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1}}}}\paperw12240\paperh15840\margl666\margr133\margt666\margb453
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\fs18\cf0\par\pard\li1333\ri0\sl-560\slmult0 \fs32\cf1\f0\charscalex100\b {GU�A
B�SICA PARA EL EX�MEN F�SICO DEL RECI�N}\b0 \par\pard\li1733\ri0\sl-546\slmult0
\fs32\cf1\f0\charscalex100\b {NACIDO Y DEL NI�O EN UN CONSULTORIO DEL}\b0
\par\pard\li3506\ri0\sl-546\slmult0 \fs32\cf1\f0\charscalex100\b {M�DICO DE LA
FAMILIA . }\b0 \par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-373\slmult0
\fs24\cf0\f0\charscalex100\b \ul {Autores: }\b0 \ul0 \fs24\cf0\f1\charscalex100
{Dr. Marco J. Albert Cabrera (1), Dr. Suiberto Hechavarr�a Toledo
(2),}\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {Dr. Ricardo V.
De la Fuente Crespo (3), Dra. Yaima Carolina Pino Pe�a
(4) }\par\pard\li1493\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1493\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{(1) Especialista de 1er y 2do Grados en Medicina Interna, Prof.
Auxiliar. }\par\pard\li1493\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {(2)
Especialista de 1er Grado en Medicina Interna, Prof.
Asistente. }\par\pard\li1493\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {(3)
Especialista de 1er Grado en Medicina General Integral. }\par\pard\li1493\ri0\sl-
413\slmult0 \fs24\cf0\f1\charscalex100 {(4) Medico Residente de 1er a�o de
Medicina General Integral }\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
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\fs18\cf0\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100\b
{MENSURACIONES: 1 libra corresponde a 16 onzas. }\b0 \par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100\b {Etapa
Prenatal}\b0 \fs24\cf0\f1\charscalex100 {: A las 28 semanas de edad gestacional el
feto pesa }\par\pard\li1133\ri0\sl-413\slmult0 \fs22\cf0\f1\charscalex100
{aproximadamente 1,1 Kg., a partir de aqu�, hay una ganancia de peso lineal,
y }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {alcanzar� 2,2
Kg. a las 34 semanas; tendr� un peso de 3,3 Kg. al termino de
las}\par\pard\li1133\ri0\sl-426\slmult0 \fs24\cf0\f1\charscalex100 {40 semanas.
Como promedio ganar� 26 gramos diarios, lo que equivale casi
a }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {una onza por d�a
}\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
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\fs24\cf0\f0\charscalex100\b {Al nacer: }\b0 \fs24\cf0\f1\charscalex100 {Bajo peso:
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{\uc1\u8211X}\fs24\cf0\f1\charscalex100 { 2999 g }\par\pard\li1133\ri0\sl-
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factor de conversi�n de libras a kilogramos es dividiendo
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\fs24\cf0\f0\charscalex100\b {TALLA }\b0 \par\pard\li1493\ri0\sl-213\slmult0
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{ }\fs24\cf0\f1\charscalex100 {el crecimiento es de 5-}\fs24\cf0\f1\charscalex100
{6}\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {cm. por a�o.
