AUFMED

ANTHROPOMETRIC MEASUREMENTS
Weight
-average: 3000g
-LBW= below 2500 gms; regardless of AOG

Length
- average: 50cm
-techniques: using tape measure
(supine with legs extended)
- crown to rump
- head to heel
Head Circumference (HC):
- average: 35cm
- technique: using tape measure
- from the most prominent part of the
OCCIPUT to just above the EYEBROWS
- 1/3 the size of an adults head
- disproportionately LARGE for its body
- HC should be = or 2cm > CC
Chest Circumeference (CC):
- 30 to 33cm
- Technique: using tape measure
- from the lower edge of the SCAPULAS to
directly over the NIPPLE LINE anteriorly
- CC should be = of <2cm than HC

SKIN
NURSERY CARE CONSIDERATIONS
Under natural light
Assess for:
- color
- hair distribution
- Turgor/ testure
- pigmentation/ birthmarks
- other skin marks
Skin Color
Velvety smooth and puffy esp. at the legs, dorsal
aspects of hands and feet and in the scrotum of
labia
Pinkish red (light skinned) to pinkish brown to
yellow (dark skinned)
Ruddy or reddish due to increased RBC
concentration and decreased subQ tissues
especially premature infants
Acrocyanosis
Bluish discoloration of palms of hands and soles
of feet
Due to immature peripheral circulation
Exacerbated by cold temperatures
Normal within 1st 24 hours

Dr. Rodolfo Ng | June 25, 2015 | Pediatrics

CARE OF THE NEWBORN II

Pallor/ Cyanosis

May indicate hypothermia, infection (usually non

specific in newborns), anemia, hypoglycemia,
cardiac, respiratory or neurological problems
Usually when we extract blood from prematures,
we take note of the amount of blood extracted

Jaundice

50% full term and 80% preterm visibly jaundiced

by 3-5 days
Common among Chinese newborns

Physiologic Jaundice
- noted after 24-48 hours of life
- Term: peak 3-4 days and disappear 7-10
days
- Preterm: peark 5th and gone 2 weeks
- due to immaturity of liver
Pathologic Jaundice
- occurs on the 1st 24 hours of life
- BIlirubin increases >0.5 mg/dl/hr
- peak bilirubin >12mg/dl term and >15mg/dl
in preterm during the first week of life
- hepatosplenomegaly and anemia
- clinical jaundice persisting >1 week (term)
and > 2 weeks (preterm)
*Ask the mother what the color of the urine is
because usually babies are red after birth.
Breastfeeding jaundice
Early onset of jaundice within the first 3-4 days
Also called exaggerated jaundice, lack of
breastmilk jaundice
Factors: oral administration of water of glucose
water, inadequate nursing and decreased stool
output
Rx: continuous breastfeeding; no complementary
feedings
Breast Milk Jaundice
Later onset of jaundice occurring towards the end
of the 1st week and persisting for 3 weeks to 3
months

Cause: unknown, unknown constituent in

breastmilk
Dx by exclusion
Rx: stop breastfeeding x 2-3 days

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Reassure the mother that the jaundice is not

because of breastfeeding
Phototherapy (eyes and sex organs should be
covered to prevent damage)

BIRTHMARKS
1. Mongolian Spots
- Blue-green or gray pigmentation
- Lower back, sacrum & buttocks
- Disappears by 4 years of age

Meconium Staining

Over the skin, fingernails and umbilical cord

Due to passage of meconium in utero due to fetal
hypoxia
Passage of meconium due to asphyxia in baby <
34 week gestation is UNUSUAL
The baby was in a state of hypoxia and
underwent fetal distress.
Prematures do not pass meconium

Lanugo
Found after 20 weeks of gestation on the entire
body except the palms and soles
Fine downy hair that covers the shoulders, back
and upper arms
NURSERY CARE CONSIDERATIONS
More mature, less lanugo
May diappear within 2 weeks
Preterm: woolly patches of lanugo on skin and
head
Post term: parchment-like skin without lanugo
Vernix Caseosa
Protective cheesy-like, gray-white fatty substance
FT: skin folds under the arms and in the groin
under the scrotum or in the labia
Nursing considerations:
-Use baby oil
-DO NOT attempt to remove vigorously

