The health newborn infant

Question 1

What is the typical weight loss range in newborns during the first 3 to 5 days of life?

Answer 1

Newborns may experience a weight loss of up to 10% of their birth weight during the first 3 to 5 days of life.

Question 2

When is birth weight typically regained in newborns?

Answer 2

Birth weight is usually regained by the seventh day of life in newborns.

Question 3

How does weight gain typically progress in infants during the first three months?

Answer 3

Subsequent weight gain in infants is usually about 200 g a week (25–30 g/day) for the first three months of life.

Question 4

How does weight loss in preterm infants compare to term infants during the first days of life?

Answer 4

In preterm infants, weight loss may be greater, reaching up to 15% of their birth weight during the first few days of life.

Question 5

How does the duration of weight regain differ between preterm and term infants?

Answer 5

Weight regain in preterm infants may take longer compared to term infants.

Question 6

What is the typical range of head circumference at term?

Answer 6

The typical range of head circumference at term is 33 to 37 cm, with an average of 35 cm.

Question 7

What is the average rate of increase in head circumference per week?

Answer 7

On average, head circumference increases by approximately 7 mm per week, with a range of 5 to 10 mm.

Question 8

What is considered a typical increase in head circumference per week?

Answer 8

An average increase of approximately 7 mm per week is considered typical for head circumference during early development.

Question 9

What is caput succedaneum?

Answer 9

Caput succedaneum refers to the oedematous thickening of the scalp in the presenting area during birth, which often crosses suture lines. It typically disappears within a few days after birth.

Question 10

Describe the anterior fontanelle.

Answer 10

The anterior fontanelle is diamond-shaped and of variable size. It is normally slightly concave and may be observed to pulsate

Question 11

When does the anterior fontanelle close

Answer 11

Typically, it closes by 18 months of age

Question 12

How does caput succedaneum differ from cephalohematoma?

Answer 12

Caput succedaneum involves oedematous thickening of the scalp in the presenting area during birth and usually crosses suture lines, resolving within a few days. In contrast, cephalohematoma is a subperiosteal collection of blood, typically limited by suture lines, and may take weeks to months to resolve.

Question 13

What is the typical shape and closure time of the posterior fontanelle?

Answer 13

The posterior fontanelle is typically small and triangle-shaped, closing by around 4 months of age.

Question 14

Define moulding in newborns.

Answer 14

Moulding refers to the altered shape of the newborn’s head in response to pressure during birth, sometimes resulting in the overriding of cranial bones.

Question 15

What is craniotabes, and when does it typically occur?

Answer 15

Craniotabes is the softening of the skull bones and is a normal finding in most newborns, especially in the parietal region. It may persist in many infants up to 3 months of age

Question 16

What does persisting craniotabes suggests

Answer 16

Severe or prolonged craniotabes may suggest metabolic bone disease or osteogenesis imperfecta.

Question 17

What is the typical appearance of the neck in a newborn?

Answer 17

A newborn typically appears to have a short neck.

Question 19

What are examples of midline swellings that are rare in newborns?

Answer 19

Midline swellings such as dermoid and thyroglossal cysts are uncommon in newborns.

Question 20

What is a sternomastoid ‘tumour,’ and when does it typically appear?

Answer 20

A sternomastoid ‘tumour’ is a hard lump that appears in the body of the sternomastoid muscle, usually a few days after birth.

Question 21

What causes sternomastoid “tumor”

Answer 21

It is often caused by trauma or avascular necrosis.

Question 22

What condition may result from a sternomastoid ‘tumour,’ and how is it treated?

Answer 22

A sternomastoid ‘tumour’ may cause torticollis, a condition characterized by the neck being twisted to one side. Torticollis usually improves with physiotherapy.

Question 23

How common are sternomastoid ‘tumours’ in newborns?

Answer 23

Sternomastoid ‘tumours’ are uncommon in newborns.

Question 24

What may cause difficulty in examining the eyes of newborn infants initially?

Answer 24

Strong reflex closure of the eyes may cause difficulty in examining newborn infants’ eyes initially.

Question 25

What is the significance of the 'red reflex' in newborn eye examinations?

Answer 25

The 'red reflex' should be present, indicating the reflection of light from the back of the eye

Question 26

What does a white pupil suggest

Answer 26

A white pupil may suggest conditions like cataracts or retinoblastoma

Question 27

How does the appearance of the pupil contribute to eye examination findings?

Answer 27

The pupil should appear black and not grey. Abnormalities such as cataracts and retinoblastoma can cause a white pupil.

Question 28

What can the color of the sclerae indicate in preterm infants?

