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Initial examination of the newborn. Newborn patronage: caring for mother and child

The purpose of the examination of a newborn is to detect any pathology or to identify any "medical problems", as well as to remove certain questions from the mother and difficulties that she has encountered when communicating with her child. Finally, the purpose of the check-up is to give the mother routine advice on caring for the child before he is discharged from the hospital. In the case of a home birth, advice is given on raising a newborn during the first week of life.

Before examining a newborn, check the weight of the newborn. Find out if the pregnancy and childbirth were normal? What is the mother's Rh factor? Choose a quiet, warm and bright room for the examination, and enlist the help of the baby's mother. Explain to her the purpose of your examination. Notice if she looks angry or depressed? If she says something, listen carefully to her. Examine the child in a specific system, for example, from head to toe.

Head. You should measure the circumference of the head and pay attention to its shape (various deformations associated with childbirth usually pass soon), the condition of the fontanelles (they strain when the baby cries, as well as with an increase in intracranial pressure). Eyes: note if there is corneal opacity or conjunctivitis? Ears: pay attention to the shape and position of the auricles. Are they very low (i.e. below the eyes)? Nose: it serves as a kind of indicator of jaundice. Breathing out through the nose with the mouth closed is a test for the presence of choanal atresia. Color of the skin: with pathology, it can be cyanotic, pale, icteric, red. Oral cavity: insert your finger into the child's mouth and ask if the integrity of the soft and hard palate is preserved? Is the sucking reflex sufficiently pronounced?

Hands and hands. Selected palmar folds- lines, can be a manifestation of the norm or Down's disease. If the child's hand is in position "A waiter waiting for a tip" remember about Erb's palsy in case of damage to the trunks C 5 -C 6.

Rib cage. Observe breathing movements chest. If you notice "grunting" when breathing or displacement of the intercostal spaces, then this may indicate the presence of respiratory distress. Palpate the cardiac and apical tremors in the atrial region. Have auscultation heart and lungs. Inspect the entire spine to detect possible defects in the spinal canal (neural tube).

Stomach. Wait a bit with palpation of the liver and spleen. Pay attention if there are any pathological masses in the abdominal cavity? Now carefully examine the navel. Is he healthy? Tuck the skin on your belly into a fold to assess skin turgor. Examine the genitals and anus. Are the openings of the urethra and anus clearly visible? 93% of newborns have spontaneous urine flow in the first 24 hours. Is there an incorrect position of the opening of the urethra (hypospadias), are both testicles descended? The clitoris in newborns looks rather large. A slight bleeding from the vagina can be considered a variant of the norm, this is due to the cessation of the flow of estrogens from the mother into the child's body.

Lower limbs. Tests to detect congenital dislocation of the hip joint. Avoid reapplying these tests, as it is painful and, moreover, in itself can summon dislocation. Pay attention if not femororadial pulse lag, this may indicate the presence of coarctation of the aorta. Is there a persistent deformation of the foot)? Now assess the state toes- are they too many, too few, too cyanotic?

The gluteal region and sacrum. Are there “Mongolian spots” on the skin (they are bluish)? Fortunately, they are safe.

CNS testing. First of all, hold the baby in your arms. And now only intuition can tell you whether the child is sick or healthy? Is he prone to flinching (this may indicate hypoglycemia, hypocalcemia, infection)? Already at this stage of development, the child should have some control over the position of the head. Are the limbs moving normally, muscle tone - spastic or sluggish? The study of the Moro reflex is rarely informative and, moreover, it is unpleasant for the child. This reflex is investigated as follows: the child is seated at an angle of 45 °, supporting his head. At the moment of his deprivation of this support, both of his hands make an abduction, palms open, and then the hands are brought. To induce the grasping reflex, lightly hit the child on the palm.

It is important to find out if the birth was late or premature, or happened on time?

Discuss any abnormality you find with the child's mother and father.

The examination of the newborn in the delivery room is carried out by a pediatrician-neonatologist, who, together with obstetricians-gynecologists, is present at childbirth. The midwife (doctor) prepares for childbirth, as for a surgical operation, washes her hands with a disinfectant solution, puts on a sterile gown, gloves, and a mask. Currently, most maternity hospitals use a sterile disposable kit when giving birth, which is preferred.

Umbilical cord processing

The newborn is taken in sterile, warmed diapers. The dressing and processing of the umbilical cord is carried out in two stages. During the first 15 seconds after birth, two sterile clamps are placed on the umbilical cord for a child who has not cried out: the first one is at a distance of 10 cm from the umbilical ring, and the second is 2 cm outward from it. Then the section of the umbilical cord located between the two clamps is treated with a 5% alcohol solution of iodine or 96% ethyl alcohol and crossed.If the child cried out in the first seconds of life, then it is better to put clamps on the umbilical cord about 1 minute after birth ...

At the second stage, the remainder of the umbilical cord is wiped with alcohol soaked, and then with sterile dry gauze wipes and squeezed tightly with the index and thumb. Then put on this place at a distance of 0.2-0.3 cm from the umbilical ring using sterile forceps, a metal or plastic Rogozin brace (this is done by a midwife). Newborns from Rh-negative mothers, especially if the mother had a high level of antibodies before giving birth and the threat of developing hemolytic disease of the newborn, instead of the Rogovin staple, a sterile silk ligature (thread) is applied to the remainder of the umbilical cord 2-3 cm long, since they may need replacement blood transfusion ... At a distance of 1.5 cm from the place of application of the staple or ligature, the umbilical cord is dissected with sterile scissors. The cut surface is treated with a 5% alcohol solution of iodine, or a 5% solution of potassium permanganate, or a 0.5% solution of chlorhexidine.