2. Strawberry Marks
- Nevus Vasculosus or Capillary Hemangioma
- Dark red, raised lobulated tumor
- Head, neck trunk & extremities
- After 7 to 9 years of age

3. Large Capillary Hemangioma

4. Cavernous Hemangioma

It is helpful if you do not totally remove especially

for prematures
Post matures usually look paranoid
Desquamation
Dryness/ peeling of the skin
Usually occure after 24-36 hours
Marked scalliness and desquamation=
signs of postmaturity
Milia

Multiple, yellow or pearly white papules

approx. 1 mm wide
Due to enlarged or clogged sebaceous
gland
Usually found on the nose, chin, cheeks,
eyebrows and forehead

5. Sturge-Weber Syndrome
- A sporadic vascular disorder and
- Consists of a constellation of symptoms and
signs including:
facial capillary malformation (port-wine
stain)
abnormal blood vessels of the brain
(leptomeningeal angioma)
abnormal blood vessels of the eye
leading to glaucoma

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Patients present with seizures, hemiparesis,

stroke-like episodes, headaches, and
developmental delay
Port-wine stain (nevus flamneus) involving
the forehead and upper lip, glaucoma and
contralateral jacksonian seizures

6. Kasabach-Merritt Syndrome
- Association of a giant hemangioma with
localized intravascular coagulation causing
thrombocytopenia and hypofibrinogenemia
- The site of the hemangioma is obvious, but
retroperitoneal and intraabdominal
hemangiomas may require body imaging for
detection
- Inside the hemangioma there is platelet
trapping and activation of coagulation, with
fibrinogen consumption and generation of
fibrin(ogen) degradation products.
Arteriovenous malformation within the lesions
can cause heart failure
- Peripheral blood smear shows
microangiopathic changes
- Cavernous hemangioma
- Thrombocytopenia
- Microangiopathic changes in RBC (detected
thru peripheral blood smear)

OTHER SKIN MARKS

1. Mottling
- Cutis marmorata
- Reticulated pattern of constricted capillaries
and venules due to vasomotor instability in
immature infants
- Bluish mottling or marbling of skin in
response to chilling, stress or overstimulation
- *Infection of blood/sepsis may also manifest
as mottling in newborns

2. Erythema Toxicum
- Newborn rash; urticaria of newborn;
eosinophil rash (because eosinophils are
present upon examination of lesion under the
microscope)
- Small, white, yellow, or pink to red popular
rash
- Trunk, face and extremities
- Within 48 hrs.
- May be mistaken for septic spots. Careful
examination must be done to prevent
unnecessary administration of antibiotics.
- Suspect allergic or hypersensitivity reaction

3. Petechiae
- Pinpoint hemorrhages on skin
- Due to increased vascular pressure, infection
or thrombocytopenia
- Within 48 hrs.
- *Petechiae do not disappear after blanching
- *May result from mechanical causes such as
cordcoil and pressure during delivery.

4. Ecchymosis
- Bruises
- As a result of rupture of blood vessels
- May appear over the presenting part as a
result of trauma during delivery
- May also indicate infection or bleeding
problems

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5. Harlequin Sign
- When on side, dependent side turns red and
upper side/half turns pale
- Due to gravity and vasomotor instability or
immature circulation
- Clowns Suit

*At birth, it is possible that there is no more

posterior fontanel present due to early
closure/overlapping of sutures
- Bulging or sunken
Sutures
- Overriding or separated
Head lag
- Common when pulling newborn to a sitting
position
- When prone, NB should be able to lift the
head slightly and turn head from side to side

1. Caput Succeedaneum
- Swelling of soft tissues of scalp
- Due to pressure
- Crosses the suture lines
- Presenting part

2. Cephalhematoma
- Subperiosteal hemorrhage with collection of
blood
- Due to rupture of capillaries as a result of
trauma
- Does not cross suture lines
6. Caf-au-lait spots
- Tan or light brown macules or patches
- No pathologic significance, if <3cm in length
and <6 in number
- If >3 or 6 = Cutaneous neurofribromatosis
Molding
Overlapping of skull bones
Due to compression during labor and delivery
Disappears in a few days

