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Sunday, October 25, 2020

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Baby Birth: the characteristics of the newborns

 

Every newborn baby has its own characteristics: skin, eyes, nose, arms. Discover in detail each part of the body of this little being. 

The skin of the newborn

The color of the skin

At birth, the skin of the newborn is bright pink or red (erythrosis) and shows a fine hairline or mottling (livedo). The skin reddens as a whole if the baby cries energetically. The color of the skin is related to ethnic origins, but newborns often have a very clear skin which will darken in the days following the birth.

Cyanosis (bluish discoloration) of the palms of the hands and soles of the feet is normal in the first few days after bathing.

Jaundice (jaundice) is responsible for the yellow tint of the skin and mucous membranes around the third day. It requires monitoring.

The aspect of the skin

The skin is soft, covered with a fine down (lanugo), especially on the forehead, temples, shoulders and back. It falls in a few days and is more abundant in the premature baby.

You may notice the presence of a yellowish fatty substance all over the body, but mainly on the skin folds and vulva in girls. This is the "vernix caseosa" which dries in a few hours if it is not cleaned. It comes from the secretion of sebaceous glands and epithelial cells. The skin often desquamates during the first fifteen days.

The elasticity of the skin is a sign of good health: there is no skin fold that persists if the skin is pinched between two fingers.

30 to 50% of newborns have small telangiectasias or flat angiomas on the nape of the neck, the root of the nose or the eyelids. These dark red spots become more pronounced when crying and will disappear within the first two years.

Tiny white spots (milium) may be seen on the nose, around the nose, on the chin, and on the penis in boys. They are due to the obstruction of the sebaceous glands and disappear spontaneously in 2 to 3 months.

The mongoloid, slate blue spots are present on the buttocks and lower back in children of Asian or African origin. They fade between 2 and 6 years.

The toxic erythema of the newborn (or neonatal transient erythema) sometimes appears on the second day of life and is exacerbated by rubbing the skin. These flat red pimples, centered by a small yellowish swelling, are sometimes present in patches on the trunk. Of unknown cause, this erythema disappears within a week and is not serious. No treatment is necessary.

You will sometimes observe marks on the skin caused by the trauma of birth: forceps marks, purpura and cyanosis on the face after cord circularity etc. These lesions disappear in a few days.

On the other hand, folliculitis is made up of small pustules on healthy skin or with peripheral inflammation. Staphylococci are often responsible for it. Treatment is necessary.

The head of the newborn

At birth, the head often appears large compared to the rest of the body.

The bones of the skull are not fused. Overlapping of the sutures due to the shaping of the skull bones sometimes occurs during vaginal delivery. After a caesarean section, on the other hand, the head is round and symmetrical.

The serosanguineous hump is a soft, purplish mass present under the scalp where the head presented at the vulva. It disappears within a week.

A cephalohaematoma is rarer: it is a hematoma under the periosteum of one of the skull bones. This hematoma resolves spontaneously in a few weeks, which sometimes prolongs the evolution of physiological jaundice.

The fontanelles often worry young mothers, especially when the doctor applies his fingers on them... It is actually a part of the skull not yet ossified. This membrane is elastic but not fragile. The dimensions of the anterior fontanel are very variable, around 3 cm wide and 4 cm long. It has the shape of a rhombus located at the junction of the two parietal bones and the two frontal bones. It normally closes between 12 and 18 months. The posterior, triangular fontanel is much smaller and is usually closed at birth in full-term infants. The fontanelles bulge when the child cries.

The skull is bald or covered with silky fetal hair that usually falls off within a few weeks. More rarely, the baby has abundant hair that will persist. After a few weeks, you may notice a tonsure where his head rests on the mattress.

The newborn's neck 

The neck appears short and wrinkled. Palpation of the sternocleidomastoid muscles allows us to look for a hematoma in the form of a thickening. In this case, the baby's head is always turned to the same side. Physiotherapy would then be necessary to avoid the formation of a congenital torticollis. Inspection and palpation of the neck will help to detect an increase in thyroid volume (goitre).

Palpation of the clavicles can detect a fracture during a difficult childbirth. No treatment is necessary, the fracture consolidates on its own and is not painful. This fracture can be discovered at a distance around 1 month before the discovery of a bone callus on the clavicle.

The eyes of the newborn 

The eyes of newborns are often blue-gray, but the final color appears rather around 3 months (if it is a darker shade). The sensitivity to light is clear from the first days. Newborns have a glare reflex: bright light causes the eyelids to become occluded and the pupils to shrink. He fixes the light and follows it from his eyes; he can follow a colored object located 30 cm from his eyes.

The eyelids are oedematous. For the newborn to open his eyes, you just have to sit him down and rock him or make him suck. 
Subconjunctival hemorrhages can be a concern. These small pools of red blood visible in the whites of the eyes are frequent and not serious. They regress in a few weeks without treatment.

Conjunctivitis (discharge of yellowish pus in the eye, which sticks to the eyelids) is sometimes observed and justifies instilling antibiotic eye drops after bacteriological sampling. An abnormal persistence of this conjunctivitis or a rapid relapse leads to the suspicion that the tear duct is not permeable: the tear outlet is blocked. In this case, a small, benign operation to unclog the tear duct is carried out by an ophthalmologist around the age of 2 or 3 months in case of failure of local care (washing, eye drops, massages).

Strabismus is frequent during the first few months and should therefore not worry you. If it persists after 6 months, you should report it to your pediatrician. The eyeballs do not follow the rotation of the head (doll's eyes). When examining your child, the pediatrician will routinely look for certain eye diseases.

