This document provides guidelines for assessing newborns. It describes performing a comprehensive history and physical examination at birth and within 24 hours. The examination includes evaluating vital signs, appearance, gestational age, and screening for abnormalities of various body systems. The physical examination involves inspection, palpation, auscultation and measurement of things like temperature, heart rate, abdominal organs and limbs. The goals are to ensure healthy transition after birth, detect any malformations, and establish breastfeeding.
Oligohydramnios by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
• Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. It is typically diagnosed by ultrasound examination and may be described qualitatively (eg, reduced amniotic fluid volume) or quantitatively (eg, amniotic fluid index ≤5 cm, single deepest pocket <2 cm).
• Oligohydramnios may be idiopathic or have a maternal, fetal, or placental cause The fetal prognosis depends on several factors, including the underlying cause, the severity (reduced versus no amniotic fluid), and the gestational age at which oligohydramnios occurs. Because an adequate volume of amniotic fluid is critical to normal fetal movement and lung development and for cushioning the fetus and umbilical cord from uterine compression, pregnancies complicated by oligohydramnios from any cause are at risk for fetal deformation, pulmonary hypoplasia, and umbilical cord compression.
• Oligohydramnios is associated with an increased risk for fetal or neonatal death, which may be related to the underlying cause of the reduced amniotic fluid volume or due to sequelae of the reduced amniotic fluid volume.
• This topic will discuss issues related to oligohydramnios. Methods of amniotic fluid volume assessment are reviewed separately.
• Oligohydramnios occurs when the amniotic fluid is < 5th centile for gestational age.
• The most common causes are premature rupture of membranes (often missed by the mother) and placental insufficiency, however structural abnormalities such as renal agenesis should be considered.
• Prognosis is linked to gestation at diagnosis and likely development of pulmonary hypoplasia and premature delivery.
• Treatment is by optimising gestation of delivery
Clinical case presentation- Rh incompatibility.pptxArpitaChandra12
This is a clinical case with Rh incompatibility. A 10 days baby diagnosed with Rh incompatibility and also having Bacteremia and Klebsiella pneumoniae is causing nosocomial infection in NICU
Oligohydramnios by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
• Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. It is typically diagnosed by ultrasound examination and may be described qualitatively (eg, reduced amniotic fluid volume) or quantitatively (eg, amniotic fluid index ≤5 cm, single deepest pocket <2 cm).
• Oligohydramnios may be idiopathic or have a maternal, fetal, or placental cause The fetal prognosis depends on several factors, including the underlying cause, the severity (reduced versus no amniotic fluid), and the gestational age at which oligohydramnios occurs. Because an adequate volume of amniotic fluid is critical to normal fetal movement and lung development and for cushioning the fetus and umbilical cord from uterine compression, pregnancies complicated by oligohydramnios from any cause are at risk for fetal deformation, pulmonary hypoplasia, and umbilical cord compression.
• Oligohydramnios is associated with an increased risk for fetal or neonatal death, which may be related to the underlying cause of the reduced amniotic fluid volume or due to sequelae of the reduced amniotic fluid volume.
• This topic will discuss issues related to oligohydramnios. Methods of amniotic fluid volume assessment are reviewed separately.
• Oligohydramnios occurs when the amniotic fluid is < 5th centile for gestational age.
• The most common causes are premature rupture of membranes (often missed by the mother) and placental insufficiency, however structural abnormalities such as renal agenesis should be considered.
• Prognosis is linked to gestation at diagnosis and likely development of pulmonary hypoplasia and premature delivery.