HEAD

Forceps Marks
U-shaped bruising usually on the cheeks after
forceps delivery

What to Assess:
For symmetry, shape, swelling, movement
- Soft, pliable, moves easily
Measure HC; HC = or > CC
Fontanelles soft spot
- Anterior fontanel closes between
months
- Posterior fontanel closes at 2 months

Craniotabes
Localized softening of the cranial bones
Can be indented by pressure of fingers
MOST common among 1st born babies,
pathological in older children (consider possibility
of metabolic dosorders)
Caused by pressure of the fetal skull against the
mothers pelvic bone in utero

9-18

Craniosynostosis
Premature closure of the fontanelles

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FACE, EYES, EARS, NOSE, MOUTH

What to Assess:
Facial movement and symmetry
Symmetry, size, shape, and spacing of eyes,
nose, and ears
Eyes
-

Ears
-

Color: white sclerae; slate gray, brown, or dark

blue; final eye color is acheieved after 6-12
months
Symmetrical
Pupils equally round, reactive to light and
accommodation (PERRLA)
(+) Blink reflex
(+) transient strabismus due to weak EOM,
maybe normal up to 4-5 months of life
Able to move and fixate momentarily
(+) red reflex; if (-), screen for congenital cataract
or retinoblastoma
(+) edema on eyelids related to pressure during
delivery or as effect of medications
(-) tear formation (begins at 2-3 months)
The child may be crossed eyes, normal, within 45 months
At this point in the lecture, Dr.Ng started
enumerating oddities that are physiologic for the
child:
o Anemia (as long as Hgb is not <9)
o Alopecia (usually at the area of the
External occipital protuberance)
o Anorexia (usually until 10 months)
o Hyperactivity (usually at 1 to 4 years old)
o Strabismus (4 to 5 months)

soft and pliable, with firm cartilage

Pinna should be at the level of outer canthus of
the eye
(+) low set ears : assess for renal or
chromosomal abnormalities (eg Trisomy 21)
May be congested and hear well after a few days
Accessory tragus : remnant of the 1st branchial
arch
Congenital preauricular sinus : ends blindly;
may be a risk for infection and therefore requires
closure via surgery

Mouth
Pink, moist gums
Intact soft and hard palates with (+) Epsteins
pearls
Uvula at midline
Tongue moves freely, symmetrical with short
frenulum
(+) extrusion and gag reflexes
(+) bronchial sounds
(+) breast engorgement : subsides after 2 weeks
(+) edema and prominence of nipples

(+) accessory nipples

(+) witch milk

ABDOMEN
Umbilical Cord
2 arteries and 1 vein [AVA]
2 vessels (1 artery and 1 vein only) : assess for
risk of congenital renal malformation or genetic
disorder eg Trisomy 18
Gradually falls of by the 7th to 10th days
Delayed sloughing : assess for infection, disorde
of granulocyte formation (rare)
DAILY CORD CARE:
o Keep cord dry and clean, clamped for
security
o Apply 70% isopropyl alcohol to the cord
with each diaper change and at least 2-3
times a day
o DO NOT cover with diaper
o Note for any signs of bleeding or
drainage from the cord and other
abnormalities
o Avoid use of Povidone Iodine (Betadine) :
due to the high risk of iodine absorption
via he stump, which may alter thyroid
homeostasis
o Children are abdominal breathers, that is
why putting a piece of fabric around their
abdomen may limit their capacity to
breathe
o Children learn to expectorate only at 6-7
years old, younger ages usually vomit
what is meant to be expectorated
Gastro Intestinal Tract
Capacity: 90mL; with rapid intestinal peristalsis (2
to 3 hours)
Bowel sounds (+) within 1-2 hours after birth
Assess for presence of masses, distention,
depression, or protrusion
Abdomen of children are usually globular
(+) scaphoid : Diaphragmatic Hernia
(+) Distention : LGIT obstruction and mass
Anus
-

check for patency (may use the thermometer to

assess patency while measuring temperature
initially)
First stool (Meconium) appears within the initial
24 hours
Meconium is sticky, blackish-green, odorless
material
IMPERFORATE ANUS
o VATER : Vetebral Anomalies; Anal
atresia; TEF; and radial, renal dysplasia
o VACTERL : same as VATER but with (+)
Cardiac and Limb abnormalities

