Transcript Common Newborn Findings-I

Common Newborn
Findings
Monica Riojas, MD
November 18, 2010
Common Skin Rashes
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Match the Description to the Rash
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Picture 1
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Appears at 2 weeks of age,
resolves within 3 months,
localized to scalp and face.
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Appears within 2-3 days of life,
fades within 5-7 days, lesions
contain eosinophils.
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Present at birth, lesions in
different stages, widespread,
lesions contain neutrophils.
Picture 2
Picture 3
Neonatal Pustular
1 Transient
Melanosis
3 Erythema Toxicum Neonatorum
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Neonatal Acne
Milia, Miliaria, and Sebaceous Gland Hyperplasia…?
Milia
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Small keratin filled
cysts.
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Common on face and
scalp, but seen
everywhere.
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Resolve within a few
months.
Dew Drops
Miliaria
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Obstruction of eccrine sweat ducts.
Associated with increased temperature.
Scalp, forehead, neck, intertriginous and
occluded areas.
Resolves with cooling.
Crystallina → dew drops, fades within several
hours.
Rubra → “prickly heat”, disappears in days.
Sebaceous Gland Hyperplasia
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Tiny yellow macules or
papules, present at the opening
of each pilosebaceous follicle.
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Localized to nose and cheeks.
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Resolves by 4-6 months of age.
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Caused by maternal androgens.
Mongolian Spots
• Congenital, benign macular blue-gray pigmentation.
• Usually fade during the first or second year of life.
• Not to confuse with bruises of child abuse (fade into surrounding skin
and have different colors).
Case 1
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FT female born to a 33yo G1P0, (+) PNC, all
maternal labs (-), MBT B(-)/BBT A(+), mom
exclusively breastfeeding.
What is this patient at risk for?
On DOL #3, Indirect Bili 10.4
Jaundice
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Clinically apparent at serum bili levels of >5 mg/dl.
Cephalo-caudal progression.
Peaks between days 2-4, usually resolves spontaneously.
On exam, pressing lightly on the skin with a finger will
result in a yellow color blanch compared with the
surrounding skin.
Useful to determine whether the jaundice is progressing
or improving over time.
Exam not accurate after phototherapy due to “bleaching
effect”.
Salmon Patches (Nevus Simplex)
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40 – 70% of newborns.
Capillary malformations.
Darken with crying and exertion.
Nape of the neck (stork bite), glabella, forehead (angel
kiss), upper eyelids, scrotum, lumbosacral.
Usually fade in first year (may persist, especially if
nuchal or lumbosacral).
No further evaluation.
Common HEENT Findings
Case 2
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FT male born via NSVD, prolonged labor and
uncomplicated delivery. You are called to the
nursery to examine the baby…
Should you be worried?
Molding
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Temporary asymmetry of the skull.
Caused by birth.
Mainly seen with vaginal deliveries and
prolonged labor.
Normal head shape is
usually regained
within 1 week.
Case 3
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FT male born via vaginal delivery, complicated
by maternal fatigue. Vacuum extraction was
used. On PE, the newborn is noted to have
swelling of the head that crosses suture lines.
What is the most likely diagnosis?
Caput Succedaneum vs Cephalhematoma
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Crosses suture lines.
Involves scalp only (soft tissue
swelling).
Seen at birth.
Resolves spontaneously within
24-48 hours.
Common cause of jaundice.
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Does NOT cross suture lines.
Involves bone (subperiosteal
hemorrhage).
Fluctuant on palpation.
Not seen at birth, but can
increase in size over first few
days.
Slow resolution (3 wks-3mo).
Can be seen with nondepressed
skull fx.
Caput Succedaneum
Cephalhematoma
Subconjunctival Hemorrhage
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Frequent finding in normal newborns.
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Caused by the breakage of small vessels during the
pressure of delivery.
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Always confined to the limits of the sclera.
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Asymptomatic, does not affect vision, and
spontaneously resolves in several days to a few weeks.
Leukocoria
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Causes:
 Congenital cataracts (18% unilateral and 42% bilateral).
 Retinoblastoma (11% unilateral and 7% bilateral)
 Retinal detachment (2.8% unilateral and 1.4% bilateral)
 Uveitis: TORCH
 ROP
 Persistent hyperplastic primary vitreous (90% unilateral)
 Vitreous hemorrhage
 Coat’s disease (retinal telangectasia), presents 8-10yrs.
Case 4
An infant in the newborn nursery is
normally grown and normally formed,
except for a preauricular pit
(preauricular sinus) bilaterally. He has
passed his newborn hearing screening.
When you meet the baby's mother, you
learn that she has progressive, bilateral
sensorineural hearing loss for which she
uses hearing aids.
Of the following, the MOST helpful
test to aid in diagnosis and management
of this baby's condition is
A.
chromosome analysis
B.
head ultrasonography
C.
ophthalmology
consultation
D.
radiographic skeletal
survey
E.
renal ultrasonography
Preauricular Pit/Sinus
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Uni or bilateral.
Malformed external and middle ears may be associated with renal
anomalies, craniofacial malformations, and inner ear
malformations.
Screening for associated renal anomalies if:
 Associated malformations
 FHx of deafness, renal or auricular malformations
 Mother with gestational diabetes
• Branchio-oto-renal syndrome: audiologic testing, renal
evaluation
Preauricular Skin Tag
Preauricular Skin Tag
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Often a familial trait.
Most often benign and isolated.
Can be associated with cleft lip and palate.
If associated to abnormal pinna, other malformations, or risk
factors for hearing loss: further evaluation recommended.
Microtia
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Rare.
Grade I – IV, grade III most common.
Often unilateral (4:1), right side.
Hearing evaluation and ENT referral.
50% have an associated genetic syndrome.
 Goldenhar, Treacher Collins, hemifacial microsomia
Low Set Ears
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If an imaginary line is drawn from the outer canthus of
the eye straight back to the occiput, a low set ear will
fall completely below the line.
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An ear with normal set will cross or touch the same
line.
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This infant had trisomy 18 as an underlying etiology.
Case 5
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You are assessing a FT newborn for the first
time in the mother’s room. As you are
examining the patient, the mother asks you what
the bumps are on the baby’s upper and lower
gums. What do you respond?
Bohn's Nodules
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Unknown etiology.
Different type of inclusion cysts, thought to be remnants of
salivary glands.
Present either on the lateral aspect of the gum or on the
periphery of the palate.
When large can be mistaken by congenital teeth (but located in
the external surface of the gum vs. alveolar ridge).
Benign finding and disappear within 3 months.
Salivary Glands
Epstein’s Pearls
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Keratin containing cysts.
Normal variant.
Seen only in newborns.
Located on the raphe of hard and soft palates.
Resolve within several weeks.
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Natal Teeth
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1 in 2,000 - 4,000 newborns
Usually lower incisors.
Can present visible or as eruption cysts completely covering the
teeth.
They are usually part of the primary dentition, so they should not
be removed unless they are mobile, presenting an aspiration risk,
or causing secondary tongue ulceration or problem feeding.
Dental X-ray and consultation is indicated.