Alcanzada esa etapa (alrededor de los 12 a�os para las hembras)
y }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {a los 13 � 14
a�os para los varones, ganar�n en ese primer a�o del
estir�n }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {alrededor
de 9 y 10 cm. cada sexo respectivamente. }\par\pard\li1133\ri0\sl-426\slmult0
\fs24\cf0\f1\charscalex100 {Estir�n Puberal (12 a 14 a�os): 10 cm., y la 9
cm. }\par\pard\li1133\ri0\sl-440\slmult0 \fs24\cf0\f1\charscalex100
{Adulto: }\fs24\cf0\f1\charscalex100 { }\fs24\cf0\f1\charscalex100 { 157 cm. (a
los 17 a�os cesa el crecimiento) }\par\pard\li2080\ri0\sl-440\slmult0
\fs24\cf0\f1\charscalex100 { }\fs24\cf0\f1\charscalex100
{169 }\fs24\cf0\f1\charscalex100 {cm. ( a los 18.5 a�os
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{\*\shpinst
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{ }\fs24\cf0\f1\charscalex100 {Talla adulta (cm.) = 1.29 x estatura (a los 3
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adulta (cm.) = Estatura (a los 2 a�os) x 2 }\par\pard\li1133\ri0\sl-426\slmult0
\fs24\cf0\f1\charscalex100 {Talla adulta (cm.) = Estatura (a los 2 a�os) x 2 (al
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\fs24\cf0\f1\charscalex100 { 12
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\fs24\cf0\f0\charscalex100\b {CIRCUNFERENCIA CEF�LICA. }\b0
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\fs18\cf0\par\pard\li1133\ri0\sl-453\slmult0 \fs24\cf0\f1\charscalex100 {A
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cm. }\par\pard\li1133\ri0\sl-426\slmult0 \fs24\cf0\f1\charscalex100 {A los 6 meses:
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{\uc1\u61607X}\fs22\cf0\f1\charscalex100 { 5 a�os }\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
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{\uc1\u61607X}\fs22\cf0\f1\charscalex100 { 6 a�os }\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs22\cf0\f3\charscalex100
{\uc1\u61607X}\fs22\cf0\f1\charscalex100 { 9 a�os }\par\pard\li1133\ri0\sl-
413\slmult0 \fs24\cf0\f3\charscalex100 {\uc1\u61607X}\fs24\cf0\f1\charscalex100
{ 10 a�os }\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100 {Alterna los
pies al bajar escaleras, recibe una pelota, dibuja}\par\pard\li0\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {la figura humana, nombra uno o m�s colores, repite
4 }\par\pard\li0\ri0\sl-426\slmult0 \fs24\cf0\f1\charscalex100 {d�gitos, copia una
cruz, realiza juegos de cooperaci�n. }\par\pard\li0\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {Trepa y mantiene el equilibrio, se viste solo, juega
con los}\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {ni�os, repite
una historia corta, cuenta hasta 4 objetos, }\par\pard\li0\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {dibuja cuadros, colores
primarios. }\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {Cuenta
hasta 5, copia tri�ngulos, distingue el d�a de la }\par\pard\li0\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {noche y la derecha de la
izquierda. }\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {Cambia
monedas y lee por iniciativa propia. }\par\pard\li0\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {Escribe cartas
cortas. }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn1
33\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100\b
{Indicadores de Maduraci�n }\b0 \par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
440\slmult0 \fs24\cf0\f1\charscalex100 { Incluye la evaluaci�n de la edad �sea y
dental, fontanelas, desarrollo del}\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {lenguaje y el control de
esf�nteres. }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-426\slmult0
\fs24\cf0\f0\charscalex100\b {DESARROLLO DEL LENGUAJE }\b0 \par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-426\slmult0 \fs24\cf0\f1\charscalex100 {Reci�n
Nacido hasta las 4 semanas: Llora. }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {1 a 4 meses: Emite arrullos y ruidos similares a la
risa. Establece di�logo bocal}\par\pard\li1133\ri0\sl-426\slmult0
\fs24\cf0\f1\charscalex100 {con su madre. }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {A los 2 meses comienza a evidenciarse el desarrollo
del lenguaje con el gorjeo. }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {5 meses: Vocaliza, abundante balbuceo con consonantes.
Emite sonidos}\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{nasales (m, n) y algunos labiales. }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {6 a 7 meses: Balbuceo con autoimitaci�n (ma, da di,
do). }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {8 a 9 meses:
Juego sonoro de autoimitaci�n. Emite s�labas y palabras que
dicen }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{otros. }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {10 a 11
meses: Repite palabras que dicen otros. Responde apropiadamente
a }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {muchas palabras
familiares para cosas y acontecimientos. }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {12 meses: Imita con mucha habilidad y aparecen las
primeras palabras}\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{calificativas. }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\m
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1}}}}\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn386\pard\
li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
400\slmult0 \fs24\cf0\f1\charscalex100 {18 meses: Aumenta el inventario de palabras
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\fs24\cf0\f1\charscalex100 {adulto y dice frases de 2 palabras
comprensibles. }\par\pard\li1133\ri0\sl-426\slmult0 \fs24\cf0\f1\charscalex100 {24
meses: Comprende cientos de palabras y oraciones. Vocabulario de
50 }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {palabras o m�s,
hace combinaciones de 2 palabras m�s inteligibles. }\par\pard\li1133\ri0\sl-
413\slmult0 \fs24\cf0\f1\charscalex100 {30 meses: Gran incremento del vocabulario.