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TRANSITIONAL STOOL
o Within 2 to 10 days antenatal
o Breastfed infants : golden yellow,
mushy, more frequent (TID/QID) and has
a sweet smell; watery like
o Bottle-fed infants : pale yellow, firm,
less frequent (BID/TID) and has a more
distinct odor

GENITALS
Female
Labia is edematous
Clitoris is enlarged
Pseudomenstruation is possible
Visible hymen tag
Initial voiding within 24 hours

o
o
o
o
o
o

(+) Ortolanis Click & uneven gluteal folds =

CONGENITAL HIP DYSPLASIA
- (+) inward turning of the foot = CLUB FOOT or
TALIPES EQUINOVARUS
- (+) extra digits = POLYDACTYLY
- (+) web fingers = SYNDACTYLY
- OSTEOGENESIS IMPERFECTA
Brittle Bone Disease
Autosomal recessive
Etiology: unknown
Multiple fractures and callus formation
Severe form: stillbirth or early death
If lived beyond infancy, prognosis is good but
potential to be handicapped

Male
-

Prepuce covers the glans penis

o (+) adherent foreskin : Phimosis
Scrotum is edematous
o Enlarged : hernia
Meatus is centrally located
o If Ventral / Dorsal : Hypo / Epispadias
Testes are fully descended
o Undescended : Cryptorchidism
AMBIGUOUS GENITALIA
- The assessment of ambiguous genitalia may be
summarized through the use of the following
parameters:
o U pelvic ultrasound
o G palpable gonads
o L electrolytes: if there is hyponatremia and
hyperkalemia, suspect CONGENITAL ADRENAL
HYPERPLASIA (CAH)
o Y chromosomal studies
o S steroid tests: urine CS & 17-KS: to rule out
CONGENITAL ADRENAL HYPERPLASIA (CAH)

Skin Creases over the Palms and Soles

Ambiguous Genitalia: Note that the clitoris is

enlarged (resembles glans) and the labia are
thickened (resemble scrotum)
Eliciting the ORTOLANIS SIGN
EXTREMITIES
- Flexed, full ROM, symmetrical
- Clenched fists; flat soles
- With 10 fingers and toes in each hand
- Legs bowed
- Even gluteal folds
- (+) Creases on soles of feet
o (-) Creases = PREMATURITY
- Check for hip fractures or dysplasia

CLUBFOOT/TALIPES EQUINOVARUS

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POLYDACTYLY (Above) and SYNDACTYLY (Below)

OSTEOGENESIS IMPERFECTA

Swallowing Reflex
Occurs spontaneously after sucking and
obtaining fluids
NEVER disappear
Newborn swallows in coordination with
sucking without gagging, coughing or
vomiting

Tonic Neck Reflex/Fencing Reflex

While the baby is falling asleep or sleeping,
gently and quickly turn the head to one side
As the baby faces the left side, the left arm
and leg extend outward while the right arm or
leg flex and vice-versa
Disappears within 3-4 mos

Palmar (Grasping)/Plantar Reflex

Place a finger in the palm of the babys hand,
then place a finger at the base of the toes
Fingers will curl or grasp the examiners
finger and the toes will curl downward
Palmar: fades within 3-4 mos
Plantar: fades within 8 mos

Moro Reflex
Hold baby in a semi sitting position then allow
the head and trunk to fall backward to at least
a 30-degree angle
Symmetrically abducts and extends the arms;
fans the fingers out and forms a C with the
thumb and the forefinger; and adducts the
arms to an embracing position & returns to a
relaxed state
Present at birth; complete response at 8
weeks
MOST significant singular reflex indicative of
CNS problem (>6 mos)
Disappears after 4-5 mos

NEUROLOGIC SYSTEM
REFLEXES
o Sucking/Rooting Reflex
Touch the lip, cheek or corner of the mouth
Turns head toward the nipple, opens mouth,
takes hold of the nipple and sucks
Disappears after 3-4 mos up to 1 year

