Symptoms

and Procedures
Logbook (31-60)
31-35
31.Cyanosis
-Bluish discoloration of the skin
Acrocyanosis (Case 3) Central cyanosis
• Sites : Skin and extremities (palms and • Sites : skin ,mucus membranes and
soles tongue
• NORMAL in newborn • NEVER NORMAL in newborns
• Cause : oxygen uptake by tissues due • Cause : Low hemoglobin saturation and
to  movement through capillaries low arterial PaO2
increased venous deoxygenated blood
• Indicates problems with lungs,heart or
• Indicates vasomotor changes (instability blood
and constriction due to cold)
32. Oxygen delivery by Prongs
(Case : Tuberculous meningitis)
PROCEDURE
1. Select the appropriate size nasal prong for patient
2. Lubricate prongs with infant’s saliva or gel
3. Suction to clear secretions (if present)
4. Position prongs along patient’s checks and secure the
nasal prongs on the face with adhesive tape
5. Then position tubing over the ears and secure behind
head
6. Check prongs and tubing for patency,kinks or twists
(clear or change prongs if needed)
7. Connect to ventilator
8. Change adhesive tape weekly or more frequently if
required
FLOW RATE
• 1-2 litres/min (0.5 litres/min for young infants) to deliver
an inspired oxygen concentration of upto 40 %
• Humidification is not required (Low flow)
AIM
• Oxygen saturation > 90 %
MONITORING
• Check if equipment is working regularly
• Remove and clean prongs at least twice daily
• Monitor child every 3 hours to check and correct any
problems
 33. Oxygen delivery by Mask

PROCEDURE FLOW RATE

Simple mask • Minimum flow rate = 4 LPM
1. Select a mask that best fits from the child’s bridge of nose • Humidification not required routinely
to the cleft of jaw
Indications for humidification :
2. Connect to ventilator
• Patients with :
3. Adjust nose clip and head strap to secure mask in place • Increased/thickened secretions
Non –rebreathing face mask • Secretion retention
1. Reservoir bag needs to be inflated prior to placing on • Conditions such as asthma
patient
AIM
2. Ensure bag is fully inflated during the whole respiratory
cycle ( inspiration and expiration) Oxygen saturation > 90 %
 Not for routine use outside ED and PICU MONITORING

For for more information :

https://www.rch.org.au/rchcpg/hospital_clinical_guideline_inde
x/Oxygen_delivery/
34. Oxygen delivery by CPAP
(Case : Respiratory distress due to meconium aspiration )
PROCEDURE INITIAL SETTING
• Usual range : 5-8 cmH2O
1. Position patient so airway is open • Higher CPAP (12-14 cmH2O) indicated in clinical conditions such as
bronchiolitis,severe chronic lung disease and tracheal issues)
2. Suction to clear secretions from both nares if present
• INCREASE in initial setting of CPAP required if WORK OF
3. Use measurement tape to determine right bonnet size (hat,cap or BREATHING,RESPIRATORY RATE,OXYGEN REQUIREMENT AND CONDITION
elastic band can also be used) DETERIORATES
4. Place bonnet over the head of infant (ensure the ears and nape of the DELIVERED CPAP
neck is covered) and close bonnet with ribbons for fit
• Commonly this is lower than set pressure
5. Prongs or mask can be used (select appropriate size)
WEANING CPAP SETTINGS
6. Mount prongs or mask to CPAP generator
• In increments of 1 cmH2O every 12-24 hours
7. Secure the tubing (take a fixation pillow and put it on top of bonnet then
put the tubing on pillow and secure) • Need to asseess condition of patient before weaning
8. Turn on CPAP machine CEASING CPAP
9. Secure prongs or mask on face • Only remove when infant demonstrates stable respiratory pattern on CPAP
of 5 cmH20 in < 30% of FiO2 for 12-24 hours
10. Check if the prongs or mask is placed correctly
• Can change to high or low flow nasal cannulae oxygen if appropriate
11. Check for any leakage