After the described treatment, a sterile gauze bandage is applied to the remainder of the umbilical cord.

Necessary procedures

A sterile individual kit is used for the initial treatment of the newborn. The treatment of the baby's skin is carried out with a sterile cotton swab moistened with sterile vegetable or vaseline oil from an individual single-use bottle. Considering that the child's parents may have a latent form of gonorrhea, which is asymptomatic and with negative laboratory diagnostics (this disease can lead to gonorrheal eye infection in a newborn), gonoblenorrhea is prevented immediately after birth. For this purpose, a 20% solution of sodium sulfacil (ALBUCID) is instilled into the child's eyes. The solution is instilled in 1 drop alternately on each pulled lower eyelid, Then the eyelids are closed and both eyes are gently rubbed. Re-instill in the conjunctival sac of both eyes 1 drop of a 20% solution of albucid 2 hours after birth - already in the neonatal department. For girls in the delivery room, 1-2 drops of a 1-2% solution of silver nitrate are instilled into the genital crevice.

Immediately after birth, the neonatologist should warm the newborn by placing it on a table with radiant warmth, and give his head the correct position: the baby lies on his back, his head tilted back and slightly to the side (sneezing position). The baby's upper respiratory tract is freed from mucus and remaining amniotic fluid. Then the child must be dried, stimulating his breathing. All these activities are carried out by the neonatologist in the first minute after the birth of the baby.

First "estimate"

In the first 30 seconds of a child's life, a neonatologist assesses his condition. If the baby is not breathing (apnea) or the heart rate is less than 100 beats per minute, the neonatologist helps the baby breathe with an oxygen bag or mask. The main goal of these activities is to deliver enough oxygen to the lungs, help the baby breathe and expand the lungs.

The baby inhales air to obtain oxygen using his own lungs. His first cry and deep breath are powerful enough to remove fluid from the airways. As soon as the required amount of oxygen enters the bloodstream, the baby's skin, which has a gray-blue tint, turns pink.

After attempts to inhale, the child experiences primary apnea (stopping breathing), during which stimulation such as wiping dry or patting on the feet can lead to breathing recovery. However, if the lack of oxygen persists, the child will make several attempts to get air, and then enter a state of secondary apnea, when stimulation can no longer force the child to breathe. In this case, assisted ventilation of the lungs may be required, which is carried out by a neonatologist in the delivery room.

When the child screamed and began to breathe effectively, the pediatrician-neonatologist assesses the baby's condition on the Apgar scale. This scale was developed and proposed in 1952 by Virginia Apgar, who assessed five main features in points (heart rate, respiration, muscle tone, reflex irritability to the catheter in the nostrils and skin color).

Apgar scores quantify and summarize the newborn infant's response to the ectopic environment and resuscitation. Each of the five characteristics is assigned a value of 0, 1 or 2. Then the five values ​​are summed up, and this result is an Apgar score.

Apgar scale

Sign

Points total

Heart rate

absent

Less than 100 strokes / min

More than 100 strokes / min

Breath

absent

Irregular

effective, shout

Muscle tone

weak

some flexion

active movements

Reflex irritability (nostril catheter, tactile stimulation)

no reaction

grimace

coughing, sneezing, screaming

Skin color

blue or pale

pink body, blue limbs

completely pink

Apgar scores should be determined at the 1st and 5th minutes after birth. The higher the score, the better. If the amount in the 5th minute is less than 7, additional measurements should be taken every 5 minutes for the next 20 minutes. Long-term work experience shows that in prematurely born children, the sum of points on the Apgar scale 1 minute after birth determines the severity of asphyxia (this is the name for a lack of oxygen as a result of respiratory disorders) and allows you to choose the most adequate complex of resuscitation measures directly at the birth of a child.

The results of the assessment on the Apgar scale are recorded in birth history.

At the "appointment" with the doctor

After assessing the Apgar scale, the midwife weighs the newborn, measures the head circumference, chest circumference, which are also recorded in the birth history.

After the necessary measurements have been taken, the pediatrician-neonatologist proceeds to the direct examination of the newborn.

Normally, the child breathes rhythmically, makes automatic movements of the limbs in a sufficient volume and symmetrically.

In a full-term newborn, the head is 1/4 of the body. Its large size is associated with the prevailing development of the brain. Determining the shape of the head and the circumference of the skull at birth is important. During the first 2-3 days of life, the child retains the configuration of the skull, due to the passage of the head through the birth canal. The variants of the norm include such forms of the skull as an anteroposteriorly elongated (dolichocephalic), transversely elongated (brachycephalic), turret skull. The bones of the skull are somewhat elastic, they are observed to be on top of each other along the seams. The parietal bones can be found on the occipital or frontal.

The circumference of the skull in full-term babies is 33-36 cm and can exceed the circumference of the chest by 1-2 cm. The anterior (large) fontanelle is open, its size (the distance from the sides of the rhombus formed by the bones) normally does not exceed 2.5-3 cm. Size posterior (small) fontanel - no more than 0.5 cm.

