Appearance of newborn

1. THE
APPEARANCE
OF A NEWBORN
“UNIQUE AND IND. DIFFERENCES”

2. SKIN

3. COLOR
CYANOSIS – mottling of skin, bluish
Acrocyanosis- immature peripheral circulation (normal 12 – 48
hrs.)
CENTRAL CYANOSIS – in contrast, cyanosis of “trunk”,
decreased in oxygen
HYPERBILIRUBINEMIA – caused by excess bilirubin in blood
serum,
PHYSIOLOGIC JAUNDICE- yellowish, breakdown of fetal RBC,
heme and globin released
CEPHALOHEMATOMA – birth pressure causes collection of
blood in skull (periostome)
ACUTE BILIRUBIN ENCEPHALOPATHY- permanent neurologic
damage of above normal bilirubin

4. •NOTE: Breast feeding is the preventive
measure. If the level rises to more
than 10-12 mg/100mL, treatments are
required. Phototherapy/ blanket to
initiate liver enzyme and Light
emitting diode (LED lights).

6. PALLOR
anemia
• Low iron stores caused by poor maternal nutrient during pregnancy
• Blood incompatibility in which a large no. of RBC were hemolyzed in utero
• Fetal maternal transfusion
• Inadequate flow of blood in the cord before being cut
• Excessive blood when cord was cut
• Internal bleeding
NOTE: Therapies like supplement iron and packed red cells for transfusion.

7. HARLEQUIN SIGN
• –side appears red but the half is pale, dependent color caused by
immature blood circulation and usually fades when changed position,
infant’s kicks or cries.

8. BIRTHMARKS
HEMANGIOMAS – vascular tumors and has 3 types
Type 1: Nevus flammeus (Firemark)

9. • Port wine – face and thighs
• Stork bites – nape of neck
• Treatment:
• Port wine- fades naturally, cosmetics, laser
• Stork bites – not fading, no treatment because usually
covered by hair

10. Type 2: Infantile or Strawberry
• Elevated areas formed by immature capillaries and endothelial cells
• At birth or after 2 weeks
• May enlarge at 1 yr. of age
• Mostly in scalp, face and neck
• Treatment: Health education, Propranolol, surgical excision
Type 3: Cavernous
• Caused by dilated vascular spaces
• Raised, ireg. Shape and looks like strawberry
• Can cause internal organ lesions on spleen or liver
• Permanent mostly in face, behind ears and neck
• Treatment: surgical removal, steroids and hematocrit levels
assessed for blood loss

12. VERNIX CASEOSA – white cream, cheeselike that
serves as skin lubricant and temp. regulator
• Note: Avoid rubbing and always use gloves to evade open portal entry
of bacteria
• Yellow – amniotic fluid was stained from excess bilirubin or blood
dyscrasia maybe present
• Green – suggest meconium presence in amniotic fluid

13. LANUGO – fine, downy hair that covers the infant
and 2 weeks gone by being rubbed in bed/clothes

14. DESQUAMATION – dryness within 24 hrs after
birth, similar to sunburn, apply mild lotion

15. MILIA- lesions of unplugged or unopened
sebaceous gland, nose chin and cheeks, naturally
fades

16. ERYTHEMA TOXICUM
• appear in approximately one half of all normal newborn infants. The
condition may appear in the first few hours of life, or it can appear
after the first day. The condition can last for several days. Although
erythema toxicum is harmless, it can be of great concern to the new
parent.

17. FORCEPS MARKS – marks disappears after 1-2 days

18. SKIN TURGOR – poor turgor = malnutrition, poor
hydration, must be elastic and fall back smoothly

19. THE HEAD
Features of the head:
Forehead appears large and prominent
Chin appears receding and quivers easily when the infant
cries
Full bodied hair

20. Fontanelles
Diamond shape of 2-3 cm in width
and 3- 4 cm in length. While the
posterior fontanelle located at the
junction of parietal bone and
occipital bone that was triangular
form with 1- 2 cm in length.
Anterior fontanelle is the soft spot.
Normally closes at 12-18 months. If
indented, sign of dehydration. If
bulged is a sign of intracranial
pressure.

