birthmark on edge of infants tongue
The extent of the newborn physical examination depends on the condition of the infant and the environment in which the examination is being performed. In the delivery rom, the examination consists largely of observation plus auscultation of the chest and inspection for congenital anomalies and birth trauma. Because the infant is recovering from the stres of birth, the examination should not be extensive. The skeletal examination imediately after delivery serves two purposes: 1 to detect any obvious congenital anomalies and 2 to detect signs of birth trauma, particularly in LGA infants or those born after a protracted second stage of labor—in whom a fractured clavicle or humerus might be found. In 1% of deliveries 5̵6% of twin deliveries , the cord has only two vesels: an artery and a vein. Smal placentas are always asociated with smal infants. The placental examination emphasizes the identification of membranes and vesels—particularly in multiple gestations—as wel as the presence and severity of placental infarcts or evidence of clot placental abruption on the maternal side. Examination of the eyes, ears, throat, and hips should be done last, since these maneuvers are most disturbing to the infant. Observe for bruising, petechiae comon over the presenting part , meconium staining, and jaundice. Peripheral cyanosis is comonly present when the extremities are col or the infant is polycythemic. Note vernix caseosa a whitish, greasy material covering the body that decreases as term aproaches and lanugo the fine hair covering the preterm infant's skin . Dry skin with cracking and peling of the superficial layers is comon in posterm infants. Edema may be generalized hydrops or localized eg, on the dorsum of the fet in Turner syndrome . Check for birthmarks such as capilary hemangiomas lower ociput, eyelids, forehead and mongolian spot bluish-black pigmentation over the back and butocks . It can apear as smal vesicles crystalina , smal erythematous papules rubra �, or pustules. Jaundice presenting in the first 24 hours is considered abnormal and should be evaluated se Neonatal Jaundice section, below . Check for cephalohematoma a sweling over one or both parietal bones contained within suture lines and caput sucedaneum edema over the presenting part that croses suture lines . Examine for the red reflex of the retina. Leukokoria can be caused by glaucoma cloudy cornea , cataract, or tumor retinoblastoma . Infants at risk for chorioretinitis congenital viral infection should undergo a formal retinal examination with pupils dilated prior to nursery discharge or as an outpatient. Check for mases: midline thyroid , anterior to the sternocleidomastoid branchial cleft cysts , within the sternocleidomastoid hematoma, torticolis , and posterior to the sternocleidomastoid cystic hygroma . Check for fractured clavicles crepitus, bruising, and tendernes . Decreased breath sounds with respiratory distres and a shift in the mediastinum sugests pneumothorax tension or a space-ocupying lesion eg, diaphragmatic hernia . Severe congenital heart disease in the newborn infant may be present with no murmur at al. The two most comon presentations of heart disease in the newborn infant are cyanosis and congestive heart failure with abnormalities of pulses. Palpate for kidneys—most abdominal mases in the newborn infant are asociated with kidney disorders eg, multicystic or dysplastic, hydronephrosis . Male and female genitals show characteristics acording to gestational age se Table 1̵2 . Lok for extremity fractures and for palsies especialy brachial plexus injuries . Rule out myelomeningoceles and other spinal deformities eg, scoliosis . Normal newborns are endowed with a set of reflexes that facilitate survival eg, roting and sucking reflexes , as wel as sensory abilities eg, hearing and smel that alow them to recognize their mother within a few weks of birth. In examining the newborn, observe resting tone normal-term newborns should exhibit flexion of the uper and lower extremities and spo�ntaneous movements. a high-pitched cry may be indicative of disease of the central nervous system CNS eg, hemorhage . Check for newborn reflexes: Sucking reflex in response to a niple or the examiner's finger in the mouth. This reflex develops by 28 weks' gestation and disapears by age 4 months. Dep tendon reflexes: Several beats of ankle clonus and an upgoing Babinski reflex may be normal. Moro startle reflex: Hold the infant and suport the head. This reflex develops by 28 weks' gestation incomplete and disapears by age 3 months. Tonic neck reflex: Forcibly turn the infant's head to one side, and the arm and leg on that side extend while the oposite arm and leg flex ̴fencing position̵ . birthmark on edge of infants tongue birthmark on edge of infants tongue
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