Hace oraciones gramaticalmente }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {iguales a las del adulto. Entiende casi
todo. }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {36 meses:
Puede saber m�s de 1000 palabras. La sintaxis es casi}\par\pard\li1133\ri0\sl-
413\slmult0 \fs24\cf0\f1\charscalex100 {completamente adulta. Sabe expresar lo que
piensa. }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {48 meses:
Sabe de 1500 a 2000 palabras y comprende 20000. }\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-426\slmult0 \fs24\cf0\f0\charscalex100\b {CONTROL
DE LOS ESF�NTERES. }\b0
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colno1\colw2573\colsr-0\colno2\colw8866\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
440\slmult0 \fs24\cf0\f1\charscalex100 {Vesical: }\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
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{Anal: }\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
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{Diurno: a los 3 a�os. }\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{Nocturno: a los 5 a�os. }\par\pard\li0\ri0\sl-213\slmult0
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\fs24\cf0\f1\charscalex100 {De 1� a 2
a�os. }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133
\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
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{DESARROLLO OSEO. }\b0 \par\pard\li1133\ri0\sl-440\slmult0
\fs24\cf0\f1\charscalex100 {Al nacer: Existen puntos de osificaci�n en la
extremidad distal del f�mur y el}\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {cuboides. Luego se miden por radiograf�as de la
mano: }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133
\cols2\colno1\colw2573\colsr-0\colno2\colw8866\pard\li1133\ri0\sl-426\slmult0
\fs24\cf0\f1\charscalex100 {Grande }\par\column\pard\li0\ri0\sl-426\slmult0
\fs24\cf0\f1\charscalex100 {5
meses. }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn13
3\pard\li1133\ri0\sl-413\slmult0 \*\tx2573\fs24\cf0\f1\charscalex100
{Ganchoso }\tab \fs24\cf0\f1\charscalex100 {6 meses. }\par\pard\li1133\ri0\sl-
413\slmult0 \*\tx2573\fs24\cf0\f1\charscalex100 {Piramidal }\tab
\fs24\cf0\f1\charscalex100 {2 a 3 a�os. }\par\pard\li1133\ri0\sl-413\slmult0
\*\tx2573\fs22\cf0\f1\charscalex100 {Semilunar }\tab \fs22\cf0\f1\charscalex100 {3
a 5 a�os. }\par\pard\li1133\ri0\sl-413\slmult0 \fs22\cf0\f1\charscalex100
{Escafoides 4 a 7
a�os. }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133
\cols2\colno1\colw2573\colsr-0\colno2\colw8866\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {Trapecio }\par\column\pard\li0\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {5 a 7
a�os. }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133
\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {Trapezoide 6 a 7 a�os.
