معاینه نوزاد

صفحه 1:


صفحه 2:
معاينه نوزاد دکتر محمود نوری شادكام تسس رس لس در اسرد ‎(eas)‏ ‏دانشیار گروه کودکان 

صفحه 3:
+ peat Wet 0 RE We) RY) NeaL CET) پیدا کردن مسائل غیر. طبیعی که بعضاً نیاز به اقدامات اورثانسى دارد (0-2 96 نوزادان ناهنجارى مادرزادى دارند) 

صفحه 4:
شرح حال در طب نوزادی ESB Sorento eal ناخوشی‌هاوطبیگ ذشته در مادر و خانوادم2 مشكلاتبارورىقبلىمادر-3 اك 0 توصيفؤليمان5 

صفحه 5:
تواناييهاى تعاملى و ارتباطى نوزاد بلافاصله پس از تولید هوشیار بوده و در صورتیکه فرصت داده شود آماده خوردن است در( ‎Ed‏ 0 پس از ارتباط اجتماعی اولیه که حدود (۳0) دقيقه طول می کشد یک دوره خواب ۳ es است) ae 

صفحه 6:
2 35 46.4 50.5 54.4 كن 52.9 49.9 45.4 37.2 34.8 32.6 0 32.1 34.33 9 2.54 3.27 5 WT 2:36, 323 6 

صفحه 7:
۱ " حركات خشن و لرزشى همراه با ميوكلونوس مج يا و فى در نوزادان شايعتر و كم اهميت تر از سنين ديكر است. جنين حركاتى بيشتر در زمانى كه نوزاد فعال است ديده مى شودء در حاليكه انقباضات تشنجى بيشتر در حالت آرامش به وجود مى آيد. "ا نوزاد ادم ندارد 

صفحه 8:


صفحه 9:
۱۳۸2۰ "A grayish-white ‏کت‎ ‎consisting of sebaceous gland secretions, | lanugo, and desquamated epithelial cells, that covers the skin of the fetus and newborn. ™ Vernix is theorized to serve several purposes = 1-moisturizing the infant's skin = 2-Facilitating passage through the birth canal ™ 3-Serves to conserve heat and protect the 2 ‏دای با تور یاک رازه ارت ات۰‎ 5 "There is little evidence to support a chemical role of vernix in protecting the infant from infection, it may forma physical barrier to the passage of 

صفحه 10:


صفحه 11:
Acrocyanosis ™ Assessment of color — A normal infant appears pink. Acrocyanosis, a bluish appearance of the hands, feet, and perioral area, is common in the first few days after delivery. However, central cyanosis, which is seen best on the tongue and mucous membranes of the mouth, suggests hypoxemia. 

صفحه 12:


صفحه 13:


صفحه 14:
Mongolian spots ۳ spots are the most frequently encountered pigmented lesions in newborns. There are marked racial differences in prevalence : =™90 percent in Asian,American,African&lindian Neonates ™">60 percent in black neonates ™46 to 70 percent in Hispanic neonates ™<10 percent in white neonates 

صفحه 15:
Mongolian spots = The lesions are results of the delayed disappearance of dermal melanocytes. The sacral area and medial buttocks are sites where active dermal melanocytes frequently remain at birth. Dermal melanocytosis is less often seen in extra sacral ("aberrant") sites, eg, the superior or anterior trunk and extremities. A biopsy, which is rarely indicated, shows the widely spaced dermal melanocytes in the deep dermis. 

صفحه 16:
Mongolian spots ™ Mongolian spots are completely benign and usually fade during the first or second year of life. By 6 to 10 years of age, the vast majority have disappeared. However, approximately 3 percent remain into adulthood, particularly those in extra sacral locations 

صفحه 17:


صفحه 18:
Harlequin COIOr change + ™ Harlequin color change is observed when an infant is lying on his or her side. It is characterized by intense reddening of the dependent side and blanching of the non- dependent side, with a demarcation line along the midline. The duration ranges from a few seconds to 20 minutes. The etiology of harlequin color change is unknown. It may be related to immaturity of the autonomic regulation of cutaneous blood vessel tone . 