• Treatment is by optimising gestation of delivery
Clinical case presentation- Rh incompatibility.pptxArpitaChandra12
This is a clinical case with Rh incompatibility. A 10 days baby diagnosed with Rh incompatibility and also having Bacteremia and Klebsiella pneumoniae is causing nosocomial infection in NICU
Meconium-stained amniotic fluid is common complication, seen in 1 out of every 5 pregnancies.Golden rule for management of MSAF is Foetal Heart Monitoring
Meconium-stained amniotic fluid is common complication, seen in 1 out of every 5 pregnancies.Golden rule for management of MSAF is Foetal Heart Monitoring
Newborn Examination
History taking
General Examination
Systemic Examination
Newborn reflexes
Reference : Paediatric clinical examination by Dr Santhosh Kumar
Prepared by Binisha Sebby,
Final year Medical Student,
Dr SMCSI Medical College,
Karakonam, Trivandrum, Kerala
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
2. Framework for the clinical
diagnosis & plan of care
Comprehensive Newborn History
Physical assesment
3. Identifying data
Chief complaint
History of presenting problem
Antepartum history
Obstetric history
Intrapartum history
Family medical, Maternal medical, and
social history
Comprehensive Newborn History
4. Assessment → a continuous process of
evaluation throughout the course of
routine care of the neonate
Initial examination at birth
Evaluation of extrauterine transition
Determination of gestational age
Comprehensive examination in 24 hour
Discharge examination
Physical
assessment
5. Examination of the newborn baby
Minimum prerequisites
o Mother & baby together
o The baby should be naked under radiant warmer, Warm
room, fresh clean sheet/clothes
o Thermometer
o Weighing scale
o Watch with seconds
o Stethoscope
Always wash hands & clean stethoscope before each examination
5
6. Examination at birth
Aim
o To describe and carry out an examination of a
baby soon after birth
Objectives
o To screen for malformations , birth injuries
o To observe smooth transition to extra uterine life
o An asses overall of baby’s condition
7. Assess:
Look for
Look for abnormal swelling
Abnormality of limbs & spine
Eyes, ears, umbilicus
Observe
Breathing rate / pattern
Color
Heart rate
Activity- feeding , movements
8. Color of the baby
Normal vs. Abnormal
EN-Teaching Aids: ENC 8
13. Any abnormal swelling:
Caput, cephalhematoma
Palpable femoral pulses
Dislocation of hip
Capillary refill time ( CRT)
Confirm the findings of inspection
Palpate the abdomen
Feel for testes in male baby
Assess:
Feel for
14. Weighing the baby
Prepare the scale: cover the pan with a
clean cloth/autoclaved paper; ensure the
scale reads zero
Preparing and weighing the baby
Remove all clothing
Wait till the baby stops moving
Weigh naked
Read and record
Return the baby to the mother
Scale maintenance
Calibrate daily
Clean the scale pan between each
weighing
15. Temperature recording
Hands and feet should be checked for
warmth with the back of the hand to see if
the baby is in cold stress
Temperature measurement
Use clean thermometer
Hold vertically in the axilla for 3 minute
Read and record
Normal 36.5ºC-37.5ºC
16. Evaluation of transition
Physiologic & biochemical changes/adaptation
affect physical finding
Color, respiration, heart rate, behavioral state,
gastrointestinal function → normal during
transition but may be abnormal if they appear at
other times,
17. Acrocyanosis
Generalized hyperemia
In the 1st 15 min of life:
HR: 160-180 beats/min, murmurs
RR: 60-100 breath/min
22. Posture
The normal resting posture of a term newborn baby:
loosely clenched fists
flexed arms, hips, and knees
Small babies (less than 2.5 kg at birth or born before
37 weeks gestation)
the limbs may be extended
Babies born in the breech position may have fully
flexed hips and knees; the feet the mouth; and legs
may even reach near the mouth.
28. Assesment of Size & Growth
Battaglia & Lubchenco Curve:
Classify :
Appropriate for Gestational Age (AGA)
Small for Gestational Age (SGA)
Large for Gestational Age (LGA)
Low birth weight (LBW)
29. Based on BW:
Low birth weight (LBW) : BW 1500 - < 2500 g
Very Low Birth Weight (VLBW): BW 1000 g -
<1500 g
Extremely LBW (ELBW) : BW < 1000 g
Classification of LBW
Based on GA:
Preterm baby , AGA
Small for gestational age (SGA):
Preterm
Aterm
Post-term
30.
31. J. Head circumference and
length.
These measurements are usually done last in
the examination.
The head circumference of a term is
usually 33-38 cm (13-15 in.).
Crown-foot length is 48 to 53 cm (19-21 in.).
32. Examination within 24 hours
Objective
To describe and carry out comprehensive newborn
examination within 24 hours of birth( the 1st 12 to
18 hr of life)→ after transition has been completed
successfully.