}\par\pard\li1133\ri0\sl-413\slmult0 \fs22\cf0\f1\charscalex100 {Ext. Cubito 7 a 8
a�os. }\par\pard\li1133\ri0\sl-413\slmult0 \*\tx2573\fs24\cf0\f1\charscalex100
{Pisiforme }\tab \fs24\cf0\f1\charscalex100 {10 a 12
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{\sp{\sn shapeType}{\sv 0}}
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{\shp{\*\shpinst\shpleft1693\shptop4826\shpright10546\shpbottom5280\shpfhdr0\shpwr3
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{\shp{\*\shpinst\shpleft7226\shptop4306\shpright8373\shpbottom4506\shpfhdr0\shpwr3\
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{\shp{\*\shpinst\shpleft8400\shptop3666\shpright8400\shpbottom3680\shpfhdr0\shpwr3\
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{\sp{\sn pVerticies}{\sv 8;5;(0,0);(0,413);(773,413);(773,0);(0,0);}}
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li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
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440\slmult0 \fs24\cf0\f0\charscalex100\b { }\b0 \fs24\cf0\f0\charscalex100\b
{EX�MEN F�SICO }\b0 \par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
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\fs18\cf0\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {El examen
f�sico del reci�n nacido se realiza siguiendo una
trayectoria }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{cefalocaudal. }\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
400\slmult0 \fs24\cf0\f0\charscalex100\b {Fontanelas:}\b0
\fs24\cf0\f1\charscalex100 { La anterior mide }\fs24\cf0\f1\charscalex100
{2�}\fs24\cf0\f1\charscalex100 { -3 cm. Pudiendo llegar a
4-}\fs24\cf0\f1\charscalex100 {5 }\fs24\cf0\f1\charscalex100 {cm. y se
cierra }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {entre los
12 y los 14 meses, hasta los 18 meses. }\par\pard\li2573\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-
400\slmult0 \fs24\cf0\f1\charscalex100 {La posterior se cierra
de }\fs24\cf0\f1\charscalex100 {6 }\fs24\cf0\f1\charscalex100 {a 8
semanas }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0
\fs24\cf0\f0\charscalex100\b {Formula dentaria: }\b0 \par\pard\li2573\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-360\slmult0 \fs24\cf0\f1\charscalex100
{ 14 18 10 8 8 10
18 }\fs24\cf0\f1\charscalex100 {14}\fs24\cf0\f1\charscalex100
{ }\par\pard\li2160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2160\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li2160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2160\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li2160\ri0\sl-386\slmult0 \fs24\cf0\f1\charscalex100
{ 14 18 12 6 6 12 18
14 }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0
\fs24\cf0\f0\charscalex100\b {Adem�s tenemos el crecimiento de los molares: }\b0
\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-386\slmult0 \fs24\cf0\f1\charscalex100
{2 primeros molares superiores e inferiores: 2 a�os. }\par\pard\li1133\ri0\sl-
413\slmult0 \fs24\cf0\f1\charscalex100 {2 segundos molares superiores e inferiores:
6 a�os. }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {2 terceros
molares superiores e inferiores: 12 a�os. }\par\pard\li1133\ri0\sl-426\slmult0
\fs24\cf0\f1\charscalex100 {Cordales: 18
a�os. }\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133
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{Fascie: }\b0 \par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f0\charscalex100\b
{Orejas}\b0 \fs24\cf0\f1\charscalex100 {: }\par\column\pard\li0\ri0\sl-
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\fs24\cf0\f1\charscalex100 {En el reci�n nacido es generalmente
edematosa. }\par\pard\li0\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {Poseen un
cart�lago fuerte y regresan r�pidamente cuando se
les }\par\pard\li0\ri0\sl-426\slmult0 \fs24\cf0\f1\charscalex100
{dobla. }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn1
33\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
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ojos}\b0 \fs24\cf0\f1\charscalex100 {: Resultan dif�ciles de explorar, hay
respuesta de parpadeo ante la }\par\pard\li2573\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {luz intensa, el color del iris es generalmente
gris y var�a las}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{primeras semanas. En la mayor�a de los neonatos puede
haber}\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {una
hemorragia subconjuntival o peque�as hemorragias
retinianas. }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0
\fs24\cf0\f0\charscalex100\b {Nariz:}\b0 \fs24\cf0\f1\charscalex100 { El
puente nasal esta deprimido, se puede ver alg�n grado de
aleteo }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {nasal sin
que esto signifique una dificultad respiratoria. }\par\pard\li1133\ri0\sl-
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\fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100\b
{Boca:}\b0 \fs24\cf0\f1\charscalex100 { Se observa en la uni�n del
paladar duro con el blando un ac�mulo }\par\pard\li2573\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {de restos epiteliales que se denominan perlas de
Epstein. La }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{pr}\fs24\cf0\f1\charscalex100 {otusi�n de la lengua puede verse impedida en
alg�n grado }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{cuando existen frenillos
sublinguales. }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\mar
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\fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100\b
{Cuello:}\b0 \par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100
{Corto, sin tumoraciones palpables ni
pliegues. }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsx
n133\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f0\charscalex100\b {T�rax:
}\b0 { }\fs24\cf0\f1\charscalex100 { Predomina el di�metro anteroposterior, el
pez�n est� pigmentado }\par\pard\li2573\ri0\sl-426\slmult0
\fs24\cf0\f1\charscalex100 {con un borde que hace relieve, el bot�n mamario
ser� mayor de }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {0,5
cm. en uno o ambos lados. Las mamas se ir�n
ingurgitando, }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{tanto en ni�as como en ni�os a partir del 3er d�a, hasta el final
de }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {la 2da semana y
en ocasiones producen una secreci�n parecida al}\par\pard\li2573\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {calostro denominada leche de
brujas. }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
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\fs24\cf0\f0\charscalex100\b {Abdomen:}\b0 \fs24\cf0\f1\charscalex100 { Es
globuloso como de batracio y sigue los movimientos de
la }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {respiraci�n.
