Normal Infant in the First Week of Life

Question 1

Describe how you’d undertake a normal baby check

Answer 1

• General - sex, respiratory effort (flaring, subcostal retraction), posture and movement, colour, activity, cry
• Measurements - weight, length, head circumference
• Vitals - HR 120-160, RR 40-60, axilla temp 36.1-37)
• Skin - haemangiomas, naevi, milia - white keratinous papules on nose/cheeks. Resolve in weeks
• Head - fontanelles (anterior and posterior) and sutures for bulging/tenseness, caput (oedema, crosses sutures), cephalohaematomas (do not cross sutures), subgaleal haemorrhages (cross suture lines, firm and fluctuant. Life-threatening)
• Face - facial palsies (especially in instrumental deliveries, better seen when crying. Self-resolving)
• Eyes - spacing, symmetry, epicanthal folds, palpebral fissures, eye movement, sclerae, conjunctivae, corneas, pupils, red reflex (white - retinoblastoma, cataract)
• Ears - position (level with outer canthus), size, appearance
• Nose - patency
• Mouth - epstein pearls (white cysts on the soft/hard palate junction. Benign), frenulum (tongue-tie), clefts
• Neck - cystic hygromas (painless, transilluminable), branchial clefts (anterior SCM), haematomas, thyroglossal cysts (midline), lymphadenopathy, torticollis, excess skin (Turner’s/Down’s), clavicles (absence or fracture)
• Chest - size, symmetry, structure, movement, lactation (can be normal due to maternal hormones for weeks)
• Lungs - 40-60 breaths per minute normal, respiratory distress, grunting
• Cardiovascular - 120-160 bpm, apex beat (LLSE), murmurs, pulses
• Abdomen - shape, diastasis recti, palpation (liver 1-3 cm below ribs, kidneys palpable), umbilical cord for size, discharge, vessels
• Genitalia - female for labia, clitoris, meatus, vaginal opening, hymen (look for imperforate). Male for testes position (normally descend by 6/12), penis length, scrotum, foreskin, position of urethral opening. Check for ambiguous genitalia (CAH)
• Anus - patency (don’t assume pre-mec)
• Trunk and spine - palpate spine and check for neural tube defects (also between gluteal folds for sacral ones)
• Pulses - femoral, apex
• Extremities - hands and feet for syndactyly/polydactyly/talipes, palmar creases (single associated with Down’s), movement for symmetry
• Hips - for developmental dysplasia
• Neurological - passive and active tone (stepping, head control, suspension), reflexes

Question 2

When does the suck reflex develop in a foetus? Why is this relevant?

Answer 2

• 34 weeks
• Prems may have feeding difficulties