eight primary needs of newborn
• Adequate respiration
• Extrauterine circulation
• Body temperature stabilization
• Blood sugar stabilization
• Prevention of infection
• An infant–parent bond
• Adequate stimulation
• Ability to take in adequate nutrients
• Ability to achieve waste elimination
Physical and dev. Disorder of the skeletal system
ABSENT OR MALFORMED EXTREMITIES
Congenital skeletal disorders can result from reasons such
as maternal drug ingestion or virus invasion or amniotic
band formation in utero.
FINGER AND TOE CONDITIONS
Polydactyly is the presence of one or more additional
fingers or toes. When an entire extra finger or toe forms,
the supernumerary digit is usually amputated in infancy
or early childhood. These extra fingers are often just
cartilage or skin tags, and removal is simple and
cosmetically sound. In syndactyly (two fingers or toes are
fused), the fusion is usually caused by a simple webbing
(Fig. 27.2); separation of the digits into two sound and
cosmetically appealing ones is usually successful.
CHEST DEVIATIONS
Pectus excavatum, or “funnel chest,” is an indentation of
the lower portion of the sternum.
As a result of the deformity, lung volume is apt to be
decreased and the heart is displaced to the left.
Pectus carinatum, sternum displaced anteriorly increasing
the anteroposterior diameter of the chest.
TORTICOLLIS (WRY NECK)
Torticollis is a term derived from the terms tortus
(“twisted”) and collum (“neck”). Torticollis (wry neck)
occurs as a congenital anomaly when the
sternocleidomastoid muscle is injured and bleeds during
birth.
To relieve torticollis, parents need to begin a program of
passive stretching exercises and therapy, laying the infant
on a flat surface and rotating the head through a full
range of motion.
CRANIOSYNOSTOSIS
Craniosynostosis is the premature closure of the sutures
of the skull. This may occur in utero or early in infancy
because of rickets or irregularities of calcium or
phosphate metabolism; it also occurs as a dominantly
inherited trait and occurs more often in boys than in girls
Measuring the infant’s head circumference during the
first 18 months of life is advocated by the American
Academy of Pediatrics
Craniosynostosis is diagnosed by X-ray or ultrasound,
which reveals the fused suture line. If the suture line
involved is the sagittal, treatment may involve only
careful observation; if the coronal suture line is involved,
it will need to be surgically opened to prevent brain
compression and an abnormally shaped head by 9 to 12
months
ACHONDROPLASIA
Achondroplasia (chondrodystrophia) is a failure of bone
growth inherited as a dominant trait, which causes a
disorder in cartilage production in utero. The epiphyseal
plate of long bones cannot produce adequate cartilage
for longitudinal bone growth; this results in both arms
and legs becoming stunted
Achondroplasia can be diagnosed in utero by ultrasound
or at birth by X-ray by comparing the length of
extremities to the usual length (in the average child, the
arms can be extended to the distance of the midthigh).
Children with achondroplasia rarely reach a height of
more than 4 ft 6 in. (140 cm).
TALIPES DISORDERS
The word talipes is formed from the Latin talus (“ankle”)
and pes (“foot”). The talipes deformities, therefore, are
ankle–foot disorders, popularly called clubfoot. The term
“clubfoot” implies permanent crippling to many people,
and because this is no longer true with effective surgery,
avoid using the term when discussing talipes disorders
with parents. Some newborns who appear to have a
talipes disorder actually have only an unusual foot
position (a pseudotalipes) that developed because of
their cramped intrauterine position
A true talipes disorder can be one of four separate types:
plantar flexion (an equinus or “horse foot” position, with
the forefoot lower than the heel); dorsiflexion (the heel is
held lower than the forefoot or the anterior foot is flexed
toward the anterior leg); varus deviation (the foot turns
in); or valgus deviation (the foot turns out).
Assessment
Make a habit, therefore, of straightening all newborn feet
to the midline as part of the initial assessment to detect
this disorder. If there is a possible questionable
deformity, refer to the pediatric physician and
orthopedist specialist to begin the process of evaluating
the infant properly.