Puede ser palpable el h�gado hasta 2 cm. por debajo }\par\pard\li2573\ri0\sl-
413\slmult0 \fs24\cf0\f1\charscalex100 {del reborde costal as� como una punta de
bazo. El cord�n umbilical }\par\pard\li2573\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {deber� ser rutinariamente examinado para comprobar la
existencia }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrs
xn133\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margt
sxn666\margbsxn413\pard\li2573\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li2573\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li2573\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100 {de dos
arterias y una vena. Se desprende normalmente entre el 6
y }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {8
d�a. }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-413\slmult0
\fs22\cf0\f0\charscalex100\b {Miembros:}\b0 \fs22\cf0\f1\charscalex100 { Son
cortos con relaci�n al tronco. Generalmente se observan
en }\par\pard\li2573\ri0\sl-413\slmult0 \fs22\cf0\f1\charscalex100 {postura t�nica,
flexionados. Al examinarlos (siempre por delante y }\par\pard\li2573\ri0\sl-
413\slmult0 \fs24\cf0\f1\charscalex100 {por detr�s), debemos comprobar que los
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comprobar si en su longitud son equivalentes. Debemos }\par\pard\li2573\ri0\sl-
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camilla, y en }\par\pard\li2573\ri0\sl-413\slmult0
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realizar un }\par\pard\li2573\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
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pliegues gruesos y profundos en }\par\pard\li2573\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {su totalidad. }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {Se buscar� tambi�n la presencia de f�stulas u
otras alteraciones en el pliegue }\par\pard\li1133\ri0\sl-413\slmult0
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1}}}}\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn506\pard\
li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
440\slmult0 \fs24\cf0\f0\charscalex100\b { Puericultura }\b0
\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-426\slmult0 \fs24\cf0\f1\charscalex100 {Se debe
referir cualquier preocupaci�n de la madre, si existe o no avidez por
la}\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {succi�n,
caracter�sticas del llanto fuerte, d�bil), vitalidad, si se mantiene con
LME }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {o si se le da
agua o alg�n otro alimento, frecuencia de amamantamiento, }\par\pard\li1133\ri0\sl-
413\slmult0 \fs24\cf0\f1\charscalex100 {caracter�sticas de la micci�n (color,
chorro d�bil o bifurcado) y de la defecaci�n. }\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100 {Esquema de
vacunaci�n: Revisar las inmunizaciones ya existentes y la
pr�xima }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {a
realizar. }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{Desarrollo psicomotor: Lo que hace. }\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
400\slmult0 \fs24\cf0\f1\charscalex100 {Ablactaci�n: Lo que come. Describir
frecuencia de alimentaci�n y forma de }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {preparaci�n de os alimentos, sobre todo la
leche. }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100
{Formula dentaria: dientes de arriba/ dientes de abajo. }\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100 {Fontanela:
Cerrada o abierta, mide______ y est� normotensa. }\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100
{Mucosas: }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100
{Respiratorio: }\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
400\slmult0 \fs24\cf0\f1\charscalex100 {Cardiovascular: Adem�s explorar el llene
capilar, pulsos perif�ricos y tibieza de }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {los pies. Aclarar si existe acrocianosis, livedo
reticular, etc. }\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
400\slmult0 \fs24\cf0\f1\charscalex100 {Abdomen: }\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {Genitales