صفحه 19:
Harlequin color change Harlequin color change affects approximately 10 percent of newborns, occurring more often in preterm than term infants. The frequency is greatest in the first few days of life, but it has been observed up to three weeks after birth. ™ Harlequin color change is entirely benign. It should not be confused with the harlequin fetus, the most severe form of congenital ichthyosis that is lethal in the neonatal period. 

صفحه 20:


صفحه 21:


صفحه 22:
Erythema toxicum neonatorum = ETN occurs in 31 to 72 percent of full-term infants ™Declines in incidence with decreasing birth weight and gestational age. "Etiology is not known, but immaturity of the pilosebaceous follicles (the combined sebaceous gland and hair follicle) may contribute. 

صفحه 23:
Erythema toxicum neonatorum = rapidly progress to pustules on an erythematous base = ETN is characterized by multiple erythematous macules and papules (1 to 3 mm in diameter) The lesions are distributed over the trunk and proximal extremities, ™ sparing the palms and soles. They may be present at birth, but typically appear within 24 to 48 hours. ™ The rash usually resolves in five to seven days, although it may wax and wane before complete resolution. 

صفحه 24:
EFyYtnemda tOxICurn) neonatorum = The diagnosis of ETN is usually made upon the basis of clinical appearance. = |t can be confirmed by microscopic examination of a Wright-stained smear of the contents of a pustule that demonstrates numerous eosinophils and occasional neutrophils. However, this usually is not necessary. = A minority of patients (7 to 18 percent) may also have peripheral eosinophilia. "ETN resolves spontaneously. No treatment is necessary. 

صفحه 25:


صفحه 26:


صفحه 27:
Transient neonatal pustular ‏اعما‎ 355 ™ TNPM is less common than ETN. It mostly " affects full-term black infants, although it is ™ described in all races. ™ TNPM consists of three types of lesions : ™ Small pustules on a non erythematous base; ‏هت ات وه لا‎ ™ Erythematous macules with a surrounding ™ collarette of scale; these develop as the 5 pustules rupture and may persist for weeks to months ™ Hyperpigmented macules that gradually fade ™ over several weeks to months ™ Lesions in different sta ay be present at e same 0 even 30 ine 4 ‏م‎ 

صفحه 28:
Transient neonatal pustular melanosis ™"The diagnosis of TNPM is usually based upon the clinical appearance. ™ Microscopic examination of a Wright- stained smear of the contents of a pustule demonstrates numerous neutrophils and rare eosinophils .However, this is usually not necessary. Culture, if performed, yields no organism. No treatment is necessary. 

صفحه 29:
۳ 1 W 

صفحه 30:
۷۵ = Milia are white papules caused by retention of keratin and sebaceous material in the pilaceous follicles. They are frequently found on the nose and cheeks, and resolve in the first few weeks of life. 

صفحه 31:


صفحه 32:
Miliaria = Miliaria is a common finding in newborns, especially in warm climates. It is caused by accumulation of sweat beneath eccrine sweat ducts that are obstructed by keratin at the level of the stratum corneum. 

صفحه 33:
Miliaria =" Miliaria rarely is present at birth. It usually develops during the first week of life, especially in association with warming of the infant by an incubator, occlusive dressings or clothing, or fever. It is characteristically distributed on the face, scalp, and intertriginous areas. 

صفحه 34:
Miliaria = The diagnosis of miliaria is based upon the clinical features. ™ Microscopic examination of a Wright- stained smear of the contents of a vesicular lesion demonstrates sparse squamous cells and lymphocytes. However, this is usually not necessary. ™ No specific treatment is needed. Lesions usually resolve rapidly when the infant is placed in a cooler environment with associated measures to reduce sweating, such as light, loose clothing and cool baths. 

صفحه 35:


صفحه 36:
Epidermolysis bullosa Epidermolysis bullosa (EB) is a group of inherited diseases characterized by skin fragility and blister formation caused by minor skin trauma. EB is broadly classified into three groups by the level at which the blisters form. These are EB simplex, junctional EB, and dystrophic EB. Separation is at the intraepidermal, intra- lamina lucida, and sub-basal lamina levels, respectively. 

