11: Birth Injuries & Exam Findings Flashcards
Nonunion of the two rectus muscles from the umbilicus to the xiphoid causing a mild herniation in the midline.
Diastasis recti
Undescended testicles. Surgical intervention needed by 1 year of age for those that don’t spontaneously heal.
Cryptorchidism
Transient lesions that commonly occur in a warm environment as the result of obstruction of the sweat gland ducts. Can be confused with candida dermatitis and erythema toxicum. Sites of predilection are the intertriginous areas, face, and scalp. Rapid resolution occurs following removal to a cooler environment.
Miliaria
The arm in this position of tight adduction and internal rotation of the shoulder with arm extension and pronation at the elbow.
Erb-Duchenne palsy
May be a normal variant but is also seen with a variety of genetic syndromes and may represent ambiguous genitalia.
Bifid scrotum
Washed out, pale white appearance.
Pallor
Can produce defects in the extremities and digits from compression in utero.
Amniotic constriction bands
Results from incomplete fusion of the palate.
Cleft palate
Small pinpoint hemorrhagic skin lesions frequently seen on the presenting part and on the face if there is a history of a nuchal cord. Those occurring on the torso are more likely to be associated with thrombocytopenia or congenital infection.
Petechiae
Dark blue or purple macular areas resembling bruises, usually located over the lumbosacral area.
Mongolian spots
These small white inclusion cysts generally cluster around the juncture of the hard and soft palates. This is a normal finding that generally resolves with sucking.
Epstein pearls
A single transverse palmar crease. Highly associated with congenital abnormalities. Hypotonia while in utero.
Simian crease
Raised, pigmented areas found vertical and medial to the true nipple.
Supernumary nipple
Transient condition of unknown cause. Characterized by pustules, vesicles and hyper-pigmented macules.
Pustular melanosis
Enlarged tongue, which may be congenital or acquired.
Macroglossia
These vascular lesions are normally seen on the occipital area, eyelids, and labella. They disappear spontaneously within the first year of life.
Macular hemangioma (Stork bite)
Foot defect associated with genetic syndromes, particularly trisomy.
Rocker bottom feet
Spinal masses that presents midline.
Spinal dysraphism
Intestinal muscles fail to close around the umbilicus. Intestines protrude into the weaker area. More common in term African-American (30%) infants than in Caucasian (4%) infants.
Umbilical hernia
A clear line of demarcation with an area of redness and an area of paleness. Most likely d/t vasomotor instability. May be benign or indicate shunting of blood.
Harlequin phenomenon
Result from imperfect fusion of the tubercles of the 1st and 2nd branchial arches during gestational development.
Preauricular sinus tracts and pits
Usually appear with in a few days after birth as a raised pink or red macule that is sharply demarcated.
Strawberry hemangioma
Caused by persistence of the processus vaginalis (tube of peritoneum that precedes the testicle through the inguinal canal into the scrotum); following testicular descent, the upper portion atrophies, leaving the distal portion (tunica vaginalis) to envelop the testicle. Failure of obliteration of the upper portion of the processus vaginalis allows abdominal fluid or intestinal protrusion, creating a palpable mass.
Inguinal hernia
The most common birth injury. May feel crepitus upon palpation.
Clavicle fracture
Yellow coloring of the skin as a result of increased bilirubin levels which are usually visible at levels greater than 5 mg/dL.
Jaundice
The feet are turned down and inward. The sole is directed medially.
Club feet (Talipes equinovarus)
Upper rim of the acetabulum fails to develop and the femoral head is malpositioned. Use Ortolani and Barlow maneuvers.
Developmental dysplasia of the hip
Ortolani maneuver: Gentle abduction test can detect dislocated hips (head of femur is outside the acetabulum and can be reduced with abduction and lifting of the greater trochanter).
Barlow maneuver: Gentle manipulation test can detect dislocatable hips (head of femur is in the acetabulum and can be subluxated or dislocated by pushing posteriorly on the femur in adduction).
Solitary or scattered superficial bullae on the upper limbs and lips of infants at birth. Commonly found on the radial aspect of the forearm, thumb, and index finger.
