For undergraduate medical students

1. Dr.p.natarajan
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2.  Full term: Child born after completion of 37 weeks
and before competition of 42 weeks
 Preterm: Born before completion of 32 weeks
 Post term: Born after completion of 42 weeks
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3.  Appropriate for gestational age AFGA: birth weight
between 2.5 to 4 kg
 Heavy for gestational age HFGA: birth weight more
than 4 kg
 Light for gestational age: Birth weight less than 2.5
kg
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4. 1. Definition: weight less than 10th percentile for
gestational age.
2. Symmetrical (type I):
 All parameters (length + HC + wt) 
 Reflects long-term growth impairment.
3. Asymmetrical (type II): .
 HC remains normal while length and weight are
decreased.
 reflects short-term impairment of growth
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5.  Preterm
 LFGA : light for gestational age
 AFGA : Appropriate for gestational age
 HFGA: Heavy for gestational age
 Term
 LFGA : light for gestational age
 AFGA : Appropriate for gestational age
 HFGA: Heavy for gestational age
 Post term
 LFGA : light for gestational age
 AFGA : Appropriate for gestational age
 HFGA: Heavy for gestational age
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6.  Spontaneous in onset, low-risk at the start of labour
and remaining so throughout labour and delivery.
 The infant is born spontaneously in the vertex
position between 37 and 42 completed weeks of
pregnancy.
 After birthmother and infant are in good health.
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7. 1. No at risk status during gestation- BOH, Rh etc
2. Born between 37compeleted and before completion of 42
weeks
3. Birth weight between 2.5 to 4 kg
4. Vaginal delivery / planned caserian
5. Singleton
6. No induction except oxytocin
7. Normal Apgar- 7-10 at 1st minute
8. No major congenital defects
9. O/E: Color, cry and activity are normal
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8. 1. Whether the infant has made a successful transition
from placental to air breathing,
2. Whether any congenital anomalies are present,
3. To what extent gestation, labor, delivery, analgesics,
or anesthetics have affected the neonate,
4. Whether he or she has any signs of hypoxia,
infection or metabolic disease.
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9. 1. The state,
2. Color,
3. Respiratory effort,
4. Posture (tone)
5. Spontaneous activity.
6. Dysmorphology
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10. 1. Deep sleep(REM)
2. Light sleep (non REM)
3. Awake, light peripheral movements
4. Awake, large movements, not crying
5. Awake, crying
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12. 1. Skin Perfusion
2. Skin color for the presence of cyanosis,
3. Jaundice,
4. Pallor,
5. Plethora,
6. Any unusual pigmentation.
7. Mangolian spot
8. Erythema toxicum:
may be noted occasionally at birth, although it is more
common in the next day or two. These papular lesions with an
erythematous base are found more on the trunk than on the
extremities and fade without treatment by 1 week of age.
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14. 14

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18. 1. Universal flexion: full term
2. Universal extension: preterm
3. Asymmetric tonic neck reflex
4. Extended lower limbs flexed over abdomen:
extended breech
5. Spontaneous Activity
1. Infants stretch, move all extremities equally, open and close
hands,
2. Root and start sucking when something touches his or her
face, and
3. Yawn with great facial expression.
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20. 20