A birth tumor is typical for most newborns. This is swelling of the soft tissues of the head with a cephalic presentation; the skin over the tumor is often cyanotic, with many small hemorrhages or large bruises. A birth tumor can be the cause of prolonged jaundice of a newborn: blood from the hematoma area dissolves, while bilirubin is formed, which causes longer jaundice. A birth tumor does not require treatment and goes away on its own in 1-2 days.

Cephalohematoma - hemorrhage under the periosteum of any bone of the cranial vault; can appear clearly only a few hours after childbirth, observed in 0.4-2.5% of newborns. The tumor initially has an elastic consistency, never passes to the adjacent bone, does not pulsate, is painless, with careful palpation, fluctuation (softening) and, as it were, a roller along the periphery of the hematoma are found. The surface of the skin over the cephalohematoma is not changed, although sometimes there are bruises (petechiae). In the first days of life, cephalohematoma may increase, jaundice is often observed due to increased extravascular production of bilirubin (a breakdown product of hemoglobin). At the 2-3rd week of life, the size of the cephalohematoma decreases, and complete resorption occurs at the 6-8th week.

At the initial examination, the pediatrician determines minor developmental anomalies (stigma of dysembryogenesis). If a child has 5 or more developmental anomalies, then a deeper examination is needed for genetic pathology and the identification of malformations of internal organs. The main stigmas are presented in the table.

A full-term newborn has a fairly well developed subcutaneous fat layer, the skin is pink, velvety, covered with vellus hair, mainly in the shoulder girdle. The areola of the mammary gland is well developed (1 cm or more in diameter). The striation of the sole occupies 2/3 of its surface. The cartilage of the auricles is elastic, the nails are dense.

The umbilical ring is located in the middle of the distance between the bosom and the xiphoid process, in boys the testicles are lowered into the scrotum, in girls the labia majora are covered by the small ones.

The cry of the child is loud. Muscle tone and physiological reflexes of a full-term newborn are well expressed, the child takes a flexor position (fetal position, or flexion position).

The sucking function in a full-term baby is well developed, and if there are no contraindications, then in the first 30 minutes after birth, the baby is applied to the breast.

In the absence of visible malformations and an overall satisfactory condition, the newborn during the first 2 hours of life is in the postpartum ward, where it is monitored by a pediatrician-neonatologist, and then, together with the mother, is transferred to the postpartum department of joint stay.

In the case of a normal delivery, the postpartum examination and examination are predominantly indicative, i.e. are reduced to determining the sex of the child, assessing his basic vital functions according to the Apgar scale, or establishing a diagnosis of serious anomalies that can be detected only by examination. If, due to the condition of the newborn, there is no need to take special measures, for example, emergency therapy or accelerated transfer to another department, then the pediatrician completes the postnatal examination of the newborn by assessing the condition and indicating in which department the further care will be carried out.

The main parameters of the physical development of the newborn

The term of pregnancy at which the birth took place, week

Body weight, g

Body length, cm

Circle

Heads, cm

Chest circumference, cm

Minor developmental anomalies

Location

The nature of the anomaly

The shape of the skull is small (microcephalic), large (hydrocephalic), the skull is elongated in the anteroposterior direction (dolichocephalic), in the transverse direction (brachycephalic), tower. Low forehead, pronounced superciliary arches, overhanging or flattened occiput.

Straight line of sloping forehead and nose. Mongoloid eye section. Saddle nose, flattened nasal bridge, crooked nose. Facial asymmetry. Increased or decreased distance between the inner edges of the eye sockets (hypo- and hypertelorism). Macrognathia or micrognathia (large or small sizes of the upper jaw), split chin, wedge-shaped chin.

Low standing of the eyelids, asymmetry of the palpebral fissures, absence of the lacrimal meatus (third eyelid), double growth of eyelashes (distichiasis), irregular shape of the pupils.

Large protruding, small deformed, different sizes, located at different levels, located low; anomaly in the development of the curl and counter-coil, an increase in the earlobe.

Small mouth (microstomy), large mouth (macrostomy), fish mouth, short frenum of the tongue, folded or forked tongue.

Short, long, torticollis, with pterygoid folds, excess folds.

Torso

Long, short, depressed breast, chicken, barrel-shaped, asymmetrical, large distance between the nipples. Accessory nipples, low navel, hernias.

Shortening of the fingers (brachydactyly), unusually long and thin fingers (arachnodactyly), complete or partial fusion of adjacent fingers or toes (syndactyly), transverse groove of the palm, short curved fifth toe, curvature of all fingers.

Brachydactyly, arachnodactyly, syndactyly, sandal fissure, flat foot, finding fingers on top of each other.

Genitals

Underdevelopment or absence of testicles in the scrotum (cryptorchidism), phimosis (infringement or fusion of the foreskin), underdevelopment of the penis, underdevelopment of the labia, enlargement of the clitoris.

Depigmented and hyperpigmented spots, large birth spots with hair growth, excessive local hair growth, hemangiomas, areas of lack of skin (aplasia) of the scalp.

In this article:

From the first moments of life, a newborn is faced with many medical procedures. Even a healthy baby is not spared this fate - from birth he is constantly monitored, body parameters are measured, and the development of organs and systems is studied. Doctors at the age of 1 month of a child's life try to identify all pathologies in the child's body: congenital malformations and beginning diseases. Many problems diagnosed early are easier to treat.

Having left the walls of the hospital, the newborn comes under the close attention of a pediatrician and a local nurse at home. The first examination of the child at 1 month will take place in the children's clinic. The pediatrician will not only examine the little patient, but will also tell the young parents what kind of doctors a newborn needs to undergo at 1 month.