Aim
To ensure that malformations are detected
To ensure establishment of breast feeding ;
maintenance of temperature ;classify baby as
normal or abnormal
33. Examination at 24 hrs: Assess
Ask
o Breastfeeding
o Activity of the baby
o Any other problems*
Check
o Weigh the baby
o Temperature
Record
•Passage of meconium up to 24 hrs and urine up
to 48 hrs of life is usually normal
34. A. Cardiorespiratory System
1. Color:
Important index of cardiorespiratory function
→ in white infant: reddish pink, possibly
acrocyanosis
→ dark-skinned : the mucous membranes are
more reliable indicators than skin
→ infant of DM mother & preterm are pinker
than average
→ postmature infants are paller
35. 2. Respiration
- Respiratory rate: N : 40-60
breath/min
- Periodic rather than regular breathing,
esp in preterm → breathe at a fairly
regular rate for a minute and then have
a short period of no breathing (usually 5-
10 sec)
- No expiratory grunting, little or no flaring
of the nostril.
36. When crying : mild chest retraction, if
unaccompanied by grunting, may be
considered normal
Small babies (<2.5 kg or born before 37
wks gestation) may:
Have some mild chest in-drawing
Periodically stop breathing for a few
seconds
38. 3. Heart :
Precordial activity, rate, rhythm, the quality of
the heart sounds, and murmurs.
On the right side or left side→ auscultation and
palpation.
HR : 120 to 160 beats/minute.
It varies with changes in the infant's activity :
An occasional term or post mature infant
may, at rest, have a heart rate well below
100. In a normal infant, the heart rate will
increase if the baby is stimulated
39. If there is any doubt after auscultation
and observation that the heart is:
abnormally placed, abnormally large, or
overactive
→ a chest x-ray is the best means of further
assessment.
Distant heart sounds, especially if
accompanied by respiratory symptoms, are
often secondary to pneumothorax or
pneumomediastinum.
40. The femoral pulses should be felt (often
they are weak in the first day or two)
If there is doubt about the femoral pulses by
time of discharge, the blood pressure in the
upper and lower extremities should be
checked. In infants with coarctation, pulses
and pressures may be normal in the first few
days of life while the ductus is still open
41. B. Abdomen
The anterior abdominal organs (e.g., liver,
spleen, bowel) can often be seen through
the abdominal wall, especially in thin or
premature infants.
The edge of the liver is occasionally seen
Intestinal pattern is easily visible.
Asymmetry due to congenital anomalies or
masses is often first appreciated by
observation.
42. When palpating the abdomen:
start with gentle pressure or stroking
moving from lower to upper quadrants to
reveal the edges of the liver or spleen.
Try to appreciate mushiness when palpating
over the intestine compared with the firmer
feel over the liver or other organs or masses.
The normal newborn liver extends 2 to 2.5 cm
below the costal margin.
The spleen is usually not palpable.
Remember there may be situs inversus.
43. C. Genitalia and rectum
1. Male
Phimosis.
The scrotum is often quite large,
because it is an embryonic analog of
the female labia and has therefore
responded to maternal hormones.
Hydroceles are not uncommon, but
unless they are of communicating type,
they will disappear in time without being
the forerunner of an inguinal hernia.
44. 2. Female
Female genitalia at term are most
noticeable for their enlarge labia
majora.
Occasionally, a mucosal tag from the
wall of the vagina is noted.
45. A discharge from the vagina, usually
creamy white in color, is commonly
found and, on occasion, replaced after
the second day by pseudo menses.
The labia should always be spread,
and cysts of the vaginal wall,
imperforate hymen, or other less
common anomalies should be sought.
46. E. Skin
The epidermis of a newborn (especially a
premature infant) is thin; therefore, the
oxygenated capillary blood makes it very
pink.
Common abnormalities:
milia (plugged sweat glands) on the nose
Mongolian spots. Mongolian spots are
bluish, often large areas most commonly seen
on the back, buttocks, or thighs that fade slightly
over the first year of life.
47. Erythema toxicum may be noted occasionally
at birth, although it is more common in the next
day or two. These popular lesions with an
erythematous base are found more on the trunk
than on the extremities and fade without
treatment by 1 week of age.
Look for jaundice : Kramer 1,2,3,4,5.
48. F. Lymph nodes
Palpable in approximately one-third of
normal neonates.
Usually under 12 mm in diameter
Often found in the inguinal, cervical, and
occasionally the axillary area.
49. G. Extremities, spine, and joints
Anomalies of the digits (too few, too many,
syndactyly, or abnormal placement), club feet,
and hip dislocation are the common problems.
Because of fetal positioning:
Forefoot adduction
→ if correctable with stretching, will often correct
itself in weeks and is no cause for concern.
