteristic
facial features.
Imperforated Anus - Meningocele – typically causes mild
problems with a sac of fluid present at the
Features: gap in the spine.
The classical Wingspread classification was in low - Myelomeningocele – also known as open
and high anomalies: spina bifida, is the most severe form.

− Low Lesion – colon remains close to the skin. In

this case, there may be a stenosis (narrowing) of Causes of Hydrocephalus:
the anus, or the anus may be missing altogether,
with the rectum ending in a blind pouch.  Congenital
 Acquired – as a consequence of CNS
− High Lesion – colon is higher up in the pelvis and
infections, Meningitis, Brain tumors, Head
there is a fistula connecting the rectum and the
trauma, or Intracranial Hemorrhage, and it is
bladder, urethra, or the vagina.
usually painful.
− Persistent Cloaca (from the term cloaca, an
Treatment:
analogous orifice in reptiles and amphibians), in
which the rectum, vagina and urinary tract are Endoscopic Third Ventriculostomy (ETV), an
joined into a single channel. alternative treatment for obstructive hydrocephalus
in selected people, a surgical opening in the floor of
the third ventricle allows the CSF to flow directly to
Associated Anomalies: the basal boilers, thereby shortcutting any
obstruction.
V – Vertebral Anomalies
A – Anal Atresia
C – Cardiovascular Anomalies
Cause of Otitis Media:
T – Tracheoesophageal Fistula
E – Esophageal Atresia − Because of the Eustachian tube dysfunction, the
R – Renal and/or Radial Anomalies gas volume in the middle ear is trapped and parts
L – Limb Defects of it are slowly absorbed by the surrounding
tissues, leading to negative pressure in the middle
ear.
While many surgical techniques to definitively
repair anorectal malformations have been − Eventually, the negative middle-ear pressure can
described, the posterior sagittal approach reach a point where fluid from the surrounding
(PSARP) has become the most popular. It involves tissues is sucked into the middle ear's cavity
dissection of the perineum without entry into the (tympanic cavity), causing a middle-ear effusion.
abdomen and 90% of defects in boys can be
repaired this way. − By reflux or aspiration of unwanted secretions
from the nasopharynx into the normally sterile
middle-ear space, the fluid may then become
infected – usually with bacteria.
Spina Bifida - A birth defect where there is
incomplete closing of backbone and membranes Types: AOM, OME, CSOM, Adhesive OM
around the spinal cord.
Chronic Supporative Otitis Media - Middle ear
Types: inflammation of greater than 2 weeks that results in
episodes of ear discharge for at least 6 weeks.
 Spina Bifida Occulta
 Spina Bifida Cystica