Video link :
https://www.youtube.com/watch?v=3xGSdJwYlnk&t=26s
https://www.youtube.com/watch?v=4ZLChzT0ops
35.Oxygen delivery by Mechanical Ventilation
PROCEDURE VENTILATOR SETTINGS
1. Endotracheal intubation done • FiO2 :
• Head of patient is tilted back slightly and laryngoscope • Start at 100 % and quickly wean down to a level or 60 %
is inserted through mouth and down to throat
• I: E ratio :
• Blade is used to lift the epiglottis and then proceed to
trachea • Normally 1:2- 1 : 3
• Once in trachea inflation of balloon occurs • Trigger sensitivity : set at 0 to -2
• Removal of laryngoscope • Above 0 = too frequent
2. Secure tube to corner of mouth • Too negative = increase work for patient to trigger a
ventilator breath
3. Check tube positioning in lower part of trachea via inflation
of bag and auscultate for air entry • Volume limited :
• 8-10 ml/kg with goal to get 6-8 ml/kg
4. Attach tube to ventilator
• If any leak present : 10-12 ml /kg initial
5. Monitor oxygen and carbondioxide level
6. Indication for removal : Only if patient is able to breath on For more information :
his/her own http://www.health.gov.fj/wp-
content/uploads/2014/05/Ventilation-Guidelines-for-
PICU_Oct-2010.pdf
36-40
36. Chest Tube Insertion
What is it?
A chest tube is a hollow, flexible tube placed into the chest. It acts as
a drain. Chest tubes drain blood, fluid, or air from around your lungs.

How is it done?
Rule of 4s
• 4 steps in a good plan
• 4th (or 5th) intercostal space as the basis for a ‘good’ hole
• 4 x uncuffed ET tube size as a guide to a good sized chest tube
• 4cm mark for a good stop
Indications
• Pneumothorax
• Hemothorax
• Pleural effusion

Video Link:
https://www.youtube.com/watch?v=_6sFa79u6FQ -Older children
https://www.youtube.com/watch?v=b1retCUzF38&t=208s - Infant
37. Palpate Radial/ Brachial Pulse
How?
The brachial pulse can be located by feeling the bicep tendon in the
area of the antecubital fossa. Move the pads of your three fingers
medial (about 2 cm) from the tendon and about 2–3 cm above the
antecubital fossa to locate the pulse.
• Use the pads of your first three fingers to gently palpate the radial
pulse. The pads of the fingers are placed along the radius bone, which
is on the lateral side of the wrist (the thumb side) Place your fingers
on the radius bone close to the flexor aspect of the wrist, where the
wrist meets the hand and bends.
What to note?
• Rate
• Rhythm
• Force
• Equality when measuring the radial pulse/ brachial pulse
Cases:
Week 1 Activity - Sigatoka
• 1 day old Male; Pulse: 158 beats/min
Dx :
Respiratory distress due to meconium aspiration with risk of ABO
incompatibility.
38. Auscultate Normal Heart Sounds Cardiac
Murmur
• Normal S1, S2
• Murmur:
Timing, character (systolic, diastolic, continuous)
Length (short, long)
Quality (vibratory, muscles, blowing
Frequency (high, low)
Loudness
Location
Radiation
Murmur causes:
• Infection
• Fever
• Low red blood cell count (anemia)
• Heart valve disease
Video Link
https://www.youtube.com/watch?v=ze9SCQyZQDE
Cases:
Week 1 Activity - Sigatoka
• 1 day old Male; S1 S2 Regular, No Murmur
Dx :
Respiratory distress due to meconium aspiration with risk of ABO incompatibility.

