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-DR. AKIF A.B
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
-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
-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
-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.
-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 1st bday
-Seen on 3rd to 7th day of life
- due to withdrawal of maternal hormones
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
-Moro reflex is present since birth
- disappears by 6th month
- Unilateral Moro reflex : 1) erb’s palsy
2) fracture of humerus / clavicle
3) shoulder dislocation
4) Spastic Hemiplegia
- Exaggarated moro reflex : Brain damage
Watch video of asymmetric tonic neck reflex by clicking on this link
https://www.youtube.com/watch?v=UWqafotPxTg
Appears at 4-6months and disappears at 8-12 months
Rooting reflex appears at 32 wks of gestation
-Parachute reflex appears at around 9th month and persists throughout life.
-
Landau reflex appaears at 10th month and disappears by 24 months
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.
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 Prognos
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
-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
-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
8. Not ass. With neonatal jaundice 8. Prolongs neonatal jaundice since it
contains blood
9. Edematous swelling of scalp 9. Subperiosteal swelling
1) Symptoms doesn’t appear at birth
2) Symptoms appear at 3rd week of life
3) Non bilious vomiting since obstruction is above the opening of common bile duct
at 2nd 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
-Single most important risk factor = Prematurity
- Bell’s Staging
To make it easy refer next slide
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
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
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Newborn infant

  • 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.
  • 6.
  • 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 1st bday
  • 8. -Seen on 3rd to 7th day of life - due to withdrawal of maternal hormones
  • 9.
  • 10.
  • 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
  • 12.
  • 13.
  • 14. -Moro reflex is present since birth - disappears by 6th month - Unilateral Moro reflex : 1) erb’s palsy 2) fracture of humerus / clavicle 3) shoulder dislocation 4) Spastic Hemiplegia - Exaggarated moro reflex : Brain damage
  • 15.
  • 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
  • 18.
  • 19.
  • 20.
  • 21. Rooting reflex appears at 32 wks of gestation
  • 22.
  • 23. -Parachute reflex appears at around 9th month and persists throughout life. -
  • 24.
  • 25. Landau reflex appaears at 10th month and disappears by 24 months
  • 26.
  • 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.
  • 28.
  • 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 Prognos 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
  • 31.
  • 32.
  • 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
  • 35.
  • 36.
  • 37. 1) Symptoms doesn’t appear at birth 2) Symptoms appear at 3rd week of life 3) Non bilious vomiting since obstruction is above the opening of common bile duct at 2nd 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
  • 38.
  • 39.
  • 40.
  • 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
  • 44.
  • 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