Medical examination of a newborn in the first month of life

The first visit to the newborn by the doctor takes place the day after discharge from the hospital. The pediatrician will come without a special call: the medical staff of the maternity hospital will inform the clinic about the arrival of the newborn at the place of residence. In the first month of life, the specialist will come to the baby once a week. If the child's condition raises any concerns (for example, the baby has a cold or is not breastfeeding well), visits will be more frequent. The district nurse will also visit the newborn - also up to 4 times during the month.

For the arrival of the pediatrician, you need to prepare in advance, write down all the questions that interest the young mother at the moment, so as not to forget anything. The doctor should be comfortable examining the child. As a rule, during the examination, the baby should be completely undressed, since the specialist needs to assess the condition of his skin and mucous membranes, heart rate and respiration, muscle tone and reflexes.

During the visit, the doctor advises the young mother on nutrition and baby care. Later, the specialist will invite the parents with the baby to the clinic for a routine examination of the baby at 1 month.

The first examination by a pediatrician in a polyclinic is the most interesting for young parents. During it, the doctor will not only examine the baby, but also carry out a control measurement and weighing the baby. Most often, in the first month of life, babies gain 500-700 grams and add 2-3 cm in length. After the examination, the district nurse writes out referrals for consultations of narrow specialists, analyzes and additional examinations, as well as in the vaccination room.

Which doctors do you need to undergo?

The list of doctors who need to go through a newborn at 1 month is not small.

Neuropathologist

The main task of a neuropathologist is to monitor the neuropsychic and mental development of the child, as well as to control his motor activity. At 1 month old, a neurologist checks the presence of congenital reflexes and their gradual fading in a child. An increased or, on the contrary, decreased muscle tone may be found in a baby, which will become the basis for prescribing a baby massage.

If in doubt, the doctor will prescribe a referral for an ultrasound of the brain. You need to undergo an examination immediately, while the child's fontanelle remains open. In the future, the doctor will assess the development of new skills by the baby, for example: the ability to smile, roll over, sit, climb on all fours and much more.

Oculist

For the first time, an ophthalmologist will examine a newborn in the maternity hospital for congenital eye pathologies. A routine examination of the child at 1 month will allow the specialist to examine the fundus of the baby, the condition of his lacrimal glands and assess the tendency to squint and other visual impairments. The doctor will check if the baby can focus his gaze on a particular object. During the examination, the eyelid and obstruction of the lacrimal ducts are most often diagnosed.

Often the diagnosis of a neurologist depends on the diagnosis of an ophthalmologist - in recent years, many children in the first year of life have certain problems with the vessels of the brain and fundus.

ENT

A medical examination of a child at 1 month necessarily includes a visit to an otolaryngologist. A child at this age will have to undergo otoacoustic testing for the first time. It does not hurt at all and is safe for the baby. The specialist will use a special device to check the child's hearing, as well as examine the tonsils and nasal passages.

During the examination, the ENT doctor may reveal the following problems in the baby:

  • hearing impairment, complete absence of any reaction to sound stimuli;
  • sulfur plugs;
  • difficulty or absence of nasal breathing;
  • ear pain, otitis media;
  • foreign bodies in the ENT organs.

Also, a specialist can advise a young mother about why her child is bad or refuses to suck from a bottle: this may be due to ear pain. If everything is in order, then the next examination at the ENT doctor is not waiting for the baby soon - at 12 months.

Surgeon

The surgeon assesses the child's reflex development, the presence of muscle hypo- or hypertonicity, diagnoses umbilical and inguinal hernias. In male infants, the external genital organs are carefully examined to exclude pathological conditions such as cryptorchidism, dropsy, and non-prolapse of the testicles into the scrotum, hypospadias.

Also, the surgeon can note deviations in the structure of the newborn's body. Most often, anomalies such as lymphangioma, vascular and internal organ damage are detected. If necessary, the specialist gives a referral for a massage for children or explains how to work with a child at home, which muscle groups it is important to pay attention to.

Orthopedist

An orthopedist examines a 1-month-old child in a polyclinic, assessing the development of his musculoskeletal system. A doctor may detect conditions such as clubfoot, congenital dislocation of the hip joint, dysplasia, or underdevelopment of the hip joints. Dysplasia needs to be identified as early as possible, until the baby has learned to stand up. To exclude this diagnosis, almost all children are prescribed an additional ultrasound of the hip joints.

During the examination, the orthopedist will carefully examine the newborn, actively bending and pushing his legs to the sides and performing other manipulations. The kid may not like this approach, but this is important, since the doctor can detect a variety of pathologies of the development of the musculoskeletal system. For example, torticollis, in which the child can only turn the head in one direction. Also, the specialist will give recommendations on home gymnastics and the treatment of dysplasia, which must be followed.

Vaccination room

If the newborn in the hospital received all the necessary vaccinations, then at 1 month you need to do another one - from hepatitis. The vaccine is injected into a large muscle of the baby - the buttock or lower leg. Before visiting the vaccination office, it is imperative to show the child to the local doctor. The pediatrician will assess the readiness of the body for vaccination, exclude the presence of infections. Vaccination can be carried out only under the condition of absolute health of the newborn.

Additional examinations

Tests for a newborn at 1 month must be taken. As a rule, this is a complete blood and urine test. To carry out tests for a newborn at 1 month, you need to collect any portion of urine, preferably the first morning.