externos: Comprobar que no existan hernias
inguinales }\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrs
xn133\margtsxn666\margbsxn413\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100
{Cord�n umbilical: Debe tener 2 arterias y 1 vena y no presentar
signos}\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {flog�sticos
en caso de que sea reci�n nacido. }\par\pard\li1133\ri0\sl-426\slmult0
\fs24\cf0\f1\charscalex100 {Se ve en abdomen. Cuando ya ha cicatrizado se debe
describir el tipo de }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {ombligo (normal, cut�neo) y si existen hernias
umbilicales. }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100
{Reflejos: se describen en sensorio. Deben ponerse los presentes y los que
ya }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {desaparecieron
aclarando si se corresponde con edad. }\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
400\slmult0 \fs24\cf0\f1\charscalex100 {Peso: }\par\pard\li1133\ri0\sl-
413\slmult0 \fs24\cf0\f1\charscalex100 {Talla: }\par\pard\li1133\ri0\sl-
413\slmult0 \fs24\cf0\f1\charscalex100 {CC:}\fs24\cf0\f1\charscalex100
{ }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {Valoraci�n
nutricional: }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100
{Si todo impresiona normal se concluye ID: Lactante sano eutr�fico y se
procede }\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {a realizar
las }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0
\fs24\cf0\f0\charscalex100\b {Indicaciones: }\b0 \par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100 {Lactancia
Materna exclusiva hasta los 6 meses. }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {Ba�os de sol diario: Se indica al dar el alta del RN en
la maternidad, vestido con }\par\pard\li1133\ri0\sl-426\slmult0
\fs24\cf0\f1\charscalex100 {la menor cantidad de ropa posible y los ojos cubiertos,
directamente expuesto al}\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {sol, sin cristal o ventana que interfiera, comenzar por
1 minuto el primer d�a, e ir }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {incrementando 1 minuto diario hasta llegar a 10, se
har� en horario antes de las}\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {10 AM o despu�s de 5 PM, recordar es importante que el
ni�o tome el sol tanto }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {en la parte anterior como la posterior de su
cuerpo. }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100
{Ba�os con agua hervida diario. Recordar la importancia de evitar sumergir en
el}\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100 {agua del
recipiente los genitales de las hembras. }\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
400\slmult0 \fs24\cf0\f1\charscalex100 {Lavado de la cavidad oral con agua hervida
despu�s de alimentar al
beb�. }\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133
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213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100
{Evitar o demorar la introducci�n o el uso de talcos y
perfumes. }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{Cura del mu��n umbilical 2 veces al d�a con alcohol al % hasta
cicatrizaci�n. }\par\pard\li1133\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
400\slmult0 \fs24\cf0\f1\charscalex100 {Charla sobre accidentes en el hogar seg�n
edad: evitar el co- lecho, los teteras}\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {con cadenas, prendas como cadenas, pulseras, anillos o
alianzas; juguetes con }\par\pard\li1133\ri0\sl-413\slmult0
\fs24\cf0\f1\charscalex100 {piezas peque�as, las cintas en s�banas o mosquiteros,
los cubos de agua,}\par\pard\li1133\ri0\sl-413\slmult0 \fs24\cf0\f1\charscalex100
{cisternas o pozos sin tapas, balcones y escaleras sin protecci�n,
etc. }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100
{Charla sobre prevenci�n de IRA y EDA y urosepsis con �nfasis si es
hembra. }\par\pard\li1133\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1133\ri0\sl-400\slmult0 \fs24\cf0\f1\charscalex100
{Estimular el desarrollo psicomotor del ni�o. }\par}