صفحه 37:


صفحه 38:
فد و ‎tt Vette‏ لبالا سا Simplex) ‎patches are small, pale pink, ill-defined,‏ ۳ لا ‎yascular macules that occur most commonly on the‏ ‎glabella, eyelids, upper lip, and nuchal area of 30- 40% of normal newborn infants. ‎™ These lesions, which represent localized vascular ectasia, persist for several months and may become more visible during crying or changes in environmental temperature. ‎™ Most lesions on the face eventually fade and disappear completely, although lesions occupying the entire central forehead often do not. Those on the posterior neck and occipital areas usually persist. The salmon patch is usually symmetric, with lesions on both eyelids or on both sides of midline. 

صفحه 39:


صفحه 40:
Port Wine Stains ™ Port wine stains (PWS) are almost always evident at birth ™ and are a capillary malformation. ۰ ™ They are usually sporadic, although some occur in " families in an apparently autosomal dominant = inheritance. They are initially pink or red, and grow in = proportion to infant growth. Although they may appear ™ to lighten in the first few months, they generally darken = after this. They can be associated with other skin ™ anomalies such as extensive mongolian spots. = Treatment of PWS is possible using a laser, although = improvement rather than complete resolution is most ‏صمصناهه‎ ‎0 

صفحه 41:
5 معمولا در صورت ديده مى شود و بايد معاينه كننده را به ياد سندرم استورج وبر (انزيوماتوز عصب سه قلوءتشنج و كلسيفيكاسيون ”ريل مانند“ داخل جمجمه اى در همان طرف ) بيندازد 

صفحه 42:


صفحه 43:
Neonatal Acne 2 ‏ی لا‎ acne may be present at birth, or Relay (al lop over the first 2-4 weeks of life. There is [0 ‏/إكات‎ over whether it is truly acne or whether it represents a form of pustular disorder in the newborn period. = The condition consists of pustules over the cheeks primarily, but also involves other areas of the face and the scalp. As opposed to infantile acne (which develops after 2 months) and acne of adolescence, there are no comedomes in the neonatal form. ™ Neonatal acne resolves spontaneously and without scarring. 

صفحه 44:


صفحه 45:
Aplasia cutis congenita = Aplasia cutis congenita (ACC) is a group of heterogeneous diseases characterized by congenital focal absence of the skin. It is most often limited to a solitary midline posterior scalp lesion, but other presentations include several smaller scalp defects or involvement of the extremities or trunk .Clinical subtypes are characterized by their location and pattern of lesions, associated malformations, and mode of inheritance . 

صفحه 46:
Aplasia cutis congenita — = ACC is usually an isolated condition. However, other malformations may be associated. These include trisomy 13 or 4p- syndrome, cleft lip and palate, and defects of the hands and feet . A subtype characterized by a ring of long dark hair surrounding a congenital scalp lesion (hair collar sign), may indicate an associated cranial neural tube defect such as an encephalocoele, meningocele, or heterotopic brain tissue [. One proposed mechanism is that this may arise from an abnormality of separation of the epithelial and neural ectoderm at the time of neural tube closure. 

صفحه 47:
Aplasia cutis congenita =" The etiology of ACC is uncertain, but it may result from a failure of ectodermal fusion during embryogenesis. "Treatment usually consists of conservative wound care. = Most lesions will reepithelialize spontaneously; larger lesions may require surgical intervention 

صفحه 48:
8 ملاج قدامی 20 102 ۲۱۲۲ ملاج سوم فقط در نوزادان نارس طبیعی است " ملاج خلفى © 0717 5 ا مى باشد. "" فونتال بزرك در جريان هيدروسفالىء هييوتيروئيديسم 52007 

صفحه 49:
امو ‎co‏ ها ‎Ue Ce Sey TOR Oe Cero ere Ses heal‏ خود باز می شود. ‎Rone Cae eb Bee ee OCCeNe ES ETL!‏ رفلکس های مردمک بعد از هفته 20-70 حاملگی نمودار می شود. * قطر قرنیه در نوزاد ترم کمتر از 16۳0 ۳ ياتولوزى داخل جشم است. 