Therapeutic Management
Although the disorder involves the ankle, the cast or brce
extends above the knee to ensure a firm correction
the infant may have to sleep in Denis Browne splints
(shoes attached to a metal bar to maintain position) or
high-top shoes at night for a few more months to ensure
an effective correction. need to perform passive foot
exercises such as putting the infant’s foot and ankle
through a full range of motion several times a day for
several months.
DEVELOPMENTAL DYSPLASIA OF THE HIP
Developmental dysplasia of the hip (DDH) (often referred
to as congenital hip dysplasia) is improper formation and
function of the hip socket and is considered a spectrum of
abnormalities affecting the hip joint.
DDH is a fairly common musculoskeletal condition found
in newborns
the acetabulum of the pelvis is unusually flattened or
shallow.
Additional risk factors include family history of DDH,
oligohydramnios, large birth weight for gestational age,
metatarsus adductus, and torticollis
Assessment
e affected leg may appear slightly shorter than the other
because the femur head rides so high in the socket. This is
most noticeable when the child is lying supine and the
thighs are flexed to a 90-degree angle toward the
abdomen, causing one knee to be lower than the other
Therapeutic Management
suggest close monitoring in mild DDH cases
Infants less than 6 months of age are usually treated by
using flexion-abduction splinting devices.
Correction of subluxated and dislocated hips involves
positioning the hip into a flexed, abducted (externally
rotated) position to press the femur head against the
acetabulum and cause the acetabulum to deepen its
contour from the pressure.
Brace and splints, such as the von Rosen, Pavlik, Craig, or
Frejka, may be utilized for treatment of an unstable hip,
and patient–family preferences should have a substantial
influence on which type is chosen
The Pavlik harness is shown to have a high success rate in
treating subluxation and reducible DDH
Physical and dev. Disorder of the gastrointestinal
system
ANKYLOGLOSSIA (TONGUE-TIE)
Ankyloglossia is an abnormal restriction of the tongue
occurring in a small number of newborns caused by an
abnormally tight frenulum, the membrane attached to
the lower anterior tip of the tongue
Tongue tie is often evaluated based on the mobility and
how close to the tip of the tongue the leading edge of the
frenulum is attached.
THYROGLOSSAL CYSTS
A thyroglossal cyst arises from an embryogenic fault that
leaves a cyst formed at the base of the tongue, which
then drains through a fistula (an abnormal or surgically
made passage between a hollow or tubular organ and the
body surface, or between two hollow or tubular organs)
to the anterior surface of the neck.
Thyroglossal cysts are congenital defects located in or
around the midline of the neck, extending to the base of
the tongue.
The cyst may involve the hyoid bone (the bone at the
anterior surface of the neck at the root of the tongue)
and may contain aberrant thyroid gland tissue.
As the cyst fills with fluid, swelling and obstruction can
lead to respiratory difficulty from pressure on the
trachea.
cyst is surgically removed to avoid future infection of the
space and, if thyroid tissue is present, the possibility of
developing thyroid carcinoma later in life.
>Observe infants closely in the immediate postoperative
period for respiratory distress because the operative area
will develop at least minimum edema from surgical
trauma. Position infants on their sides so secretions drain
freely from their mouths. Intravenous (IV) fluid therapy is
given after surgery until the edema at the incision recedes
somewhat and swallowing is safe once more
(approximately 24 hours).
If the mother is breastfeeding, encourage her to express
her milk via a hospital-grade pump or manual expression
during this time to preserve her milk supply. Observe
infants closely the first time they take fluid orally to be
certain they do not aspirate. Be certain parents have a
chance to feed their infant before the infant is discharged
from the surgical unit so they can be assured the infant is
swallowing safely
OROFACIAL CLEFTS: CLEFT LIP AND CLEFT PALATE
nfants with cleft lip, the fusion fails to occur in varying
degrees, causing this disorder to range from a small notch
in the upper lip to total separation of the lip and facial
structures up into the floor of the nose, with even the
upper teeth and gingiva absent.
A cleft palate is an opening of the palate and occurs when
the palatal process does not close as usual at
approximately weeks 9 to 12 of intrauterine life.
Assessment
When assessing newborns, be sure you have good lighting
so you can visualize the palate clearly. Because cleft
palate is a component of many syndromes, assess the
child for other congenital anomalies as well.
Therapeutic Management