Unfortunately, this is not always possible with such young children, as newborns urinate more often than adults. Therefore, it's okay that a portion of urine for testing in newborns at 1 month will not be the first, no. The most important thing is to wash your baby well before collecting urine. For convenience, you can use a special urine collection bag. Blood for analysis of a newborn 1 month old can also be taken at any time, regardless of the meal.

As an additional examination of a newborn at 1 month, the doctor prescribes an ECG (electrocardiogram), the purpose of which is to diagnose diseases of the heart and blood vessels, in particular, to exclude heart disease, cardiopathy and much more.

Screening a baby at 1 month includes an ultrasound examination of the brain and hip joints.

It is prescribed for all children who have reached 1 month to detect abnormalities in the work of the nervous system. The first ultrasound examination is mandatory, in the future they can be prescribed by a neurologist at his own discretion.

Ultrasound of the brain is most relevant in patients after complicated pregnancy and childbirth, with low results in terms of neuropsychic and physical developmental delays, with hypo- or hypertonicity of the muscular system.

Ultrasound examination of the hip joints is also mandatory for all newborns. The study helps to timely diagnose congenital hip dislocation and hip dysplasia. Treatment of these pathological conditions is effective only in the first year of life, while the baby has not yet begun to get up and walk on his own.

Of course, the observation of a newborn in the first month of life and his first visit to the clinic to a pediatrician and narrow specialists is a very important moment in the life of the baby and his parents. The latter can once again make sure that their child grows and develops according to age.

If any deviations are revealed, there is no need to panic and sound the alarm. Most pathological conditions are successfully treated in the first year of life, the main thing is not to delay the prescribed treatment and follow all the doctor's recommendations.

Useful video about the examination of a baby by a pediatrician

Clinical examination of a newborn - carried out at a temperature in the ward of at least 22 ° C, not earlier than 30 minutes after feeding in natural light. They inspect it on a heated changing table or in an incubator. The doctor's hands should be warm, otherwise, the contact will be broken, which will complicate the examination process.

External examination of the newborn For healthy full-term newborn characterized by a calm facial expression, a kind of lively facial expressions, a loud emotional cry. Excessive movements, uncoordinated, often athetic-like. Characterized by a physiological increase in the tone of the flexor muscles, which determines the posture of the child (flexion posture, embryonic posture): the head is slightly brought to the chest, the arms are bent at the elbow joints and pressed against the lateral surface of the chest, the hands are clenched into fists, the legs are bent at the knee and hip joints ...

The facial expression and posture of a healthy newborn on examination depend on the position of the fetus during labor. With extensor insertions (frontal, facial), the face is edematous, abundant petechiae and poor facial expressions are possible. The head is usually thrown back. With a breech presentation, the legs can be sharply bent at the hip joints and extended at the knee. Facial expression: dissatisfied, "painful" - noted in many diseases of newborns, "frightened" look - with subarachnoid hemorrhages, hypomimic occurs in children with subdural hematomas and encephalopathy.

Scream the child is assessed both in strength and in duration and modulation. A weak cry can be noted in a deeply premature child, aphonia is a consequence of tracheal intubation or CNS damage - subdural hematoma, hemorrhages in the cerebral ventricles, as well as severe somatic diseases. An irritated ("cerebral") cry accompanies subarachnoid hemorrhages, increased intracranial pressure. With congenital hydrocephalus, the cry becomes monotonous.
Motor activity in newborns is weakened with lesions of the central nervous system and somatic diseases and increased (hyperexcitability).
On external examination, such signs of increased neuro-reflex excitability can be noted: small-sweeping tremor of the hands and lower jaw with anxiety of the child and large-sweeping tremor - it happens with bilirubin encelopathy.
Spontaneous Moro reflex, spontaneous flinching, spontaneous and induced clonus of the feet, convulsions (with intracranial birth trauma, severe cerebral hypoxia, intrauterine infection, toxic damage to the brain nuclei by free bilirubin, metabolic disorders, hereditary metabolic disorders, etc.).

Muscle tone in sick newborns, it is more often weakened. A sharp decrease or absence of muscle tone is one of the diagnostic criteria for fetal damage during childbirth. On examination, a weakening of tone may also be due to prematurity or immaturity. In term infants, low muscle tone indicates severe hypoxia, subdural hemorrhage, acute adrenal insufficiency, and may accompany hypoklycemia and acidosis, hereditary diseases (Down's disease, etc.) An increase in muscle tone is possible with subarachnoid hemorrhage, purulent meningitis, bilirubal encephalopathy. Muscle tone is assessed by the results of the traction test and by the ability to keep the body in a horizontal position face down above the surface of the diaper (on the palm of the subject), as well as by the symptom of "flaccid shoulders". Examined newborn give an upright position, supporting it by the axillary areas. If the child's head "goes into the shoulders" - this is an indicator of ischemia in certain areas of the brain.
Changes in muscle tone underlie the occurrence of such pathological postures:

Frog pose- the arms lie sluggishly along the body, the legs are on the surface of the diaper, widely divorced at the hip and slightly bent at the knee joints. This posture is physiological for very premature babies. In full-term, it indicates a sharp decrease in muscle tone. It happens with intracranial hemorrhage, acute adrenal insufficiency;
Opistonus- the head is thrown back due to the stiffness of the occipital muscles, the arms are extended along the body, the hands are clenched into fists, the legs are extended at the knee joints and crossed at the level of the lower third of the shins. This pose is associated with a sharp increase in muscle tone - extensors. Typical for purulent meningitis, subarachnoid hemorrhage, bilirubin encephalopathy.
Fencer Pose- the head is turned to the shoulder, the arm and leg of the same name are in an extension position, and the arm is set aside. The other arm is abducted at the shoulder and bent at the elbow. And the leg is somewhat abducted at the hip and bent at the knee joint; the head is slightly thrown back, the legs are sharply bent at the knee and hip joints and are tightly brought to the stomach. This posture occurs with purulent meningitis;

asymmetric postures by hemitype- the arm and leg of one side of the body are in a physiological position, on the other side the limbs are unbent with reduced muscle tone: according to the TYPE of paraplegia (decreased muscle tone both in the upper and lower extremities);
by monotype- decrease in motor activity and muscle tone of one limb.

Asymmetric postures occur mainly in children with CNS damage.
Pathological hand settings - a "clawed paw", a drooping hand, a "monkey" hand - are characteristic of lesions of the central nervous system of various origins.

Pathological positions of the feet: vagal installation- disconnection of the foot from the axis of the limb in the medial direction; valgus position- Disconnection of the foot from the axis of the limb in the lateral direction. The pathological position of the feet may be associated with orthopedic pathology; heel position - dorsiflexion of the foot; a drooping foot is noted when the spinal cord is affected. The position of the head of the newborn is deviated from the axis of the body up to the shoulder (in the event of injury, Sternocele! Body proportions are sometimes violated with premature birth of a child, microcephaly, hydrocephalus. Features of intrauterine development also reflect body weight disorders.

Macrosomia expressed in children with diabetic fetopathy and in post-term; low birth weight on time is possible in the case of severe gestosis in the second half of pregnancy, malnutrition of a pregnant woman, with chromosomal diseases, etc.

Dysembryogenetic stigma testifies to the violation of intrauterine development. Detection of 5 or more stigmas is considered diagnostically significant.
The smell emanating from a newborn can be one of the early symptoms of hereditary diseases: "murine" in phenylketonuria; boiled vegetables - in violation of the exchange of valine, leucine.

The skin of a healthy full-term newborn is delicate, elastic, velvety to the touch, instantly straightens when trying to fold it. Its dryness is possible with low functional activity of the sweat glands. When examining the skin of a newborn, a number of features can be identified - whitish-yellow dots, more often on the tip and wings of the nose, less often on the nasolabial triangle. They are retention cysts of the sebaceous glands and disappear by the end of the neonatal period, do not require treatment;
not abundant petechial hemorrhages in the skin of the presenting part and hemorrhages in the sclera, due to increased vascular permeability, appear during childbirth;
telangiectasias - reddish-cyanotic vascular spots on the back of the nose, upper eyelids, on the border of the scalp and the back of the neck. They disappear with pressure, differing in this from hemangiomas; 1apido-vellus hair mainly on the face, shoulders, back skin; Mongoloid spots - in the region of the sacrum and buttocks, bluish color, (due to the presence of pigment-forming cells); birthmarks are more often brown or bluish-red in color of any localization; mHana sp51aHna - point bubbles resembling "dew drops" - the result of blockage of sweat glands, are noted on the face, do not require treatment.
Healthy newborn skin color. In the first minutes after birth, there is general cyanosis, acrocyanosis, perioral cyanosis (around the mouth), less often it is born pink. After the initial toilet, or a few hours after birth, the skin takes on a bright pink tint. This is due to the reaction of peripheral vessels to tactile and temperature stimuli. This state of adaptation is called physiological erythema, lasts 1-2 days, in immature and premature babies - 1-1.5 weeks. At the end of the second and third days of life, in 60-70% of children, the skin acquires an icteric shade. The icteric staining disappears by the end of the first - the middle of the second week and refers to borderline conditions (see the section on adaptation of newborns for details). The earlier onset of jaundice, its greater intensity, protracted or wave-like flow makes it possible to classify it as pathological.

Pathological changes in skin color. On examination, persistent cyanosis can be a sign of a number of diseases. There are three groups of causes that cause cyanosis:
a) central- with asphyxia, intracranial birth trauma, trauma of the cervical spinal cord, intrauterine infections with damage to the central nervous system;
b) pulmonary genesis- with pneumonia, pneumopathy, diaphragmatic hernia, lung aplasia, etc.
c) cardiac origin- congenital heart defects of "blue" color, persistent, ductus arteriosus, etc.
Facial cyanosis is observed in children born with a tight cord around the neck. It can last for several days.
Acrocyanosis and distal cyanosis - in the early neonatal period, it occurs in healthy children with a violation of the temperature regime in the department, screaming and anxiety. Persistent perioral cyanosis is more common in congenital cardiogenic pathology.

Cyanosis and some swelling of the legs is noted in those born in the pelvic (usually leg) presentation, as well as in spinal cord injury; isolated cyanosis of the upper limb is possible if the handle falls out during childbirth with the transverse position of the fetus.

The head of a newborn can be brachycephalic, dolichocephalic and irregular. The head circumference is usually 34-37 cm, which is 1-2 cm more than the chest circumference. Measurement of the head circumference is repeated no earlier than on the 3rd day of life, since by this time the configuration decreases and disappears: 1;

Examination of the eyes. In children, the first day of life is often difficult, since they are closed. From time to time, a converging strabismus may occur, a short-term fine-sweeping horizontal nystagmus is possible when changing position. Perinatal damage to the central nervous system can be accompanied by such pathological symptoms as: ptosis, lagophthalmos, persistent horizontal nystagmus and convergent strabismus, Graefe's symptoms, the "setting sun", stopped gaze, puppet eyes, floating eye movements.