Week 2 Activity – Nadi

• 11 year old Female ; Systolic murmur 2/6 heard in Mitral Area

Dx: Acute Rheumatic Fever

39. Interpret pediatric CXR • PA View : pediatric
Chest X-Ray

• Shows dense opacity in

Week 1 the left lower lobe,
Case- Nadi consistent with
pneumonia.
• Notice the loss of the left
hemidiaphragm
("silhouette sign") and
preservation of the left
heart border, indicating
involvement of the left
lower lobe

Dx: Severe Pneumonia

How to interpret Chest X- Rays:
• Check the name and date
• Type of image PA , AP, SUPINE
• Technical quality, rotation,
inspiration, penetration
• Look at the Big picture
• 5 systemic approach ABCDEFGHI
• Airways
• Bone and soft tissues
• Cardiac size

• Diaphragm

• Edge of the heart

• Fields of the lungs

• Gastric bubble

• Hila

• Instrumentation
 • Scout view of chest
shows multiple irregular
calcified areas in
paratracheal and
Week 2 perihilar regions
Case- Ba representing calcified
lymph nodes
• ET tube and NG tube
are seen insitu

Dx: Tuberculous
Meningitis
40. Palpate for Liver and Spleen
Liver
• the liver is easily palpated in most children at 1-2 cm below the right costal
margin. A normal liver should feel soft and is easily moveable upon inspiration.
• Start palpating from the lower right quadrant and work towards the costal
margin. Direct fingers inwards upon each inspiration to feel the liver edge.

Signs of an Abnormal Liver

• >3.5cm below the right costal margin in a newborn
• Rubbery (hepatitis)
• Tender (acute hepatitis, right heart failure, venous congestion)
• Firm (cirrhosis)
• Nodular (malignancy)
Spleen
One third of neonates and one tenth of children may have a normal,
palpable spleen. However, when the tip of the spleen is felt beyond 2 cm
below the left costal margin, it is considered abnormal.

Signs of Abnormal Splenomegaly

• >2 cm below left costal margin
• Abnormally rough surface
• Tender
• Hard
Video Link
https://www.youtube.com/watch?v=932E4B9UApg
Cases:
Case - Ba
• 6 Month Old Male
• Liver was palpable 1cm below the coastal margin

Dx: Urosepsis
Week 3 Case - Tavua
• 6 Month Old Male
• Deep Palpation: mild discomfort noted on RUQ

Dx: Anicteric Leptospirosis

41-45
Enlarged Liver
• The liver edge greater than 3.5cm in newborns and greater than 2cm in children
below the right costal margin suggest enlargement
• The liver span can be determined by measuring the distance between the upper
edge - determined by percussion.
• The lower edge is determined by palpation in the midclavicular line , the lower
border can be determined by auscultation as well.
• Hepatomegaly may be due to neonatal hepatitis , Cholestasis, congestive heart
failure.
• Clinical features are pale stool ,jaundice ,abdominal pain and abdominal swelling.
Enlarged Spleen
• Normal spleen may be palpable 1 -2cm below the left costal margin in infants and
children
• The tip of normal palpable spleen is soft , smooth and non tender
• An enlarged spleen may only be palpable once its 2-3 times its normal size.
• The most common causes of splenomegaly would be portal vein thrombosis,
hepatic cirrhosis and congestive heart failure , viral infections
Petechiae, Purpura and Ecchymosis
• Bleeding into the skin can occur from broken vessels that form tiny red dots
called petechiae
• Blood can also collect under the tissues in large flat areas called purpura or in
very large bruised areas called ecchymosis
Petechiae
• Are pinpoint non-blanching spots that measure less than 2mm in size ,affecting
the skin and mucous membrane
• A non blanching spot is one that does not disappear after applying brief pressure
on that area
• It results from areas of haemorrhage into the dermis as the derangements of
normal haemostasis results in petechiae
• Petechiae can be seen in meningococcal septicaemia, disseminated intravascular
coagulation, pertussis, streptococcal pharyngitis.
Purpura
• These are large (more than 2mm)typically raised non blanching lesions that
results from bleeding within the skin
• It can vary somewhat in colour based on the age of the lesions as the blood
within the skin is metabolised and fades.
• It can occur in blood clotting disorders , congenital rubella syndrome and trauma
Ecchymosis
• These are purple or purplish blue fading to green ,yellow and or brown with
time
• It can be rounded oval or irregular and may have a subcutaneous flat nodule
WHO- Case 5
• Erythematous purpuric rashes was noted on the extremities
• Maculopapular rashes were seen at the side of the abdomen
• Diagnosis – Meningococcal Septicaemia
Examine of abdomen tenderness
• Lightly palpate the abdomen on the 9 abdominal regions to assess for any
tenderness
• While doing the physical examination have a look at the child's facial expression
as this may depict pain and tenderness.
• Localised tenderness is mostly seen in appendicitis , hepatitis and pyelonephritis
• Generalised tenderness is seen in mesenteric adenitis and peritonitis
Examine of abdomen Distension
• The abdomen is inspected for any distension
• Abdominal distension may be due to constipation , Hirschsprung’s disease
,ascites ,organomegaly , malignancy
Picture case- case 3
• Abdominal distension was seen to an extend that enlarge veins were seen
• Diagnosis - Omphalitis with systemic involvement (Septicaemia)
WHO- Case 9
• Abdomen was slightly distended
• Diagnosis - Minimal change disease
46-50
1) Examine of abdomen masses.
• Abdominal mass: is a lump felt in the abdominal area.
• Examination is done on the 9 regions on the area. These are: right &
left hypochondrium, right & left lumbar, right & left iliac, epigastric,
umbilical and hypogastric regions.
• The size, shape, position, and mobility of the masses should be noted.
• Examples include: umbilical/inguinal hernia, abscess, hepatomegaly(
felt in superficial palpation).
• Masses also felt in conditions such as: Hydronephrosis, Polycystic
kidney, Meconium ileus
• Strangulated umbilical hernia in a child aged 3 years

