body temperature, heart rate, respiratory rate, color, signs of respiratory distress, tone and activity should be evaluated. The first aim is to rapidly evaluate the vital signs of the baby and to initiate a necessary resuscitation process without delay.
• In elective conditions, a second, more detailed examination should be done within the first 24 hours. At least 3 inspections should be made.
SKIN EXAMINATION
It is normal pink. Sometimes there may be mild cyanosis of the tips of the extremities (acrocyanosis). This is a normal finding in the first 48 hours.
In methemoglobinemia, newborns' skin is cyanotic despite high blood PaO2 levels.
The skin of polycythemic newborns is pletoric.
Healthy: after birth, there may be a slight edema of the eyelids and ridge of the tibia. It disappears completely within a few days.
diffuse edema can be seen: Prematurity, hypoproteinemia due to severe erythroblastosis fetalis, non-immune hydrops, congenital nephrosis, Hurler syndrome.
It should bring to mind Turner syndrome: Local edema, congenital anomalies of the lymphatic system or if it is seen in female newborns and is seen in one or more extremities.
Nails appear at 20 weeks, reaching the tip of the fingers at 32 weeks.
Long nails are characteristic of postmature newborns.
Causes of aplasia cutis:
Trisomy 13, chromosome 4 deletion, Johanson-Blizzard syndrome
Normal and non-pathological skin findings
- Mongolian spots - Photodermatitis - Cutis marmoratus - Capillary hemangiomas - Milia - Miliaria - Harlekuin discoloration - Lanugo - Neonatal acne - Transient neonatal pustular melanosis - Toxic erythema - Ebstein pearls – Ranula.
Toxic erythema:
Yellowish pustules lasting up to 1 week are filled with eosinophils. It can occur on the face, trunk and extremities.
Mongolian spots:
It is defined for the first time in Down syndrome patients, it is blue-gray in the sacral region and hips. It is mostly seen in brunette babies. They disappear around 1 year of age.
Photodermatitis:
In infants receiving phototherapy.
Cutis marmoratus:
It is common in infants with Down syndrome. In infants with a poor general condition and in shock. Both pathological and non-pathological.
Capillary hemangiomas (macular hemangiomas, Salmon spots):
They are found on the upper eyelids, the nape, the root of the nose. They disappear around 1 year of age.
Milia:
They are tiny cystic structures filled with keratin residues. They appear on the edges of the wing of the nose, in pearly white color, about the size of a pinhead.
Miliaria:
maculopapular and vesicular lesions occur on the neck and forehead. It is necessary to wash the baby and not to dress it thickly.
Harlequin discoloration (clown doll):
seen in preterm infants. With a line between the vertex and pubis, half of the body is hyperemic and half is pale.
Lanugo:
Especially in preterms, they are fine hairs. They shed in a short time.
Newborn acne:
especially in the cheeks and chin with the effect of the hormones passed from the mother in male babies. It resolves without the need for treatment.
Transient neonatal pustular melanosis:
toxic erythema can be compared to a very common and pigmented state. it corrects itself.
Ebstein pearls:
In the mouth, especially on the palate.
Ranula:
They are bluish colored retention cysts in the mouth.
pathological skin findings:
Sclerem - Petechiae and ecchymoses - (Cafe au lait) spots - junctional nevi - Jaundice - Grayish skin color - Severe edema - Port Wine stain - Cavernous hemangiomas - Amniotic bands.
sclera:
It is a sign of poor prognosis in newborns with sepsis.
Petechiae and ecchymoses: always be careful in terms of a bleeding diathesis.
(Cafe au lait) spots:
If they are numerous, neurofibromatosis should be considered.
junctional nevi:
The infant should be examined for tuberous sclerosis, xeroderma pigmentosum, and neurofibromatosis.
Jaundice:
The level of jaundice should not be decided based on skin color alone, but the bilirubin level should be measured.
Grayish skin colour:
Indicates methemoglobinemia. When phototherapy is given to a baby with direct bilirubinemia (bronze baby).
Severe edema:
may be associated with ascites and pleural effusion.
Port Wine stain:
that does not fade by stepping on it and does not improve over time. In the types that spread to the forehead and upper lips, examination should be done for Sturge Weber syndrome. (Port wine stain + glaucoma and jacksonian seizures).
Cavernous hemangiomas:
They are large red cystic hemangiomas in any part of the body. Most regression with advancing age, some with surgery or corticosteroids. Townch- Merritt syndrome: with cavernous hemangiomas + thrombocytopenia.
Amniotic bands:
On the skin, extremities, face or trunk, cause: fibrotic bands.
EYE EXAMINATION
Conjunctival and retinal hemorrhages are benign. Retinal hemorrhages are vacuum bound. Anisocoria may be present at birth (temporary).
Mucoid discharge is normal in the first 2 days. There may also be redness due to silver nitrate. Diameter of the cornea > 1 cm (congenital glaucoma should be suspected) Bilateral red light reflex is an indication of the absence of cataracts or intraocular pathology.
