Newborn Exam: Questions and Cases

Contents

By: Connie Kostacos, MD

Objectives:

 

  1. Review the pertinent historical questions that should be asked /pursued for the newborn encounter
  2. Describe the important elements of the newborn physical exam
  3. Highlight some frequently asked questions in the newborn period
  4. Recognize the warning signs of postpartum depression

Case 1

A new mother and her 5 day old infant present to your office for the infant’s first visit.  You congratulate the mother and start the visit by asking her about her pregnancy and if she had prenatal care.  She tells you that she was followed at the Allen pavilion so you ask her if it is OK that you review her record.  She agrees and even has her MR number available.  As you punch in the MR number, there is a knock at the door and it is your 3rd year medical student for the first day of his ambulatory rotation.  You invite him in and ask him to observe for the time being.  When you are finished you have some time to review the case.  The medical student seems perplexed when he reads your note.  He wonders why there are so many questions about the mother, her pregnancy, and the immediate neonatal period, when the infant looks perfectly healthy at this time.  How do you explain?

Case 2

It is the first day of continuity clinic for your intern.  Her first patient is a one week old.  She tells you that she is very comfortable with eliciting a complete history, however, although she has examined older infants and children as a medical student, she has no experience with the newborn exam.  She asks you to highlight the important aspects of the newborn exam.  What do you tell her?

 

Case 3

A first time mother comes to your office with her 2 week old.  She is energetic and enthusiastic about being a new mother.  She tells you that things have been going well, however, she has generated a list of questions that she would like you to address:

  1. I am worried that my baby has a problem with her nerves. 
    1. She is making all of these jerking movements particularly when she sleeps.  Could these be seizures?
    2. Sometimes, especially when she’s been crying, her chin quivers.
       
  2. My baby has little white bumps all over her nose and chin, and what look like pimples on her cheeks.  What can I use on her face to help them go away? 
  3. My baby has a blister on the center of her lip.  Should I pop it?
  4. When my baby spit up some breast milk, I noticed some blood in it.  Could she be allergic to my milk?
  5. When my baby was crying I noticed a white bump on her gums.  Could she be teething this early?
  6. My baby’s stool initially was yellow and now it is more green.  Could she have a GI infection?
  7. My baby cries but has no tears.  Could she be dehydrated?
  8. My baby has white discharge from her eyes since 1 week of age.  I was given antibiotic ointment by a PMD but the eyes are not better.   What can I do?
  9. My baby has a red spot over her eyelid and just above the bridge of her nose.  It seems to get worse when he cries.  Will this go away?
  10.  When we left the nursery we were told to put the baby on her back to sleep. My mother-in-law said this was dangerous because if the baby vomits, she may choke.  She told me to put the baby on her side or her stomach to sleep.  What do you recommend?
  11. My baby hiccups often.  Is this dangerous?
  12. My baby has swollen breasts.  Is this normal?
  13. My baby girl has a bloody discharge in her diaper.  Should I be worried?
  14. My baby is always straining to go to the bathroom.  What can I give her for the constipation?
  15. I noticed that the baby’s diaper is stained an orange color.  What can this be?
  16. My baby sneezes a lot.  I think she has a cold.  Can I give her Pediacare?
  17. My baby’s belly button sticks out a lot when she cries.  I’m worried that she’s in pain.  My mother-in-law told me to bind it with a baby girdle.  Will this help?
  18. I would like to pierce my baby’s ears.  When is the earliest I can do so?
  19. I want to take my baby to the DR to meet the rest of the family.  When is she old enough to travel on a plane?
  20. My baby has beautiful blue eyes but my husband and I both have brown eyes.  What is the chance that her eyes will remain blue?
  21. My baby doesn’t have an appointment for another few weeks.  Are there any reasons that I should call you prior to our next visit?

Case 4

Your next patient is a 1 week old male born to a primiparous 20 year old mother.  Mom comes into your room alone and the infant is crying in the stroller.  She does not make any attempts to console the baby.  She looks tired and a bit overwhelmed.  You pick up the baby and sooth him easily.  Your initial impression is that the mother may be at risk for post partum depression.  How do you proceed? How common is post partum depression? How do you distinguish between postpartum blues and depression?

What are the risk factors for post partum depression?