• https://www.youtube.com/watch?v=932E4B9UApg
Link of Abdominal examination in children.
47) Pitting Edema
• Edema visible swelling caused by a build-up of fluid within tissues
which causes parts of body swell and get puffy.
• Pitting Edema is when finger is pressed to a swollen area and it leaves
a dimple that doesn't go away after a few seconds.
• Etiology:
• Reduced oncotic pressure: e.g.: Nephrotic syndrome, Liver cirrhosis,
Malnutrition, Severe burns.
• Increased blood volume: Heart failure, Renal diseases Acute
glomerulonephritis Acute and chronic renal failure
• Increased capillary permeability: Vasculitis (anaphylactoid purpura,
systemic lupus erythematosus)
• In order to determine the presence of edema, normal thumb
pressure is applied to both feet for three seconds.
• Indication of edema – a symptom of malnutrition
• Case
• Age: 9 years old, Female
• Diagnosis: Minimal Change Disease.
• Description: Facial puffiness (HPI), mild edema ( P.E).
48) Umbilical cord stump for sepsis in new-
born.
• This occurs when the umbilical cord stump is not dried and surrounding
areas are not clean.
• Some of the signs are:
• Purulent or malodorous discharge from the umbilical stump
• Periumbilical erythema
• Edema
• Tenderness
• Systemic disease (sepsis):
• Disturbances of thermoregulation: Fever (temperature >38°C),
hypothermia (temperature < 36°C), or temperature instability.
• Cardiovascular disturbances: Tachycardia (pulse >180 beats per
minute [bpm]), hypotension (systolic blood pressure < 60 mm Hg in
full-term infants), or delayed capillary refill (< 2-3 seconds)
• Respiratory disturbances: Apnea, tachypnea (respirations >60/min),
grunting, flaring of the alae nasi, intercostal or subcostal retractions,
or hypoxemia
• Gastrointestinal tract disturbances: Rigid or distended abdomen or
absent bowel sounds
• Cutaneous abnormalities: Jaundice, petechiae, or cyanosis
• Neurologic abnormalities: Irritability, lethargy, weak sucking,
hypotonia, or hypertonia
• Picture Case: 2
• Description: Cellulitis around the stump with purulent discharge and
also purple discoloration surrounding the umbilicus.
• Diagnosis: Omphalitis with systemic involvement.
49) Normal male testes/ genitalia in new-born
• Expected findings:
• Urinary meatus at tip of glans penis
• Palpable testes in scrotum
• Large, edematous, pendulous scrotum, with rugae
• Smegma beneath prepuce
• Stream adequate on voiding
• Case 3:
• Age: 1 day old, Male.
• Diagnosis: Respiratory distress due to meconium aspiration with risk
of ABO incompatibility.
• Physical exams for Urinary system revealed:
• Both testes descended
• No micropenis
• No phimosis ( foreskin of the penis that is too tight to be pulled back).
• Case 4
• Age: 6 months old, Male.
• Diagnosis: Urosepsis.
• Physical exams for Urinary system revealed:
• Normal male genitalia
• Descended testes.
50) Normal female genitalia
• The labia majora are full and the labia minora thickened. The hymenal
folds appear thick and redundant. The vaginal mucosa is pink and
moist, with an acidic pH.