Tibial bowing or torsion
→Mild degrees of tibial bowing or torsion are also
normal. Decreased motion of an arm should make
one consider Erb palsy or a fracture of a clavicle or
other bone.
50. Because of fetal positioning:
Forefoot adduction
→ if correctable with stretching, will often correct
itself in weeks and is no cause for concern.
Tibial bowing or torsion
→Mild degrees of tibial bowing or torsion are also
normal. Decreased motion of an arm should make
one consider Erb palsy or a fracture of a clavicle or
other bone.
Decreased motion of an arm → consider
Erb palsy or a fracture of a clavicle or
other bone
51. a. Palmer grasp → Put your index fingers
in the infant's palms to obtain the
Palmer grasp.
Neurologic examination
Primitive reflexes
52. b. To test the Moro reflex, pull your fingers
quickly from his or her grasp just before
the head touches the mattress, allowing
the infant to fall onto the back. Usually
the Moro reflex will result, although a
"complete" Moro is demonstrable only in
approximately 20% of cases.
53. Touching the upper lip laterally will cause
most infants to turn toward the touch and
open their mouths; the hungrier and more
vigorous the infant, the more intense is
the rooting response.
Placing a nipple in the mouth will initiate a
sucking response.
54. Stepping (and placing) can be elicited by
holding the infant upright with the feet on
the mattress and then making the baby
lean forward. This forward motion often
sets off a slow alternate stepping action.
However, frequently a normal infant will
not perform the reflex.
55. Pull to sit manuver
Hold the infant's fingers
between your thumb and
forefinger and pull him or her
to a sitting position. Note the
degrees of head lag and head
control; remember a crying
infant often throws the head
back in anger. The infant
should be held in a sitting
position and the trunk moved
forward and back enough to
test head control again. Then
let the trunk and head slowly
fall back.
56. Examination at discharge
Aim
To ensure that baby is normal on exclusive breast
feeds
Objective
To screen that heart is normal
To ensure baby has no significant jaundice or
danger signs
Tell about follow up and danger signs
56
57. At discharge, the infant should be reexamined with the
following points considered:
A. Heart. Development of murmur, cyanosis, failure,
femoral pulses.
B. CNS. Fullness of fontanelles, sutures, activity.
C. Abdomen. Any masses previously missed, stools,
urine output.
D. Skin. Jaundice, pyoderma.
E. Cord. Infection.
F. Infection. Signs of sepsis.
G. Feeding. Spitting, vomiting, distension, degree of
weight loss (or gain), dehydration.
H. Parental competence. To provide adequate
care.
I. Follow-up. Arrangements made with infant's
primary physician.
58. Danger signs
EN-
Not feeding well
Less active than before
Fast breathing (>60/
min)
Moderate or severe
chest in-drawing
Grunting
Convulsions
Floppy or stiff
Temperature >37.50C
or <35.50C
Umbilicus draining pus
or umbilical redness
extending to skin.
>10 skin pustules
Bleeding from umbil.
Stump
59. Examination on follow-up
Aim
To ensure that baby is growing well on exclusive breast
feeds & give immunization as per national policy
Objective
To record the anthropometry weight , head circumference
To ensure baby has no malformations like – cardiac murmurs
60. Normal: feeding behaviour
Positioning
o Head in line with body
o Well supported
o Abdomen touches the
mother abdomen
o Turned to the mother
Attachment
o Mouth wide open
o Lower lip everted
o Little areola visible
o Chin touches mother breast
Assessment of feeding
adequacy
61. It is NORMAL for a baby
To pass urine six or more times a day after day 2
To pass six to eight watery stools (small volume) in
24 hrs
Female baby may have some vaginal bleeding for
a few days during the first week after birth. It is not
a sign of a problem.
Loses weight and regains by 7-10 days
63. Umbilicus
The NORMAL umbilicus is:
Bluish-white in colour on day 1.
It then begins to dry and shrink and
If falls off after 7 to 10 days
No discharge
LOCAL UMBILICAL INFECTION
RED umbilicus or
RED skin around the umbilicus
POSSIBLE SERIOUS INFECTION
Umbilicus draining pus or
Umbilical redness, swelling extending to skin
64. Skin
A baby may have PUSTULES
MORE than 10 are a DANGER SIGN
Refer this baby urgently
Less than 10 are a local skin
infection
Treat them immediately
65. Skin conditions: Which baby will
you treat?
Normal vs. Abnormal EN-Teaching Aids: ENC 65