Examination of the oral mucosa. The color is bright pink, dryish (slight salivation). With defects in care, white spots appear. Cleft lip (cheiloschis) and hard palate (palatoschis) are the most common facial anomalies.
Chest examination. The shape is barrel-shaped, the lower aperture is deployed, the ribs are horizontal. The rib cage is symmetrical, its lower parts take an active part in the act of breathing. The counting of the frequency of respiration and heart rate is carried out during sleep using a stethoscope (the membrane of the phonendoscope distorts auscultation). HR - 40-60 in 1 minute, heart rate 140-160 in 1 minute, blood pressure - 55 / 30-80 / 55 mm Hg. The counting is carried out for 60 seconds, since these indicators are very labile.

Palpation of the chest. When the collarbone is fractured, swelling, crepitus, or callus is detected. An increase in chest rigidity is characteristic of lung diseases (pneumonia, pneumopathy) and some developmental abnormalities (diaphragmatic hernia).

Percussion when examining newborn lungs is carried out with the middle finger, placing the child on the palm with support for the axillary areas. Shortening of percussion sound, dullness, box shade is typical for infectious and non-infectious lung lesions. Breathing over all pulmonary fields is puerile, that is, inhalation and 1 / 3-1 / 2 part of exhalation are heard. In premature babies, breathing is often weakened in the first days of life (atelectasis of the lungs). A change in the nature of breathing (weakened, hard) may be due to extrapulmonary reasons (narrow nasal passages, swelling of the nasal mucosa with acute respiratory viral infections or trauma during resuscitation measures) or be a sign of a large group of diseases and abnormalities of the respiratory system. Wheezing over the lungs in the first minutes of life is heard in most healthy newborns (the presence of residues of intrauterine pulmonary fluid in the lungs). The abundance of rales of various sizes indicates an aspiration syndrome. The presence of wheezing at birth and subsequently always speaks of pathology. Violation of the rhythm of breathing in the first hours of life can be manifested by short-term apnea and the presence of gasps. Prolonged apnea is accompanied by cyanosis and respiratory arrest (more than 6-10 seconds).

Heart sounds are clear, sonorous clean. The number of heart contractions less than 100 in 1 minute - bradycardia, more than 160 in 1 minute - tachycardia. Muffling or deafness of heart sounds are characteristic of severe intrauterine hypoxia, infectious myocardial damage, congenital heart defects. The presence of systolic murmur in the first hours and days of life does not always indicate congenital heart disease (functioning of the ductus arteriosus and / or oval window). Systolic murmur on the 3-5th day of life, which tends to increase and conduct in the axillary region and on the back, indicates a congenital heart disease.

The abdomen of a healthy newborn is rounded, takes an active part in the act of breathing, the subcutaneous fat layer is well developed. Bloating is possible with overfeeding (artificial), and can also be a symptom of low intestinal obstruction, necrotizing enterocolitis, peritonitis, with sepsis, pneumonia, intrauterine infection. A retraction of the abdomen is characteristic of high intestinal obstruction, with dehydration. Abdominal asymmetry is observed with diaphragmatic hernia (retracted), abnormalities in the development of the anterior abdominal wall (protrusion). A change in the color of the skin of the anterior abdominal wall (shiny, bright pink) is characteristic of inflammatory changes in the abdominal cavity.

On palpation, the abdomen is soft, deep palpation is available with calm behavior. The anterior abdominal wall is elastic and elastic. Pasty of the anterior abdominal wall is possible in premature infants, with inflammatory diseases of the abdominal organs, scleredema, and abnormalities in the development of the kidneys. The umbilical cord falls off between 4 and 7 days of age. The umbilical wound is dry, clean. The presence of hyperemia, serous-purulent discharge speaks of ompholyte. The liver protrudes from under the edge of the costal arch no more than 2 cm along the mid-clavicular line. An enlarged liver is possible with perinatal infections, severe asphyxia, congenital heart defects, some jaundice, HDN. The spleen is palpated at the edge of the costal arch. Splenomegaly in perinatal infections, severe forms of HDN, hereditary microspherocytosis. The kidneys (usually the right one) are palpable in premature babies with a weakly expressed subcutaneous fat layer. Disturbances of intestinal motility during abdominal auscultation are often accompanied by severe asphyxia, intracranial hemorrhage, and intrauterine infections.

Examination of the genitals. In healthy full-term boys, the testicles are descended into the scrotum, in girls, the labia majora cover the small ones; in premature boys, the testicles are not descended into the scrotum, girls are characterized by a gaping genital fissure. The scrotum may be enlarged (dropsy of the testicles, differentiated from inguinal-scrotal hernia). Significant hypertrophy of the clitoris in girls sometimes makes it necessary to determine sex chromatin to clarify the sex of the child. The presence of the anus, the discharge of meconium, and the onset of urination are recorded.

Examination of the hip joints. Despite the physiological hypertonicity of the muscles, the leg extension is possible almost to the surface of the diaper. Restriction of mobility - with damage to the central nervous system or dysplasia of the hip joints (a positive Marx symptom is a click symptom); pathological mobility - with a decrease in the muscle tone of the lower extremities (prematurity, spinal injury, Down's disease, arthrogryposis).