Extrusion Reflex
Anything place on the anterior portion of the
tongue will be spit out
To prevent swallowing of inedible substances
Disappears after 4 months
Disappearance indicates readiness for semisolid to solid foods

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Startle Reflex
Best elicited if baby is 24 hrs old
Make a loud noise or claps hands
Babys arms adduct while elbows flex with
fists clenched
Disappears within 4 mos

Babinski Reflex
Gently stroke upward along the
lateral aspect of the sole, starting
at the heel of the foot to the ball
of the foot
Dorsiflexion of big toe and
fanning of little toes
Disappears starts a 3 mos to 1
year
Disappearance indicates maturity
of CNS

Stepping/Walking/Dancing Reflex
Hold baby in a standing position
allowing one foot to touch a
surface
Simulates walking by alternately
flexing and extending feet
Disappears after 3-4 mos

Other Nursing Responsibilities:

Identification band
Band registration
Birth record and documentation
NEWBORN SCREENING
The Newborn Screening Reference Center
(NSRC) is an office under the National Institutes
of Health (NIH), University of the Philippines
Manila created under RA 9288 The Newborn
Screening Act of 2004
Performed after 24 hours of life up to 3 days
except for patient in intensive care, must be
tested by 7 days.
o Congenital Hypothyroidism (CH)
o Congenital Adrenal Hyperplasia (CAH)
o Galactosemia (GAL)
o Phenylketonuria
o Glucose-6-Phosphate-Dehydrogenase
Deficiency (G6PD Def)
o Maple Syrup Urine Disease (MSUD)

Infant Care Skills

HOLDING THE BABY
1. Football Hold
2. Cradle Hold
3. Shoulder Hold
Football Hold
Purpose: to carry on one hand free
A holding technique in bathing a baby
Use for small babies
Procedure:
1. Slide forearm under his back
2. Support neck and head with your hand

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3. Press his arm firmly against your side

4. His head faces you
5. Infants feed tucked under your elbow

Hb E/Beta + Thalassemia
Hb H Disease
Hb H/Constant Spring Disease
Hb Variant/Beta + Thalassemia
Homozygous EE
Sickle Cell Disease (Hb S/C Disease)
Sickle Cell Anemia (Hb S/S Disease)

B. Amino Acid Disorders

Phenylketonuria (PKU)
Variant Hyperphenylalaninemia
Maple Svrup Urine Disease (MSUD)
Cradle Hold
Purpose: used for feeding and cuddling a baby
Procedure:
1. Support head in crook of your arm
2. Encircle the body with your arm
3. Press baby firmly against your side
4. Use other hand to support bottom and
thigh

Shoulder Hold
Purpose: used for burping
Procedure:
1. Draw baby towards your chest with one
forearm
2. Bracing his back and your hand cradling
his head
3. Support your babys bottom and thighs
with your other arm
4. Gently press his head against your
shoulder

C. Organic Acid Disorders

Methylmalonic Acidemia MMA - (Mut0)
Methylmalonic Acidemia MMA - (Mut-)
Beta-Ketothiolase Deficiency (BKT)
Isobutyryl-Coa
Dehydrogenase
Deficiency
(IBDHD)
D. Fatty Acid Oxidation Disorders
Medium
Chain
acyl-Coa
Dehydrogenase
Deficiencv (MCAD Deficiency)
Short Chain acyl-Coa Dehvdrogenase Deficiency
(SCAD Deficiency)
Very Long Chain acyl-Coa Dehydrogenase
Deficiency (VLCAD Deficiency)
Other Fatty Acid Oxidation Disorders
E. Cystic Fibrosis and Related Disorders
Partial BD Deficiency
CFTR-Related Metabolic Syndrome (CRMS)
Cystic Fibrosis
Classical Galactosemia
Duarte Galactosemia (D/G)
Other Disorders

ADDITIONAL INFORMATION
In an article published in the ACTA MEDICA PHILIPPINA
in 2012 authored by UP-Manila Chancellor Carmencita D.
Padilla entitled Enhancing Case Detection of Selected
Inherited Disorders through Expanded Newborn
Screening in the Philippines, the following disorders
were proposed to be added:
A. Hemoglobinopathies
Alpha-Thalassemia Major
Beta-Thalassemia Major

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APPENDIX

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