21. Sutures
• Overriding sutures in 24- 48 hrs
• Fused suture lines are abnormal
• Wide separation, intracranial pressure that causes
hydrocephalus

22. Molding
Infants head molds to fit in the
cervix. After birth, it appears
prominent and asymmetric then
rounded within few days.
Caput Succedaneum
Mostly in cephalic births, no
treatment
Edema of the scalp like large egg
Edema crosess the suture lines
absorbed and disappears in few days

23. • Cephalohematoma
Collection of blood between
periosteum of the skull and bone itself
caused by ruptured periosteal capillary
because of the pressure at birth within 24
hrs,confined in ind. bone can be seen
discoloured as blue or black because of
coagulated blood. Takes weeks to periosteum
to absorbed, no treatment and associated
swelling stops at the bone suture line. As the
blood breakdowns, it’s normal that the infant
may see in jaundice.

24. Craniotabes
Skull is so soft.
Localized softening
of cranial bones by
the pressure in
pelvis at birth. The
pressure removed
and normal, after
the infant gets
calcium.

25. THE EYES
• Rare to see tears because their lacrimal ducts are not matured until 3 months
• Iris color becomes permanent between 3 – 12 months
• Must be clear, not redness and no purulent discharge
• Must have erythromycin to protect from chlamydia (24hrs)
• Birth pressure on schlera, rupture of conjunctival capillary = small
subconjunctival haemorrhage, Normal at 2-3 weeks absorbed
Slight edema can be present around the eye orbit, normal at 2-3 days after kidney
are capable
Cornea must be round and proportional, pupil darked
Congenital Glaucoma = enlarge cornea
Congenital formation = irregular pupil, discoloration (coloboma)
Congenital cataract = white pupil

27. THE EARS
Pinna tends to bend easily, strong enough to recoil after
Top of external ear must be even to the inner canthus to the outer
Small tag of skin can be removed by ligation in 1st week of life
Must be screened in hearing, startled and blinked

28. THE NOSE
Usually milia present and large to the face
Always test choanal arresia (Blockage of the nose) if there is distress
Close mouth and one naris of nose to check,they breathe through it

29. The MOUTH
• Opens mouth clearly when cries
• Tongue tied because of the frenulum membrane
• Inspect the palate if intacted, pearl like cysts can
be seen normal from a thrush that fades in weeks
• Sometimes, natal teeth erupted
• Mucus in mouth

31. The neck
• Short and appears creased skin fold
• Short and appears creased skin fold
• Head freely turn, if rigid it’s a sign of congenital torticollis or meningitis
about 24 hrs
• Not too strong to support weight of head but can control in sitting
position, can slight rise the head when in lying position and will lag in
supine position
• Trachea appears prominent on the front of neck
• Thymus gland enlarged

32. THE CHEST
Average 2cm smaller circumference in head, symmetric in size it
exceeds after 2 yrs. of age
Clavicle must be straight and smooth
Crepitus (Crackling) of the shoulder during birth
Supernumerary nipples are abnormal, mastitis – infection of breast
Male and female infants’ nipples can be engorged because of maternal
hormones
Respirations of 30-60bts/min, not in retraction and can cause respi.
Distress syndrome

33. THE ABDOMEN
• Looks protuberant
• Scaphoid and sunken appearance that other abdominal organs
positioned in the chest.
• Bowel sounds within an hour after birth
• Right side, must palpate the edge of liver in 2cm below costal margin
• Left side, must palpate edge of spleen in 2 cm below lest costal margin
• At the first hour, the stump of umbilical cord appears white, then dried,
shrink and turn down and when 6-10 days it will break free, must no
odor
• Elicit abdominal reflex

34. THE ANOGENITAL ORGANS
Anus must be patency
Male: Scrotum, rough and edematous, dark skin pigmented and both
with testes
Always elicit cremasteric reflex, penis 2cm long and small
Check the urethral opening, prepuce slide back mostly
Female: Vulva normally looks swollen caused by maternal hormones
Some cases of blood secretions called pseudomenstruation might
appear 1 -2 days only

36. BACK
Round, spine is flat in
sacral and lumbar areas,
back is concave at the first
week

37. EXTREMETIES

38. Proportion, hands are often plump and clenched
Check the reflexes
Finger tips reach the mid thigh
Legs are bowed and short
Check the palm, curvature of finger
Ankle usually not tight
Sole has many lines
Flex both hips and abduct legs to test if the femur is with
the hips

39. THANK YOU