Completing the examination, the neonatologist once again assesses the newborn's reaction to the manipulations, the stability of his thermoregulation, analyzes the neurological and somatic characteristics, the dynamics of adaptation states. A scrupulously conducted clinical examination, along with a carefully collected anamnesis, contributes to the timely diagnosis and correct treatment of the patient.

Screening is a mass examination of newborn babies to detect genetic diseases. Special laboratory tests can identify certain hereditary diseases before their symptoms appear.

The importance of newborn screening cannot be underestimated. After all, most genetic pathologies do not appear at all at birth and during the first months of life: a baby may look healthy, but at the same time have a hereditary defect. And only over time, symptoms appear that make it possible to diagnose the disease.

Early recognition of diseases and immediate treatment in the preclinical period of the disease makes it possible to prevent the rapid development of the disease and avoid serious complications.

Newborn screening includes neonatal, audiologic and ultrasound examinations.

Neonatal newborn screening

This examination is a fairly new progressive direction in pediatrics, which makes it possible to obtain a preliminary diagnosis of the presence of genetic defects by blood sampling. Studies are carried out in a maternity hospital on the fourth day of a full-term baby's life and on the seventh day in a premature baby. Blood is taken from the baby's heel and applied to a test strip. If there are deviations from the norm, parents should contact an endocrinologist or medical genetic consultation for a more detailed and thorough examination of the child. If the diagnosis is confirmed, then a course of treatment is immediately prescribed. In the event that the examination was not carried out at the maternity hospital, it must be appointed at the clinic at the place of residence of the child.

To date, five genetic diseases are diagnosed as part of neonatal newborn screening:

  • Congenital hypothyroidism is an intrauterine lesion of the rudiment of the thyroid gland. The disease leads to a disruption in the production of thyroid hormones and, as a consequence, to a delay in the development of growth and the formation of the child's nervous system. Girls suffer from hypothyroidism twice as often as boys. If the disease is diagnosed in a timely manner, then taking hormonal drugs can completely stop its development;
  • Phenylketonuria is a genetic disorder characterized by a deficiency of an enzyme that can break down the amino acid phenylalanine. The accumulation of this amino acid and its metabolites in the urine in the blood leads to severe intoxication, brain damage, serious neurological disorders and mental retardation. Virtually all protein foods contain the amino acid phenylalanine, so diet is the main treatment. A specific diet must be adhered to for a long time - on the order of the first ten years of life. With timely neonatal screening of a newborn and timely treatment started, children suffering from phenylketonuria do not lag behind their peers in mental development;
  • Adrenogenital syndrome is a hereditary dysfunction of the adrenal cortex. The disease is caused by a violation of the production of a hormone that affects the metabolic process. In the blood of a newborn, already in the first week of life, substances begin to accumulate that have a detrimental effect on the cardiovascular system, kidney function and the formation of genitals. Hormone treatments are lifelong;
  • Cystic fibrosis is the most common genetic disease characterized by a gene mutation, as a result of which the glands of external secretion are damaged. The disease leads to severe dysfunctions of the respiratory and gastrointestinal tract. Neonatal screening of newborns allows you to identify an ailment and prescribe timely drug treatment;
  • Gelactosemia is a genetically determined metabolic disorder characterized by a deficiency of an enzyme that converts galactose into glucose. In this regard, there is a severe violation of the nervous system, liver and other organs. The main treatment is a specific diet that excludes dairy products.

Ultrasound examination of newborns

This is the most important study and should be done in the first three months of a baby's life.

Ultrasound screening of newborns is carried out in order to:

  • Detection of congenital hip dislocations and hip dysplasia;
  • Brain research of a newborn;
  • Examination of internal organs.

Timely commenced correction of congenital hip dysplasia and hip dislocation leads to complete recovery of the musculoskeletal system. World practice shows that when treatment is started in the first weeks of life, the baby is completely healthy by six months. With a delay of three months, treatment continues for a year, and with a delay of six months, surgery is unfortunately inevitable.

The examination of the brain is carried out through the fontanelle in the first three months of life. Ultrasound screening of newborns reveals both congenital anomalies and diseases acquired during the prenatal period or during childbirth. Untimely diagnosis and treatment of pathologies of blood circulation and the structure of the brain can lead to irreversible consequences - impaired brain functions and the development of neurological disorders.

Ultrasound screening of newborns for examination of internal organs must be carried out in the first three months of a child's life. Do not postpone the diagnosis in cases where during the prenatal period the doctor observed abnormalities in the formation and development of the liver, kidneys, heart. Disorders of urination, digestion, growth retardation and a number of other alarming symptoms can also be an indication for an ultrasound scan.

Newborn audiological screening

This is a test for hearing loss and deafness with the use of special modern equipment and the use of progressive diagnostic techniques.

If earlier audiological screening of newborns was prescribed only to children at risk, now it is mandatory for all infants. This is due to the high efficiency of hearing regeneration, if the disease is detected on time. In addition, in the first month of life, prosthetics with hearing aids is possible.

The causes of many diseases can lie in pathologies at the genetic level. Even a child of healthy parents can be born with a disease provoked by an unfortunate combination of genes. Therefore, do not refuse examinations - they will help to detect pathology in time and develop the correct tactics in relation to it.

Text: Natalia Novgorodtseva

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