Chapter 13: Child and Adolescent Medicine

THE NEWBORN EXAM

It is important to identify neonatal distress and become aware of congenital abnormalities and correctable defects:

• History: Maternal labs, maternal health during pregnancy and labor, outcomes of previous pregnancies, potential toxic exposures, and family history.

• Apgar scores: Performed at 1 and 5 minutes; may be repeated at 10 minutes if indicated (Table 13.1). Low 5-minute Apgar scores correlate with an ↑ risk of death in the first year as well as with cerebral palsy.

Physical Findings

Skin

• Acrocyanosis: Blue hands and feet are often normal, but generalized cyanosis may be a sign of a congenital heart defect and warrants immediate evaluation.

• Birthmarks: Benign birthmarks include capillary hemangiomas and blue-grey spots (formerly called Mongolian spots). Birthmarks such as café-au-lait spots (Figure 13.1) and ash leaf spots can be a sign of an underlying disorder (eg, >6 café-au-lait spots may point to neurofibromatosis type 1 and ash leaf spots are associated with tuberous sclerosis).

Head

• Scalp:

  • Caput succedaneum: Swelling of the scalp caused by pressure on the head against the dilating cervix. Crosses suture lines (Figure 13.2).

  • Cephalohematoma: Bleeding between the skull and periosteum. Does not cross suture lines. Generally benign.

  • Subgaleal hemorrhage: Bleeding beneath the scalp; can result in extensive blood loss. Crosses suture lines.

• Eyes: An abnormal light reflex may be a sign of glaucoma, cataracts, or a tumor (ie, retinoblastoma).

• Ears: Low-set ears may be associated with congenital anomalies. Preauricular pits may be a sign of congenital hearing loss.

• Nose: Check for the patency of both nares. Since infants are obligate nose breathers, blockage of the nasal passage by abnormal tissue (choanal atresia) may lead to respiratory distress.

• Oropharynx: Check for cleft lip or palate. Epstein pearls at the junction of the hard and soft palates are epithelial retention cysts and are considered normal.