Answer 28

In preterm infants, the sclerae may have a blue tinge due to the transmission of the darker color of underlying uveal tissue through the underdeveloped sclerae

Question 29

What does a darker blue sclerae suggest

Answer 29

Darker blue sclerae may suggest osteogenesis imperfecta.

Question 30

Why may the color of the iris be unpredictable in newborn infants?

Answer 30

The color of the iris in newborn infants is indefinite and not predictive of the color in older infants.

Question 31

What is the significance of tears in newborn infants during the first few weeks?

Answer 31

Tears are rare in newborn infants during the first few weeks of life.

Question 32

What visual abilities do newborn infants possess from birth?

Answer 32

Newborn infants are able to see from birth and should be able to follow a red or bright moving object.

Question 33

Describe the appearance and significance of subconjunctival haemorrhage in newborns.

Answer 33

Subconjunctival haemorrhage appears as a bright red patch, often adjacent to the cornea, with no serious significance. It disappears within a few weeks and may be more common after traumatic delivery.

Question 34

What condition may be indicated by abnormally large eyes in newborn infants?

Answer 34

Abnormally large eyes in newborn infants may indicate congenital glaucoma, which requires early treatment due to its importance.

Question 35

What is the usual course of subconjunctival haemorrhage in newborns?

Answer 35

Subconjunctival haemorrhage usually resolves spontaneously within a few weeks.

Question 36

What are some common findings related to the ears in newborn infants?

Answer 36

Common findings related to the ears in newborn infants include preauricular skin tags and sinuses, which typically cause no problems.

Question 37

What maternal condition may be associated with hairy ears in newborn infants?

Answer 37

Hairy ears are common in newborn infants of diabetic mothers.

Question 38

What potential significance do low set ears and unusual shapes of ears have in newborn infants?

Answer 38

Low set ears and unusual shapes of ears in newborn infants can be common findings in certain syndromes.

Question 39

Congenital nasal obstruction

Answer 39

choanal atresia

Question 40

Acquired nasal obstruction

Answer 40

nasal secretions

Question 41

What is the significance of nasal obstruction in newborn infants?

Answer 41

may cause feeding problems or respiratory distress in newborn infants, as they are obligate nose breathers.

Question 42

What are sucking blisters, and where are they commonly found in newborn infants?

Answer 42

Sucking blisters are thickened areas on the upper lip of newborn infants, usually located in the midline.

Question 43

What are Epstein's pearls, and where are they typically found in newborn infants?

Answer 43

Epstein's pearls are small whitish inclusion cysts, usually visible in the midline on the hard palate of newborn infants. They are of no significance.

Question 44

What is tongue-tie, and how does it affect newborn infants?

Answer 44

Tongue-tie occurs when the frenulum linguae is inserted into or near the tip of the tongue in newborn infants. It rarely interferes with sucking or future speech.

Question 45

What do you do if you suggest nasal obstruction

Answer 45

try passing a nasogastric tube

Question 46

What is a ranula, and where does it typically occur in newborn infants?

Answer 46

A ranula is a cystic swelling that occurs in the floor of the mouth of newborn infants. It usually disappears spontaneously over time.

Question 47

What are adventitious teeth, and how do they differ from primary teeth when present at birth?

Answer 47

Adventitious teeth are occasionally present at birth and are typically loose, not interfering with sucking, and fall out spontaneously. In contrast, primary teeth present at birth may pose a potential aspiration risk.

Question 48

Vernix caseosa

Answer 48

Protective greasy white substance secreted by fetal sebaceous glands. Not present in preterm infants, and decreases in quantity after term.

Question 49

Traumatic cyanosis of the face

Answer 49

Due to many small petechial haemorrhages in the skin after congestion of the head with the cord around the neck.

Question 50

Superficial skin peeling

Answer 50

Common during the first week. It is especially marked in post-term or wasted infants.

Question 51

Hair

Answer 51

Colour at birth is poor guide to future shade

Question 52

Lanugo

Answer 52

Lanugo is fine facial and body hair which is a feature of preterm infants.

Question 53

Role of lanugo

Answer 53

Lanugo plays an essential role in binding the vernix caseosa to the skin of fetuses

Question 54

Milia

Answer 54

White pin-head sized papules which are made up of keratin and sebaceous material in sebaceous glands, causing blockage. These are due to fetal oestrogen, frequently found on the nose and cheeks and resolve within the first few weeks.

Question 55

Blue spots (‘Mongolian spot’)

Answer 55

Flat blue-black areas over sacrum or buttocks, and occasionally on back, shoulders, hands and feet. Usually disappear by 4 years.

Question 56

Vascular naevi

Answer 56

Salmon patches: pink-red superficial capillary haemangiomata may occur over the upper eyelids, upper lip, middle of forehead, and on the nape of the neck (stork-bite). They usually fade by 1 year.