صفحه 50:


صفحه 51:


صفحه 52:


صفحه 53:


صفحه 54:


صفحه 55:


صفحه 56:
لكوكوريا ممكن است ناشى از كاتاراكت»تومور چشم»کوریورتینیت شدید»زجاجیه اولیه هیپرپلاستیک ,پایدار و رتینوپاتی نارسی باشد 

صفحه 57:


صفحه 58:
دهان * مرواریدهای ابشتاین وکیست های احتباسی در چندین هفته اول زندگی ناپدید می شود. 8 اغلب در روزهای 0-0 دسته های فولیکولی با زخمی زرد یا سفید در زمینه اریتماتو بر روی ستون قدامی لوزه ها دیده مى شودء علت اين ضايعات ناشناخته بوده و طى ©6-© روز بدون درمان از بين مى رود. بب 00 ‎Si‏ ا ال ل ‏" لوزه هاى نوزاد كوجك است. 

صفحه 59:


صفحه 60:


صفحه 61:
scene 

صفحه 62:
* هیپرترفی پستان شايع است 0 خارج شود). "ا فشردن سينه ها در بدو تولد باعث وريم ويا حتى تشكيل آبسه مى كردد. 

صفحه 63:


صفحه 64:


صفحه 65:
Ee " 8 در نوزاد ترم طبيعى200-20 بار ۳ "" نوزاد نايس ممكن است با ريتم شين استوك تنفس كند تنفس نوزادء غالباً ديافراكمى است. "" خرخر (0110111110) در صورتى خوش خيم است كه 900-900 دقيقه بعد از تولد از بين برود. See ‏ا ل‎ ee Bal ‏باشد و نباید بعد از )تا ساعت اول زندگی»رال سمع‎ 0 شود. 

صفحه 66:
قلب # سوفل های خوش خیم موقتی شایع است. Ben sO (een Ne ‏ا‎ ls ‏دقیقه است.‎ * فشار خون نوزاد 202/946 است. " وجود اختلاف بيش از (20-(10) ميلى متر جيوه بين فشار. اندام فوقانی و تحتانی مطرح کننده کوارکتاسیون ائورت است. + 

صفحه 67:
شکم 0 PS ve ey rene eo eee لبه دنده لمس مى شود. نوك طحال بندرت قابل لمس است. " تا <©© ساعت بعد از تولد كاز در ركتوم ديده مى شود. " دفع مكونيوم معمولاً در ©) ساعت نخست تولد انجام مى شود (©©0,؟ نوزادان ترم و ©©9,9 نوزادان نارس تا 436 ساعت بعد از تولد) 

صفحه 68:
دستگاه تناسلی ‎Ss‏ ببس ‏در بعضی از موارد در جنس مونث از دستگاه تناسلی دفع خون داريم. بیضه ها باید در اسکروتوم باشند. ‎Ram Pe ee ene pepe) ‏اغلب نوزادان تا ©) ساعت بعد از تولد ادرار مى كنند (©©90 نوزادان ترم و نارس تا “-6©© ساعت) 

صفحه 69:
رفلکس های نوزادی ۳ " و0أم35 تكسي ففتد © حاملكى ظاهر شدم و 6 ماهكواز بينمى ‎ce)‏ 80000 (طلبيدر) سوهفته © حاملكىظاهر شدم و ©-00 ماهكىاز لس كا " قرار دادن يا سديهبدو تولد ظاهر شده و ©-60 ماهكى از بين مى رود. نشانه بابينسكى اكستانسور يا به سمت بالا است. 

صفحه 70:
8 شیر خوارانی‌که وزن‌تولد لنها بیش‌از صدک ‎OO‏ 2 5 ETRE OE Bre! ۳ ‏ا‎ 

صفحه 71:
Laboratory سطوح سرمی گلوکز در نوزادان سر موعد و سالم بندرت كمتر از 700/01140 در ©-) ساعت اول زندكى؛ كمتر از 45 09/01 در 2-26 ساعت اول و كمتر از 00/010 در دوره يس از آن است. " ميزان سرمى كراتينين و ١الا8‏ نوزاد تا يك هفته بعد از تراد ا و کراتینین مادر تبعيت مى كند. ‎Hg 16.8 (13.7-20.1)‏ = ‎WBC 18000 (9000-30000)‏ = 

صفحه 72:
Thank you for attention