THE APPEARANCE OF A NEWBORN

SKIN
 Signs of distress(potential)
 At birth: bright red, puffy, smooth
 2nd-3rd day: pink, flaky, dry
 Progressive jaundice within 24 hours
 LANUGO: appears 6 weeks of life at shoulder and back
of life
 ACROCYANOSIS: hands and feet(peripheral circulation is  Generalized cyanosis after 24 hours:
sluggish within 24 hours
congenital heart defect
 CUTIS MORMORATA: transient mottling of skin when exposed
to decreased temperature  Pallor
 VERNIX CASEOSA
COMMON VARIATIONS:
 Mottling
 Neonatal jaundice(physiologic jaundice) after the 1st 24 hours  Grayness
 Ecchymoses or petechial caused by birth trauma
 Plethora
 Milia: tiny white papules on cheeks, chin, nose
 Miliaria or sudamina: eccrine glands that appear as minute
 Sclerema
vesicles and papules, usually surrounded by
erythema,commonly located on the face  Poor skin turgor
Erhythema toxicum: pink popular rash with vesicles in

thorax, back ,buttocks and abdomen. Appears in 24 to 48
 Rashes, pustules or blisters
hours and subsides after several days  Café-au-lait spots(light brown spots)
 Harlequin color change: outlined color change as infant lies
on side, lower half becomes pink and upper half is pale  Nevus flammeus
 Mongolian spots: irregular areas of deep blue pigmentation in
sacral and gluteal regions
 Hemorrhage,ecchymoses or
 Telangiectatic nevi or stork bites: flat deep pink localized petechiae that persist
area on back of the neck. Disappears at 2 years of age
HEAD
 Anterior fontanelle: diamond shape(2.5cm Signs of Distress (Potential)
-4cm),closes at 12 to 18 months  Fused sutures
 Posterior fontanelle: triangular shape
(0.5-1 cm),closes at 2 months  Bulging or depressed fontanels when
 Fontanelles should be flat, soft and firm.
quiet
Widest part measured from bone to bone,  Widened sutures and fontanels
not suture to suture
Common variations:
 Craniotabes- snapping sensation
along the lamboid suture(resembles
 Molding following vaginal delivery
indention of pingpong balls)
 Bulging fontanelle because of crying and
coughing
 Caput succedaneum-edema of soft scalp
tissue
 Cephalhematoma (uncomplicated)-
hematoma between the periosteum and
skull bones

EYES
 Lids usually edematous
 Color-slate gray, dark blue and brown
 Absence of tears
 Corneal reflex(responses to touch)
 Pupillary reflex(response to light)
 Blink reflex(response to touch or
light)
 Rudimentary fixation on objects and
ability to follow to midline
Common variations:
 Epicanthal folds: oriental infants
 Nystagmus or strabismus
 Subconjunctival(scleral)hemorrhage
Signs of distress(potential)
 Pink color of iris
 Purulent discharge
 Upward slant in non-orientals
 Hypertelorism (3cm greater)
 Hypotelorism
 Congenital cataracts
 Constricted or dilated fixed pupil
 Yellow sclera
 Absence of red reflex, papillary or
corneal reflex
 Inability to follow object or bright
light to midline
EARS
Signs of distress(potential)
 Low set ears and minor
 Pinna in line with outer canthus of abnormalities(chromosomal defect
the eye and kidney anomaly)
 Pinna flexible, cartilage present
 Absence of startle reflex in
response to loud noises
 Startle reflex is elicited by loud,
sudden noise
Common variations
 Inability to visualize tympanic
membrane(filled aural canals)
 Pinna flat against head
 Irregular shape or size
 Pits or skin tags
NOSE

 Nasal patency Signs of distress(potential)

 Thin white mucus  Non-patent canals
 Sneezing  Thick, bloody discharge
Common variations:  Alae nasi (nasal flaring)
 Flattened and bruised
MOUTH AND THROAT
 Intact, high-arched palate
 Uvula in midline
 Frenulum of the tongue
 Frenulum of the upper lip
 Sucking reflex(strong and
coordinated)
 Other reflexes: rooting, gag and
extrusion
 Absent or minimal salivation
 Vigorous cry
Common variations:
 Natal teeth-teeth present at birth,
benign but my be associated with
congenital defects
 Epstein pearls-small, white epithelial
cysts(midline of hard palate)
Signs of distress:
 Cleft lip
 Cleft palate
 Large, protruding tongue or posterior
displacement of tongue
 Profuse salivation or drooling
 candidiasis
CHEST
 Anterior-posterior and lateral
diameters equal
 Slight sternal retractions (evident
Signs of distress:
during inspiration)
 Depressed sternum
 Xiphoid process evident
 Marked retraction of chest and
 Breast enlargement
ICS(during respiration)
Common variations:  Assymmetric chest expansion
 Pectus excavatum (funnel chest)  Redness and firmness around
 Pectus carinatum (pigeon chest) nipples
 Supernumerary nipples  Wide-spaced nipples
 Witch’s milk
LUNGS
 Abdominal respiration
 Cough reflex: absent at birth,
present by 1-2 days
 Bilateral equal bronchial breath
sounds
Common variations:
 Irregular rate and depth
respirations
 Periodic breathing
 Crackles shortly after birth
Signs of distress:
 Inspiratory stridor
 Expiratory grunt and retractions
 Persistent irregular breathing
 Periodic breathing with repeated
apneic spells
 Seesaw respirations(paradoxical)
 Unequal and diminished breath
sounds
 Persistent fine crackles
 Wheezing
 Peristaltic bowel sounds on one side,
with diminished breath sounds on the
same side
HEART
Signs of distress:
 S2 slightly sharper and higher pitch
 Dextrocardia-heart on right side
than S1  Cardiomegaly
 Apex: 4th to 5th ICS, lateral to left  Displacement of apex, muffled
sternal border
 Abdominal shunts
Common variations:
 Murmurs and thrills
 Sinus arrthymias: heart rate
increases with inspiration and
 Persistent cyanosis
decreases with expiration  Hyperactive precordium
 Transient cyanosis when crying or
straining
ABDOMEN Signs of distress:
 Cylindrical in shape  Abdominal distention
 liver: palpable 2-3 cm below right  Localized bulging
costal margin
 Distended veins
 Spleen: tip palpable at end of 1st week
of age  Absent bowel sounds
 Kidneys: palpable 1-2cm above  Enlarged spleen and liver
umbilicus  Ascites
 Umbilical cord: bluish white at birth,2  Visible peristaltic waves
arteries and 1 vein
 Scaphoid or concave abdomen
 Femoral pulses: equal bilaterally
Common variations:
 Green umbilical cord

