Document the below in baby’s delivery notes.

 

Caput Succedaneum

 

Cephalhaematoma:

 

Eye Deformity-

• Cataracts

• Retinal Haemorrhages

• Red reflex – Present/ Absent

 

Ears Deformity:

• Shape/size

• Normal level or ‘low set’?

• Check patency

• Preauricular tags & sinuses

 

Nose deformity:

• Shape

• Patency

 

Mouth deformity:

• Palate

• Lips

• Tongue

 

Pre-auricular skin tag

• Inherited as a familial trait

• Refer to plastic surgeon

 

Preauricular sinuses

• May be unilateral or bilateral

• Ensure hearing check done

 

Subconjunctival Haemorrhage:

• Breakage of small vessels during the pressure of delivery

• Confined to sclera

• Does not affect vision & Resolves spontaneously

• Absent red eye reflex –Paediatric Ophthalmologist after registrar review

• URGENT – seen by an ophthalmologist by 2 weeks)

 

Tongue tie

 

Neck & Clavicle

• Excess skin at the base of the neck (Down syndrome)

• Masses/Swellings

• Fracture

 

Respiratory:

• Any distress?

• Any upper airways noises?

• Any abnormality of chest wall?

• Good Air entry bilaterally?

 

Cardiovascular:

• HR: 120-140

• Cardiac apex – correct side?

• Heart sounds

• Femoral pulses

• Cyanosis/duskiness

 

Abdomen:

• Inspection: Shape

• Palpation:  Palpable liver or spleen

• Umbilical Cord area: Discharge, odour

• Advice on cord care

• Limbs

• Fingers/toes: Polydactyly, syndactyly

• Palmar creases

• Talipes – fixed or positional

• Hips

 

Fixed Talipes:

• Foot appears Plantarflexed and inverted

• Here the position of foot appears rigid

Treatment- Refer to Physiotherapy & Orthopaedic surgeon

 

Developmental Dysplasia Of Hips

• There is generally a positive family history

• More common in breech presentation.

Treatment- Get a hip ultrasound at 6 weeks and refer to orthopedicians. 

 

Genitalia deformities- 

In Males:

• Testes- Is it Descended?
• Penis -Urethral opening present?

Females:

• Check Labia size

• Clitoris opening present?

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Occasionally Babies can be born with the following abnormality.

 

Hypospadias:

• Here, the urethral meatus opens anywhere along the urethral groove running from the tip along the ventral aspect to the perineum

• A hooded foreskin, which allows the glans to be readily visible, can be present.

• This is a contraindication to circumcision

In these cases, refer on to the Surgical team to be seen by 9-12 months of age.

 

Chordee:

• This is the ventral curvature of penis

• Here, the penis is incompletely separated from the perineum or is tethered

• Can occur with hypospadias

This is also a Contraindication to circumcision. Refer to Paediatric Surgeon to be seen soon.

  

Hydrocele

• This is due to the fluid surrounding the testicles. This cannot be reduced as the fluid is in an enclosed space

• Here, a spontaneous resolution is expected

Treatment – Always refer to a paediatric surgeon if it is not resolved by 1 year. 

 

Inguinal hernia

• Look for fullness in the inguinal area. 

• Typically you can’t get above the swelling

• This can be reduced with digital pressure

Treatment- Needs to be referred to Paediatric Surgeon soon.

 

Undescended Testes:

• In most cases, a spontaneous descent is expected.

• If unilateral– follow up at 6 months of age.

• If not descended by 1 year then refer to paediatric surgeon.

In Bilateral cases, consider ambiguous genitalia

 

Imperforate anus:

• It can be associated with many .anomalies

• VACTERL (Vertebral, Anorectal, Cardiac, Tracheo-oesophageal, Renal, Limb abnormalities)

Admit urgently as baby will need to be kept Nil orally and needs urgent referral to Paediatric Surgeon

 

Erythema Toxicum Neonatorum:

• Lasts from 2nd day of life  to  2 weeks of age

• Seen in > 50% of newborns

• Looks like a halo of erythema with central whitish/yellowish papule

Treatment- It is benign and will disappear with no treatment

 

Milia:

• This is Keratin filled epithelial cysts

• Generally found on forehead, nose, upper lip, cheeks

• Seen in about 40% of newborn

Treatment- This is a benign, self-limited lesion and will resolve in 2 months.

 

Mongolian Birth Mark:

• These dark skin lesions are irregular in shape and are slate grey to blue-black in colour.

• These Present at birth or appear within few weeks

• Usually found over lumbosacral area and buttocks

Always document these in the baby’s documentation.