Sucking blisters (result from sucking on the affected part in utero)
Usually appears as a large, red, firm, ill-defined mass resembling a cyst, located anywhere on the body.
Cavernous hemangioma
A diffuse edematous swelling of the soft tissue of the scalp which may extend over suture lines.
Caput succedaneum
40% of infants have these multiple yellow or white papules. They are usually benign and usually disappear with in a few weeks.
Milia
The skull deformity is the result of a hemorrhage, usually from a traumatic forceps delivery. It does NOT cross suture lines.
Cephalhematoma
This congenital defect occurs in one in 300 males where the placement of the urethral meatus is anywhere between the tip of the glans and the perineum (ventral surface/underside). Wait for circumcision to use skin for surgery.
Hypospadius
Associated with submucous cleft palate.
Bifid uvula
Uncommon sublingual cysts that are benign but may rupture with vigorous sucking.
Ranulae
Deep red or purple in color usually present at birth. Blanch only minimally with pressure and do not disappear with time. Watch for ocular conditions.
Port wine stain (Nevus flammeus)
Term for widely spaced eyes. The diagnosis should be made on the measurement of the inner canthal distance.
Hypertelorism
The urethral opening is located on the dorsal surface (top side) of the penis.
Epispadias
Adduction of the forefoot, correctable with active ROM. Most common congenital foot deformity.
Metatarsus adductis
This is usually indicated if a palpable mass is covered with normal skin and moves with the skin.
Lipoma
This congenital structural depression of the sternum is usually of no clinical concern.
Pectus excavatum
Common newborn rash, numerous small areas of red skin with a yellow/red papule at the center.
Erythema toxicum
This is suspected if the bottom of a sacral pit is not visible or if there is moisture around an otherwise dry dimple, perhaps belying a small meningomyelocele or other anomaly
Pilonidal sinus
Deep, rosy red color of the skin. More common in polycythemia but may also be seen in overoxygenated or overheated infants.
Plethora
Very common, occurring in >99% of neonates. Most are classified as hamartomas, which are collections of cells of one or more elements of normal skin.
Birthmarks
A lacy red pattern noted on the skin seen in the infant with cold stress, hypovolemia or sepsis.
Cutis marmorata
The presence of fibrotic tissue that causes a ventral curvature of the erect penis. May be associated with hyposadias or can occur alone.
Chordee
Foot is dorsiflexed at a sharp angle with the top of the foot in contact with the anterior surface of the tibia. Occurs secondary to abnormal in utero positioning, and requires orthopedic consultation if postnatal positioning appears fixed.
Calcaneovalgus
The frenulum of the underside of the tongue prevents complete tongue protrusion. Concerned for eating problems.
Tongue tie (Ankyloglossia)
Rare injury to the lower brachial plexus (<2.5% of plexus injuries) involves paralysis of the muscles of the hand and weakness of the wrist and finger flexors. Grasp reflex is absent, and often a unilateral Horner syndrome (eyelid ptosis) is present.
Klumpke paralysis
Missing digits.
Olygodactyly
This fold over the medial aspect of the eye may be familial but occurs in less than 1% of the population. It is also seen as a common feature of Down syndrome.
Epicanthic folds
This is the name for the abnormal fusion of the digits (fingers or toes).
Syndactyly
Present in one in 3,500 live births.
Natal teeth
Extra digits.
Polydactyly
Tends to be just lateral to midline on the spine.
Sacrococcygeal teratoma
This reflex occurs by placing the infant in the supine position and turning the head to one side. The upper extremity on the side that the head is turned toward the shoulder extend and the upper extremity on the opposite side should flex.
Tonic neck reflex (Fencing)
Blue or dusky appearance of skin.
Cyanosis
Rupture of small conjunctival capillaries which can occur normally but is most common following a traumatic delivery.
Subconjunctival hemorrhage
These salt and pepper spots of the irises are often seen with Down syndrome.
Brushfield spots
Tiny white or yellow lesions visible at the opening of each pilosebaceous follicle. They are more prominent on the nose, upper lip, and over the malar regions. They spontaneously diminish in size after birth and are no longer visible after the first weeks of life.
Sebaceous gland hyperplasia