 Umbilical hernia
 Presence of only 1 artery in cord
 Diastasis recti-midline gap between  Urine or stool leaking from cord
recti muscles  Palpable bladder distention following
 Wharton jelly scanty voiding
FEMALE GENITALIA
Signs of distress:
 Edematous labia and clitoris  Enlarged clitoris with urethral
meatus at tip
 Urethral meatus behind clitoris
 Fused labia
 Vernix caseosa between labia
 Absence of vaginal opening
 Urination within 24 hours
 Masses in labia
 Meconium from vaginal opening
 Ambiguous genitalia
Common variations:
 No urination within 24 hours
 Pseudomenstruation: blood tinged
or mucoid discharge
 Hymenal tag
MALE GENITALIA
Signs of distress:
 Urethral opening at the tip of glans penis
 Testes palpable in each scrotum
 Hypospadias(urethral opening at ventral
surface)
 Scrotum usually large, edematous, pendulous,
and covered with rugae, usually deep  Epispadias (urethral opening at dorsal
pigmented(dark skinned) surface
 Smegma
 Chordee (ventral curvature)
 Urination within 24 hours
 Testes not palpable in scrotum or
inguinal canal
Common variations:
 Urethral opening covered by prepuce
 No urinal within 24 hours
 Inability to retract foreskin  Inguinal hernia
 Epithelial pearls(small, firm, white lesion at  Hypoplastic scrotum
tip of prepuce)
 Erection or priaprism
 Hydrocele
 Testes palpable in inguinal canal  Masses in scrotum
 scrotum  Discoloration of testes
 Ambiguous genitalia
BACK AND RECTUM
Signs of distress(potential)
 Spine intact, no openings, masses
or prominent curves  Anal fissures or fistulas
 Trunk incurvation reflex  Imperforate anus
 Anal reflex  Absence of anal reflex
 Patent anal opening  Pilonidal cyst or sinus
 Passage of meconium within 48  No meconium within 36-48 hours
hours  Tuft of hair (spine)
 Any degree of spina bifida
Common variations:
 Green liquid stools in infants
( under phototherapy)
 Delayed passages of meconium in
very low-birth-weight neonates
 Common variations:

EXTEMITIES 


Polydactyly
Syndactyly
 Complete fingers and toes  Phocomelia (hands or feet attached close to trunk)
 Full range of motion  Hemimilia (absence of distal part extremity
 Nail beds pink, with transient cyanosis  Hyperflexibility of joints
(immediately after birth)
 Persistent cyanosis of nail beds
 Creases on anterior 2/3 of sole
 Yellowing of nail beds
 Sole usually flat
 Sole covered with creases
 Symmetry of extremities
 Simian crease
 Equal bilateral muscle tone
 Fractures
 Equal bilateral brachial pulses
 Decreased or absent range of motion
Common variations:
 Dislocated or subluxated hip
 Partial syndactyly between 2nd and 3rd toes
 Limitation in hip abduction
 2 toe overlapping the 3 toe
nd rd
 Unequal gluteal or leg folds
 Wide gap between 1st ( hallux) and 2nd toes
 Allis or Galeazzi’s sign(unequal knees height)
 Deep crease on plantar surface of foot
between 1st and 2nd toes
 Ortolani’s sign

 Asymmetric length of toes

 Asymmetry of extremities

 Dorsiflexion and shortness of hallux

 Unequal muscle tone or range of motion
NEUROMUSCULAR
 Extremities maintain some degree
of flexion
 Extension of extremity followed
by previous position of flexion
 Head lag while sitting, momentary
ability to hold head erect
 Turns head from side to side
( prone)
 Hold head in horizontal line with
back( prone)
Common variations:
 Quivering or momentary tremors
Signs of distress(potential)
 Hypotonia
 Hypertonia
 Asymmetric posturing
(except tonic-neck reflex)
 Opisthotonic posturing
 Tremors, twitches, and myoclonic
jerks
 Marked head lag in all position
THANK YOU!
THAT IN ALL THINGS GOD MAYBE GLORIFIED