• Normal decline of maternal estrogen in the first week of life can
stimulate vaginal bleeding, usually resolves in 7 to 10 days.
• https://www.youtube.com/watch?v=K9OdfIUrdsE: Link of Genitalia
examination in children.
51-55
51. Hypospadias
• Defined as an atypical urethral opening anywhere along the shaft of the penis,
scrotum, or perineum, hypospadias is often associated with a deficient prepuce
and chordee
52. Preterm female genitalia
• Clitoris is prominent
• Labia majora are poorly developed and gaping
53. Jaundice of prematurity
• Infant jaundice is a common condition, particularly in babies born before
37 weeks' gestation (preterm babies).
• Infant jaundice usually occurs because a baby's liver isn't mature enough
to get rid of bilirubin in the bloodstream
Encountered in:
picture case: picture 4
IMCI
• Case - Very severe disease, Jaundice, Low weight due to feeding problem
• Case – Jaundice
• Case – local bacterial infection, jaundice
WHO
Case 10 – anicteric leptospirosis
54. Premature baby
• Defined as neonates born at less than 37 weeks of gestation.
Features of premature baby
• Small size, with a disproportionately large head
• Sharper looking, less rounded features than a full-term baby's
features, due to a lack of fat stores
• Fine hair (lanugo) covering much of the body
• Low body temperature, especially immediately after birth in the
delivery room, due to a lack of stored body fat
• Labored breathing or respiratory distress
• Lack of reflexes for sucking and swallowing, leading to feeding
difficulties
55. Ortolani maneuver/ Barlow maneuver
• The Ortolani test is part of the physical examination for
developmental dysplasia of the hip, along with the Barlow maneuver,
both maneuvers are used for screening of newborns.
• Barlow maneuver is performed first
• This maneuver tests if the hip is dislocatable.
• The maneuver is performed by bringing the thigh towards the midline
(adducting the hip). Mild pressure is then placed on the knee while
directing the force posteriorly. The femoral head will be pushed out of
the socket. The Barlow test is considered positive if the hip can be
popped out of socket with this maneuver
• Ortolani maneuver is performed after Barlow maneuver and is used
to confirm the findings of Barlow maneuver
• The Ortolani test is performed by an examiner first flexing the hips
and knees of a supine infant to 90°, then with the examiner's index
fingers placing anterior pressure on the greater trochanters, gently
and smoothly abducting the infant's legs using the examiner's
thumbs.
• A positive sign is a distinctive 'clunk' which can be heard and felt as
the femoral head relocates anteriorly into the acetabulum
• A positive sign is noted if hip is dislocated.
https://www.youtube.com/watch?v=Qy3uSkDhMZs :Open Pediatrics
https://www.youtube.com/watch?v=AhRdwyXFuWw : Osmosis
55-60
Recognizing Arthritis
• Stiffness
• Swelling
• Location of pain and stiffness
• Nature of joint symptoms
• Other symptoms
Case Discussion
Diagnosis: Acute Rheumatic Fever
• Hot and swollen right knee, immobilized
• Painful left ankle