In cataracts occurring in the first year of life, congenital cataract and white reflux are taken. It can be alone or together with systemic diseases:
Alport syndrome (with kidney diseases)
Marinesco-Sjögren syndrome (with CNS diseases)
Marfan syndrome (with skeletal system diseases)
Hallerman-Streiff syndrome (with mandibulofacial diseases)
Galactosemia (if proper diet is used before 6 weeks, cataract development is prevented)
In non-hereditary congenital cataract: (may cause)
rubella, toxoplasmosis, mumps, retrolental fibroplasia, neonatal hypoglycemia and hypocalcemia.
RESPIRATORY SYSTEM EXAMINATION
- respiratory rate 30-60/min. Respiration rate is higher in premature babies.
- Irregular breathing pattern (50-60/min) in premature infants, called "periodic breathing (Cheyne-Stokes breathing)", of less than 20 seconds duration, not accompanied by cyanosis and bradycardia, and followed by apnea for 10-15 seconds. respiratory attacks may occur.
- One of the most important signs of respiratory distress in newborns is "groaning". other findings: nasal wing breathing, suprasternal, intercostal and subcostal retractions. sometimes cyanosis.
CIRCULATION SYSTEM EXAMINATION
The average heart rate is 110-140 beats/min, and 90 beats/min while sleeping and 180 beats/min when crying.
In newborns, peripheral pulses are measured from the femoral and brachial arteries (if the baby is quiescent, it may also be carotid).
Oxygen saturation <96% after 24 hours of life should be taken as the cut-off value for serious congenital heart diseases.
It is absolutely necessary to measure the lower and upper extremities separately and see if there is a difference.
blood pressure values in term newborns are 50/30 - 80/50 mmHg.
Abdominal Examination
Liver 2 cm, spleen 1-1.5 cm can be palpated.
The most common cause of abdominal masses is renal pathologies.
the most common cystic abdominal masses; hydronephrosis, multicystic dysplastic kidneys, adrenal hemorrhage, hydrometrocolpos, intestinal duplication and common bile duct, ovarian, omental or pancreatic cysts.
The most common solid masses are; neuroblastoma, congenital mesoblastic nephroma, hepatoblastoma and teratomas.
A solid mass in the lower quadrant should suggest renal vein thrombosis (also: hematuria + hypertension + thrombocytopenia)
renal vein thrombosis; It is associated with conditions that increase the tendency to coagulation, such as polycythemia, dehydration, diabetic mother, asphyxia, sepsis, nephrosis, and anti-thrombin III or protein C deficiency.
The most common accompanying anomaly is renal anomalies, and the most common accompanying syndrome is trisomy 18.
Late umbilical cord: hypothyroidism - F-XIII deficiency - in leukocyte adhesion defects.
abdominal distention: meconium ileus - Hirschsprung's disease - NEC - sepsis - peritonitis.
Kayak abdomen: diaphragmatic hernia.
Congenital anomaly/syndromes associated with omphalocele:
Beckwith-Wiedemann Syndrome, trisomy 13 and 18 siamese twins, meningomyelocele, imperforated anus and cardiac anomalies.
Granuloma and umbilical polyps:
umbilical granuloma: causes seropulent discharge and predisposes to infection. Cauterization with silver nitrate in treatment. Umbilical polyp: If the polyp is in contact with the ileum or bladder, there may be fecal material or urine discharge. Surgical resection in treatment.
URO-GENITAL EXAMINATION
testicles 32-34. They descend into the scrotum after the gestational week.
In premature girls, the labia majora is smaller and the labia minora is more prominent, and the prominent clitoris can sometimes be confused with the ambigus genitalia.
hypospadias or epispadias: sex chromosome abnormalities.
prominent clitoris: masculine female. (first manifestation of adrenogenital syndromes).
Most newborns urinate in the first 12 hours, and 95% of preterm and term newborns urinate in the first 24 hours.
Urine drip by drop: posterior urethral valve.
vaginal discharge and bleeding are normal findings (from maternal hormones).
Anal opening seen on inspection is not sufficient to rule out anal atresia. The anal opening should be checked with a fine feeding tube.
EXAMINATION OF LIMB
Hemihypertrophy: Wilms tumor, neurofibromatosis, Silver-Russel syndrome, and Beckwith-Widemann syndrome.
hip dysplasia signs:
The knee and foot are higher on the dislocated side in a newborn who is held under the armpit and swayed in the space (Galeazzi sign).
Femoral head: Ortolani test (snaps in), Barlow test (displaces)
NEUROLOGICAL EXAMINATION
Spontaneous position of term newborns is semiflexion. The findings of fetal neuromuscular diseases are breech presentation, polyhydramnios, respiratory failure at birth, pulmonary hypoplasia, hip dislocation, undescended testicles, thin ribs, and club-foot deformity.