Question 57

Strawberry naevus

Answer 57

A raised cavernous haemangioma with a surface resembling a strawberry. At birth, the strawberry-to-be may show as a white (depigmented) patch of skin. Growth is rapid and it may easily reach 4 cm in diameter. It usually starts to subside by 1 year and most have disappeared by 7 years of age. Surgical removal is rarely necessary.

Question 58

Port wine mark (capillary haemangioma or naevus flammeus)

Answer 58

Is a low-flow capillary malformation that can occur anywhere and may be extensive. It persists for life. If situated over the ophthalmic division of the trigeminal nerve it may be associated with a meningeal haemangioma (Sturge-Weber syndrome). Large marks may require laser treatment later.

Question 59

Erythema toxicum

Answer 59

Very common. Red blotchy rash with yellow central pin-head papules (which may look like pustules but contain eosinophils) occurring between the second and eighth days. Seldom seen in preterm infants and never on palms or soles. Cause unknown. No treatment needed.

Question 60

Transient neonatal pustular melanosis

Answer 60

A benign condition in a well infant with 3 stages – vesicles, ruptured vesicles and hyperpigmented macules

Question 61

Fat necrosis

Answer 61

Localised areas of induration on back, thighs, or face (after forceps delivery). It has a dark red appearance and may fluctuate. Resolves spontaneously but needs to be differentiated from skin abscesses. Can be painful.

Question 62

Sclerema

Answer 62

Very firm rubbery feel to the skin. Associated with severe infection, hypothermia or severe hypoxia.

Question 63

Wasting

Answer 63

Dry, loose skin hangs in folds due to loss of muscle and subcutaneous fat resulting from recent intrauterine starvation.

Question 64

What causes breast enlargement in newborn infants, and how long does it typically last?

Answer 64

Breast enlargement in newborn infants is common and usually lasts for a week or two, but it may persist for months. It is due to the effect of fetal estrogen and progesterone.

Question 65

What precaution should be taken regarding handling in newborns with breast enlargement

Answer 65

Handling should be avoided in newborns with breast enlargement, as it may cause mastitis.

Question 66

How common are supernumerary nipples in newborn infants?

Answer 66

Supernumerary nipples are common in approximately 1 in 40 newborn infants.

Question 67

What is the normal reason for infants to vomit?

Answer 67

Infants may vomit due to swallowing air while feeding or bringing up a small amount of milk when burped.

Question 68

When should persistent vomiting in infants be assessed and investigated?

Answer 68

Persistent vomiting in infants should be carefully assessed and investigated, especially if bile is present.

Question 69

What is the significance of occasional large vomits in infants?

Answer 69

Occasional large vomits in infants may occur without cause and are considered normal.

Question 70

Serious causes of vomiting

Answer 70

* Alimentary tract obstruction due to atresia, meconium ileus, volvulus, strangulated hernia, inspissated cows’ milk, Hirschsprung’s disease and necrotising enterocolitis. * Marked gastro-oesophageal reflux. * Infection (including urinary tract). * Cerebral pathology (including intracranial bleed or meningitis). * Metabolic disorders.

Question 71

What is the typical composition of the umbilical cord in newborns?

Answer 71

The umbilical cord usually consists of two arteries and one vein.

Question 72

What conditions are associated with having only one artery in the umbilical cord?

Answer 72

Having only one artery in the umbilical cord is associated with a higher incidence of chromosomal, gastrointestinal, or renal abnormalities.

Question 73

What is the typical outcome for umbilical hernias in newborns?

Answer 73

Umbilical hernias are common in newborns and typically close spontaneously by the age of 5.

Question 74

When is meconium typically passed in newborns?

Answer 74

Meconium is typically passed within 48 hours of birth in the majority of infants.

Question 75

What should be considered if meconium is passed in utero?

Answer 75

If meconium is passed in utero, it may indicate fetal distress.

Question 76

What intervention may be used if obstruction is caused by a firm meconium plug?

Answer 76

If obstruction is caused by a firm meconium plug, it may be relieved by gently inserting a small glycerine suppository into the anus.

Question 77

How do breast milk stools typically appear?

Answer 77

Breast milk stools are usually bright yellow (varying from orange to green), may vary from watery to pasty, and may contain mucus.

Question 78

When do stools typically replace meconium in newborns?

Answer 78

Stools replace meconium on day 3 or 4.

Question 79

How many stools are usually passed by newborns each day, and what is the range of variation?

Answer 79

Newborns usually pass two to five stools each day. However, the variation can range from one stool a week to 12 stools a day.

Question 80

What are the characteristics of stools produced by infants fed with cow's milk (formula)?