Diagnosis: Septicemia resulting in multiple system

involvement/damage
• Right elbow – warm, swollen and erythematous and decreased range
of motion.
Assess gait and lump
• Ask the child to walk to the end of the examination room and
then turn and walk back whilst you observe their gait paying attention to:
• Gait cycle: note any abnormalities of the gait cycle (e.g. abnormalities in
toe-off or heel strike).
• Range of movement: often reduced in the context of chronic joint
pathology (e.g. osteoarthritis, inflammatory arthritis).
• Limping: may suggest joint pain (i.e. antalgic gait) or weakness.
• Leg length: note any discrepancy which may be the cause or the result of
joint pathology.
• Turning: children with joint disease may turn slowly due to restrictions in
joint range of movement or instability.
• Trendelenburg’s gait: an abnormal gait caused by unilateral weakness of
the hip abductor muscles secondary to a superior gluteal nerve lesion or L5
radiculopathy.
• Waddling gait: an abnormal gait caused by bilateral weakness of the hip
abductor muscles, typically associated with myopathies (e.g. muscular
dystrophy).
• Assess the child’s footwear: unequal sole wearing is suggestive of an
abnormal gait.
The gait cycle has six phases:
Heel-strike: initial contact of the heel with the floor.
Foot flat: weight is transferred onto this leg.
Mid-stance: the weight is aligned and balanced on this leg.
Heel-off: the heel lifts off the floor as the foot rises but the toes remain in contact with the
floor.
Toe-off: as the foot continues to rise the toes lift off the floor.
Swing: the foot swings forward and comes back into contact with the floor with a heel
strike (and the gait cycle repeats).
Normal gait variations in children
• Toe walking is common up to 3 years.
• Children walk with knees and feet pointing inwards (this is
most common between ages 3-8 years).
• Internal tibial torsion is also common (knees point forwards
but feet point in).
• Metatarsus adductus is a flexible 'C-shaped' lateral border of
the foot. Most resolve by the age of 6 years.
• Bow legs (genu varus) are common from birth to early toddler-
hood, maximum at age 1 year, often with out-toeing. Most
resolve by 18 months.
• Knock knees (genu valgus) are common and associated with in-
toeing. Most resolve by the age of 7 years.
• Flat feet are common. Most children have a flexible foot with a
normal arch on tiptoeing. Flat feet usually resolve by the age of
6 years.
• Crooked toes. Most resolve with weight-bearing.
Abnormal gait patterns in children

SPASTIC GAIT
Person drags his or her feet while walking. This
type can also make someone appear to be very
stiff when walking.

Stiff, foot-dragging with foot inversion. This is

often seen in upper motor neurone
neurological disease (eg, diplegic or
quadriplegic cerebral palsy)
CIRCUMDUCTION GAIT
Gait in which the leg is stiff, without flexion at knee and ankle, an
d with each step is rotated away from the body, then towards it, f
orming a semicircle.
Typically seen with a leg length discrepancy, with a stiff/restricted
joint movement as in JIA, or with unilateral spasticity as in
hemiplegic cerebral palsy.
Trendelenburg gait is an abnormal gait resulting from a defective hip abductor mechanism.
Results from hip abductor muscle weakness or hip pain. While weight-bearing on the ipsilateral
side, the pelvis drops on the contralateral side, rather than rising as is normal. With bilateral hip
disease, this leads to a waddling 'rolling sailor' gait with hips, knees, and feet externally rotated.
May be observed in Perthes' disease, slipped upper femoral epiphysis, developmental dysplasia
of the hip, arthritis involving the hip, muscle disease (eg, inherited myopathies), and
neurological conditions.
Toe-walking gait with absent heel contact

Habitual toe walking is common in children and associates with normal tone,
range of movement around the feet and normal walking on request. However,
persistent toe walking is observed in spastic upper motor neurone neurological
disease (eg, cerebral palsy). It can (rarely) be a presentation of mild lysosomal
storage disorder.
STEPPING GAIT
The entire leg is lifted at the hip to assist with ground clearance.
Occurs with weak ankle dorsiflexors, compensated by increased knee flexion.
Observed in lower motor neurone neurological disease (eg, spina bifida, polio) and
peripheral neuropathies (eg, Charcot-Marie-Tooth disease).
Antalgic gait (caused by pain)

Reduced time spent weight-bearing on the affected side.

