Expected and Abnormal Findings in Newborns

Introduction

• Presenter: Meris from Level Up RN
• Topic: Expected and abnormal findings in newborns following birth
• Materials: Maternity flashcards from Level Up RN (available at their website)

Newborn Skin Findings

Expected Findings

• Pink color or Acrocyanosis:
  • Trunk is pink, extremities may be bluish
  • Normal as newborn adjusts to extra-uterine life
• Vernix:
  • Thick, creamy, white substance on infant's skin
  • Found in creases (armpits, neck) of full-term babies
• Lanugo:
  • Fine downy hair for warmth
  • Present on sides of face, upper back, shoulders

Abnormal Findings

• Jaundice in First 24 Hours:
  • Always abnormal
  • Bold and emphasized in teaching materials
• Green/Brown Skin Discoloration:
  • Indicates meconium passed inside uterus
  • Suggests fetal distress

Normal Skin Variations

• Telangiectatic Nevi (Stork Bites):
  • Pink discoloration on eyelids, between eyes, neck, head
  • Disappears in 18 months
• Milia:
  • White cysts on face
  • Disappear in weeks
• Mongolian Spots (Congenital Dermal Melanocytosis):
  • Blue/purple pigmentation on back/buttocks
  • Common in darker skin infants
  • Not harmful but should be documented
• Nevus Flammeus (Port-Wine Stain):
  • Red/purple discoloration, usually on face/neck
  • Permanent
• Erythema Toxicum:
  • Transient papular rash
  • Disappears in weeks

Head Findings

Expected Findings

• Fontanels:
  • Presence of anterior (diamond-shaped) and posterior (triangular) fontanels
  • Should be soft, flat, open, and symmetric
• Round Head Shape:
  • Result of passing through birth canal

Normal Variations

• Molding:
  • Elongated head shape due to birth canal passage
• Caput Succedaneum:
  • Soft tissue swelling crossing suture line
  • Resolves in 3 days
• Cephalohematoma:
  • Blood collection not crossing suture line
  • Lasts several months

Physical Assessment

Face, Neck, Clavicle

• Face:
  • Intact blink reflex
  • Ears aligned with outer canthi of eyes
• Mouth:
  • Pink, moist membranes
  • Epstein pearls (white cysts) on gums/palate
• Neck and Clavicles:
  • Full range of motion, no crepitus
  • Check clavicles for fractures

Umbilical Cord

• Structure:
  • 2 arteries, 1 vein (mnemonic: baby Ava - A-V-A)
• Pathology:
  • May be sent to pathology for further investigation

Hips

• Symmetry:
  • Equal leg length, symmetrical gluteal/thigh creases
• Tests:
  • Ortolani and Barlow maneuvers to check for hip dysplasia
  • Negative results are normal findings

Conclusion

• Encouragement to engage with video content and reflect on quiz questions:

  • Jaundice assessment in the first 24 hours
  • Identification of Mongolian spots
  • Identifying and understanding a cephalohematoma
  • Correct number of arteries and veins in umbilical cord

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