Answer 80

Stools from infants fed with cow's milk (formula) are pale yellow, firmer, and less frequent, with up to 5 stools a day or one stool every second day.

Question 81

How would you describe "starvation stools" seen in under-fed infants?

Answer 81

"Starvation stools" in under-fed infants are characteristically small and dark green in color.

Question 82

What could be the cause of blood in infant stools, and how can it be distinguished from fetal blood?

Answer 82

Blood in infant stools may be due to swallowed maternal blood, which can be distinguished from fetal blood by the Apt test.

Question 83

In what scenario are loose green stools commonly observed in infants?

Answer 83

Loose green stools are commonly observed in infants undergoing phototherapy.

Question 84

What is a common and normal occurrence related to the back of newborns?

Answer 84

A coccygeal sinus is common and normal in newborns.

Question 85

How would you characterize a benign sacral midline dimple in newborns?

Answer 85

A benign sacral midline dimple typically has a visible intact base and a diameter of less than 0.5 cm.

Question 86

What should be considered if any sacral patch, dimple, or sinus is observed in newborns?

Answer 86

Any sacral patch, dimple, or sinus in newborns may indicate an underlying occult spina bifida or tethering of the spinal cord and warrants further investigation.

Question 87

What is the typical timeframe for newborn infants to pass urine after birth?

Answer 87

Newborn infants should pass urine within the first 24 hours after birth, often immediately after birth.

Question 88

What might dribbling urine suggest in newborn boys?

Answer 88

What might dribbling urine suggest in newborn boys?

Question 89

What is the normal frequency of bladder emptying in newborns during the first few weeks?

Answer 89

In the first few weeks, the infant bladder is emptied up to 20 times a day.

Question 90

How might urates affect the appearance of urine and nappies in newborns?

Answer 90

Urates may heavily color the urine, leaving a brick-red stain on the nappy, which can sometimes be mistaken for blood.

Question 91

What are the risks associated with urine collection in newborns?

Answer 91

While collecting urine using a collecting bag is the most common method, contamination is a risk. Uncontaminated urine may be obtained by suprapubic bladder puncture or urethral catheterization.

Question 92

What is the term used to describe the normal decrease in urine output seen in newborn infants during the first few days after birth?

Answer 92

Physiological oliguria.

Question 93

How long does physiological oliguria typically last in newborn infants?

Answer 93

Physiological oliguria usually persists for the first three days after birth.

Question 94

How does the kidney function of a newborn infant compare to that of an older child?

Answer 94

The newborn kidney is less able to excrete a solute load and has a reduced concentrating capacity compared to an older child.

Question 95

What implications does the reduced kidney function of newborns have?

Answer 95

The reduced kidney function in newborns means that they may be more susceptible to electrolyte imbalances and may require careful monitoring of fluid intake and output.

Question 96

How does the reduced concentrating capacity of the newborn kidney affect urine production?

Answer 96

The reduced concentrating capacity means that newborns may produce more dilute urine compared to older children, which can affect their ability to maintain fluid balance.

Question 97

What is the typical location of testes in male infants at birth?

Answer 97

What is the typical location of testes in male infants at birth?

Question 98

What is the recommended course of action if testes are incompletely descended in infants at six months?

Answer 98

Infants with undescended testes at six months should be referred for surgery at one year of age.

Question 99

How do the genitalia of preterm infants typically differ from those of term infants?

Answer 99

Preterm infants tend to have incompletely descended testes and a less well-developed scrotum compared to term infants.

Question 100

What condition is more common in males, especially if born preterm, and requires repair to prevent incarceration?

Answer 100

Inguinal hernia is more common in males, especially if born preterm, and should be repaired to prevent incarceration.

Question 101

What is a common condition in male infants characterized by a soft swelling of the scrotum that easily transilluminates?

Answer 101

Fluid hernia is a common condition in male infants, characterized by a soft swelling of the scrotum that easily transilluminates.

Question 102

What is the typical adherence of the foreskin to the glans penis in newborns?

Answer 102

The foreskin is normally adherent to the glans penis in newborns and cannot be pulled back without trauma.

Question 103

At what age do approximately 90% of males become fully retractable?

Answer 103

Approximately 90% of males become fully retractable by the age of 3 years.

Question 104

What is the significance of a mucoid vaginal discharge in female infants at birth?

Answer 104

A mucoid vaginal discharge is present in nearly all mature female infants at birth and is of no pathological significance.

Question 105

What phenomenon occasionally occurs at the end of the first week in female infants, which is attributed to fetal hormone withdrawal?

Answer 105

Vaginal bleeding occasionally occurs at the end of the first week in female infants, which is a fetal hormone withdrawal effect of no pathological significance.