A multitude of possible causes.
A smaller child may just present with unwillingness to weight-bear, so an index of
suspicion is required.
May be observed in juvenile idiopathic arthritis (JIA), although children do not always
complain of pain.
Examine Spine
Examine:
• Posture
• Curvatures
• Rigidity
• Webbed neck
• Spina bifida
• Pilonidal dimple or cyst
• Mobility
• Tufts of hair
• Tenderness over spine
https://www.youtube.com/watch?v=KB3CYuWJM9M&t=4s
• Lordosis. Also called swayback, the spine of a person
with lordosis curves significantly inward at the lower
back.
• Kyphosis. Kyphosis is characterized by an abnormally
rounded upper back (more than 50 degrees of
curvature).
• Scoliosis. A person with scoliosis has a sideways curve
to their spine. The curve is often S-shaped or C-
shaped.
If the child is able to place their hands flat on the floor it suggests joint hypermobility.
Spina Bifida
• Spina bifida is a birth defect that occurs when the spine and spinal
cord don't form properly. It's a type of neural tube defect. The neural
tube is the structure in a developing embryo that eventually becomes
the baby's brain, spinal cord and the tissues that enclose them.
• In babies with spina bifida, a portion of the neural tube doesn't close
or develop properly, causing defects in the spinal cord and in the
bones of the spine
Pilonidal cysts usually occur when hair cuts the
skin and then becomes trapped. The cyst can
sometimes drain blood or fluid. If it becomes
infected it can be extremely painful.
Congenital skin fold from the neck to the Shoulders
May appear as loose folds of skin at the neck

Causes
Turner's Syndrome
Noonan Syndrome
Klippel-Feil Syndrome
Case Discussion
Diagnosis
Respiratory distress due to meconium aspiration with
risk of ABO incompatibility.
• No spina bifida
• No meningocele
• No sacral edema
Recognize Scoliosis
Posture
• Anterior inspection – Asymmetrical posture
• Posterior inspection – inspect for lateral curvature of the spine
suggestive of scoliosis
Neural Tube Defects
• Neural tube defects are birth defecs of the brain, spine, or spinal cord.
They happen in the first month of pregnancy, often before a woman
even knows that she is pregnant. The two most common neural tube
defects are spina bifida and anencephaly. In spina bifida, the fetal
spinal column doesn't close completely. There is usually nerve
damage that causes at least some paralysis of the legs. In
anencephaly, most of the brain and skull do not develop. Babies with
anencephaly are usually either stillborn or die shortly after birth.
Another type of defect, Chiari malformation, causes the brain tissue
to extend into the spinal canal.
• The exact causes of neural tube defects aren't known.
You're at greater risk of having an infant with a neural
tube defect if you
• Have obesity
• Have poorly controlled diabetes
• Take certain antiseizure medicines

• Getting enough folic acid, a type of B vitamin, before and

during pregnancy prevents most neural tube defects.

• Neural tube defects are usually diagnosed before the

infant is born, through lab or imaging tests. There is no
cure for neural tube defects. The nerve damage and loss
of function that are present at birth are usually
permanent. However, a variety of treatments can
sometimes prevent further damage and help with
complications.
Anencephaly

absence of bony covering over the back of the

head
missing bones around the front and sides of
the head
folding of the ears
cleft palate--a condition in which the roof of
the child's mouth doesn't completely close,
leaving an opening that can extend into the
nasal cavity.
congenital heart defects

*Absence of brain/skull*
Spina bifida
• With spina bifida occulta, the most obvious sign might be a tuft
of hair or a birthmark at the site of the defect.
With meningocele and myelomeningocele, you can see the sac
poking through the infant’s back. In the case of meningocele,
there may be a thin layer of skin over the sac.
• With myelomeningocele, there’s usually no skin covering, and
the spinal cord tissue is out in the open.
Other symptoms of myelomeningocele include:
• Weak leg muscles (in some cases, the infant can’t move them
at all)
• Unusually shaped feet, uneven hips, or a curved spine
(scoliosis)
• Seizures
• Bowel or bladder problems