21. 1. Rectal(core) and axillry or skin (add .5 C)
2. It is unusual for neonates to develop fevers except
in response to increased environmental
temperature (dehydration fever).
3. Hypothermia indicates exposure to cold
environment, sepsis, shock etc.
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22. 1. The normal respiratory rate is 30 to 60 per minute
2. some normal infants breathe shallowly and then
rapidly.
3. The heart rate is 110 to 160 beats per minute
4. There may be a small pause during respiration;
5. Pause longer than 20 minutes is apnea
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23. 1. The heart rate is 110 to 160 beats per minute
2. Preterm infants have increased resting heart rate
3. Tachycardia > 160/mt:
central nervous system (CNS) irritability, congestive heart
failure, sepsis, anemia, fever, or hyperthyroidism.
4. Low resting heart rates: < 100 mt
1. mild perinatal asphyxia,
2. congenital heart block etc.
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24. 1. The flush method for systolic BP
2. The Doppler methods, although providing diastolic
and systolic pressures.
3. Capillary
4. Normal Bp at birth: BP (90th percentile) 87/68
5. Capillary Refill Time: CFT
The skin over the mid-sternum is pressed with ball of the
thumb for 5 seconds so that it blanches. The thumb is then
lifted and time taken for refilling of the capillaries and return to
original skin color is noted. Normal CRT is < 3 seconds.
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26. 1. Unusual facial appearance : odd facies or dysmorphism
2. (OFC)HC: 35 cm
3. Size of the head is appropriate for the size of the face
4. Abnormal occipital prominence : Dandy-Walker malformation
5. Frontal prominence: hydrocephalus
6. HC less than 10 percentile : Microcephaly
7. The boat-shaped scaphocephaly is synostosis of the sagittal
suture
8. Right-sided flattening (plagiocephaly) occurs more often than left
due to the more common left occiput anterior descent during
birth
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27. 1. Hypertelorism
2. Hypotelorism
3. Mangoloid or antimangoloid slant
4. Low set ears
5. Upturned nose
6. Beaking of nose
7. Downturned mouth
8. Syntrichosis
9. Saddle nose
10. Long filtrum etc
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37. Fontanelles too large :
1. hypophosphatasia, osteogenesis imperfecta
2. Hypothyroidism
3. Increased intracranial pressure,
4. Hydrocephalus
Fontanelles too small
1. Hyperthyroidism
2. Craniosynostosis
3. Microcephaly
4. Third fontanelle down syndrome
5. AF Closure: 6-24 months
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38. 1. The hair colour should have racial concordance.
2. blond hair in a dark-skinned infant: albinism
3. White forelocks: Eg. Wardenburg syndrome with
deafness and mental retardation
4. In 97.5% of newborns, there is a single parietal hair
whorl with clockwise rotation.
5. More than two, an isolated frontal or a significantly
abnormally positioned whorl may be a sign of
abnormal development of underlying structures.
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39. 6. If there is extreme hair unruliness with multiple
directions of growth, particularly with unusual
facies, microcephaly, or SGA, there may be poor
brain growth of early fetal onset. Eg. Cornelia de
Lange and Down syndromes.
7. Telangiectatic or staining lesions appear over the
scalp.
8. Transillumination of the skull may detect large fluid
collections: Hydrocephalus.
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42. 1. six bony plates: one frontal, two parietal, two
temporal, and one occipital.
2. Six sutures: metopic, sagittal, and paired coronal and
lambdoid.
3. Pathologic craniotabes occurs in syphilis and rickets
4. Posterior fontanel in Cretinism
5. Wide AF in rickets, osteogensis imperfecta
6. Small AF in microcdephaly
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44. 1. Typically a cephalohematoma develops after
delivery and expands during the first few hours as
blood accumulates between the surface of a
calvarial bone and its pericranial membrane.
2. The cephalohematoma is rounded and discrete with
boundaries limited by suture lines.
3. cephalohematoma feels fluctuant.
4. The blood contained in a cephalohematoma may
take several weeks to resorb and prolong neonatal
jaundice.
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46. 1. Congenital neck masses include cystic hygroma,
lymphangioma, and cervical teratoma
2. Sternomastoid tumor is due to hematoma
3. Goiter in hypothyroidism
4. Webbing in Turner and Noonan syndromes
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47. 1. Rocking gently back and forth may encourage spontaneous eye
opening in dim light
2. Subconjunctival hemorrhages may be present following vaginal
delivery
3. Synophrys may raise suspicion that the infant has a syndrome
such as cornelia de lange
4. Absent eyelashes may be a clue to ectodermal dysplasia
5. The signs of congenital glaucoma include photophobia,
excessive tearing, cloudy cornea, or eyes that appear large
6. Cataract
7. Coloboma of iris
8. Conj. Telangiectasia
9. Cornea: clouding indicates mucopolyscchridosis, glaucoma 47

48. 48

49. 1. Posteriorly rotated or low-set ears occur when
cephalad migration and anterior rotation fail to
complete. At least 30% of the pinna should be
above a line extended between the medial canthi
2. A behavioural reaction (eg. Moro) to a
standardized sound excludes gross bilateral
hearing deficits
3. Preauricular sinus and preauricular buds
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50. 1. Nasal patency:
 It is assessed by free passage of a small catheter through
both nares and into the stomach.
 Absence of nasal canal is called choanal atresia which may be
unilateral or bilateral.
2. Congenital obstruction of the nasolacrimal duct
occurs in approximately 20% of newborns; Common
signs are tearing without stimulation, dried mucoid
residue after a nap.
3. Dacryocystocele is a dilation of the lacrimal drainage
system due to obstruction at both ends and filling of
the enclosed space.
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51. 1. One to six pairs of small benign midline cysts
known as “Epstein pearls” may be present at the
junction of the hard and soft palates.
2. Natal teeth,are present in 1:2,000 to 3,000 live
births
3. Macroglossia
4. Cleft palate and lip
5. Oral thrush
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53. 53

54. 1. Icterus progresses in a cephalocaudal pattern and is
best appreciated in natural light.
2. Detection may be improved by gently blanching the
skin to remove the blood from the dermal capillaries.
3. Areas of hypo- or hyperpigmentation such as café au
lait spots are important to document as they may be
associated with neurologic disorders.
4. Marbling of the extremities from vasoconstriction
(cutis marmorata) occurring when the infant
undergoes hypothermic stress
5. Lymph nodes are palpable in more than one-third of
all neonates, most commonly in the inguinal region
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55. 1. The umbilicus normally is halfway between the xiphoid and
pubis.
2. Meconium staining of the cord is a sign of prior fetal distress
3. If the base of the umbilical cord itself is especially broad or
remains fluctuant there may be omphalocoel
4. Single umbilical arteries occur in approximately 1% of
pregnancies with nearly 10% of identified cases having another
congenital malformation.
5. The base should not appear red or indurated.
6. After the cord falls off, the umbilicus should be examined for
granuloma or continued leakage through a patent urachus
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56. 1. The liver is normally palpable 3 cm below the costal
margin
2. a left lobe larger than the right may reflect situs
inversus
3. The spleen is often not palpable in the newborn
period.
4. The kidneys are palpable if the abdomen is soft
5. Fullness in the lower abdomen may be a distended
bladder
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57. 1. Resting rate 120-130 bpm (range 100-150);
2. Apicasl impulse is in the fourth or fifth intercostal space in the
midclavicular line.
3. Hyper dynamic precardium suggests cardiomegaly
4. The absent or typical radial-femoral delay is observed in
coarctation of the aorta
5. Bounding peripheral pulses are indicative of PDA or less
commonly an arterio-venous malformation.
6. A systolic murmur from a closing PDA will be present in the first
24 to 48 hours of life.
7. Infants with the most serious forms of congenital heart disease
may have no murmur
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58. 1. Penile length at term is 2.5 cm. phimosis is normal
2. The scrotum is often quite large, because it is an
embryonic analog of the female labia and has therefore
responded to maternal hormones
3. Virilization in the female is noted by varying degrees of
clitoral hypertrophy and labioscrotal fusion
4. Maturity:
1. Pigmentation, rugacity, testes in male
2. Labium minora covers clitoris and minora in female
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59. 1. The length of the upper extremities should allow the
fingers to reach to the upper thighs
2. fifth digit with shortening of the mid phalanx may show
radial deviation – clinodactyly
3. Polydactyly
4. Syndactyly
5. Phocomelia
6. Hemimelia
7. Radial and thumb anomaly
8. If the legs are unequal, there may be dislocation of the
shorter leg (i.e., Galeazzi sign) and Barlow maneuver and
Ortolani maneuver.
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60. 1. A neonate with facial asymmetry while crying and
who has a flattened or absent nasolabial fold has a
facial palsy.
2. C-5 and C-6, are most commonly damaged, leaving
the infant with a prone adducted arm
3. Jitteriness, characterized by rhythmic tremors in an
extremity or the jaw, may occur in 41% to 44% of
healthy newborns. It may also be a sign of
hypoglycemia, hypocalcemia, or drug withdrawal.
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61. Pithed frog posture is a
sign of floppy infant
syndrome of hypotonia
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62. 1. The postnatal environment
2. Breastfeeding
3. Warmth
4. Cord care
5. Hygiene
6. Immunization
7. Vit.K
8. Eye c are
9. Danger signs
10. Weight gain pattern
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