The mouth of the newborn 

Small pearly white beaded bumps are sometimes visible at the edge of the gums or on the palate (Epstein pearls). They are completely normal.

You may be surprised to discover one or two small lower medial incisor teeth.

An asymmetry of the face when shouting makes you diagnose a hypoplasia of the triangular muscle of the lips without gravity.

A large tongue means looking for symptoms of certain rare diseases. The length of the tongue brake varies a lot between children. It is rare, however, that the tongue remains permanently behind the gum line and impedes sucking. Surgical treatment by incision of the tongue brake is rarely necessary.

The chin is recessed. It trembles (trembling) at the slightest stimulation (crying, etc.).

The ears of the newborn

The pediatrician verifies the absence of morphological abnormalities of the ears in their implantation, size, shape and symmetry.

Screening for deafness is necessary in case of a family history of deafness, infections during pregnancy, neonatal anoxia and severe jaundice. A calibrated noise emitted near the newborn's ear triggers various reactions, the most significant of which is the cochleo-palpebral reflex: to the sudden noise, the child closes his or her eyes. In case of doubt, the ENT specialist will use a small electronic device to check for oto-emissions. This simple examination allows for the early detection of deafness and its immediate treatment.

The chest and breasts of the newborn baby

The thorax

The chest should then be examined at birth.  The breathing rate is around 35 to 40 breaths/min and the heart rate is around 130 beats/min. A heart murmur may suggest a heart defect, in which case an ultrasound scan is required.

Breasts

Breast congestion (mastitis) is common in both sexes. It is a swelling of the breasts from which sometimes comes out a whitish liquid called "witch's milk" in common parlance. This phenomenon, caused by the fall of maternal hormones in the child's blood, disappears spontaneously in a few weeks. Avoid manipulating the breasts and do not apply any product to them, as this may superinfect the gland.

Supernumerary nipples are sometimes observed but do not require treatment.

The abdomen and umbilical cord of the newborn baby

The abdomen

The abdomen must be flexible. Often the muscles of the abdomen do not touch at the midline and a small vertical median arch is visible from the lower end of the sternum to the navel, especially when the newborn is screaming.

The liver is often palpable, not more than 2 cm above the costal margin. The lower pole of the spleen is sometimes felt, as is the left kidney.

The umbilical cord


The umbilical cord is always examined at birth: it must have a vein and two umbilical arteries. Otherwise (single umbilical artery), it is usual to look for associated kidney malformations.

The cord dries out in a few days and falls out around the 7th day. After some time, the scar at the umbilicus retracts and invaginates (becomes hollow in relation to the skin surface). The skin often remains dark in this area for several months. Sometimes, after the cord falls out, the scar tissue forms an oozing bud that the pediatrician will burn with a silver nitrate pencil.

Superinfection of the scar (purulent oozing discharge, redness, unpleasant odor, etc.) requires careful disinfection and sometimes the prescription of antibiotics to prevent microbial spread and peritonitis.

The place where the umbilical cord joins the abdomen is examined to ensure that a portion of the intestine does not appear at the base of the cord (omphalocele).

A small umbilical hernia is not uncommon. It usually disappears before the age of 4 or 5 years. The various means of restraint (coins held by a band, etc.) are useless. This type of hernia always closes spontaneously in the first 3 or 4 years with the development of the abdominal muscles.

Palpation of the abdomen should also reveal the existence of a bladder globe indicating urine retention and therefore a problem with the urinary system.

The genitals and anus of the newborn baby

The genitals

The pediatrician verifies the absence of sexual ambiguity in the external genitalia.

In boys, the size of the penis and bursa vary greatly. The foreskin adheres to the glans.

A transient hydrocele may be responsible for a bulky scrotum: the bursae are full of water. This hydrocele regresses without treatment in the vast majority of cases. Puncture is never necessary.

At birth, the testicles have not always descended into the scrotum; however, they must be in the following months.
A spermatic cord cyst should not be confused with an inguino-scrotal hernia. A malformation of the urinary meatus implies an ultrasound scan for an associated renal malformation.

In girls, the labia minora are voluminous and the clitoris protrudes. The labia majora are poorly developed and do not cover the vulva.

The genital crisis due to withdrawal of maternal hormones consists of a whitish or bloody vaginal secretion ("menstruation") associated with mastitis and sometimes galactorrhea ("witch's milk").

A swelling the size of an olive on the upper part of a large lip corresponds to a hernia of the ovary which must be surgically reintegrated into the abdomen between 2 and 3 months in order to avoid torsion and necrosis of the gland.

The first emission of urine occurs within the first 24 hours. Otherwise, a bladder globe detected by palpation or the abnormal nature of the urinary stream should raise fears of malformation: an exploration in a specialized environment is then necessary.


The anus

The correct position of the anus is checked. Its permeability is checked with a small probe.

The black, viscous, spinning and odourless meconium is normally emitted within the first 24 hours. The transition to normal bowel movements occurs around the fifth day. A delay in its evacuation raises fears of certain diseases.

Newborn members

The hands are chubby and the baby keeps his fists closed. Fingers appear short. Nails are smooth and soft and stick out beyond the fingertips.

A very common metatarsus varus is often found: the feet turn inwards. This reducible attitude is due to ligament hypotonia: mobilization easily puts them back in the axis of the leg. A little physiotherapy is often useful and can be carried out by the mother: rubbing the outer edge of the feet is enough to stimulate the lateral muscles and actively straighten the feet. This manoeuvre can be repeated several times a day and often avoids the need for orthopedic shoes later on.

Equine varus clubfoot must be detected quickly. Only a very early treatment will allow a good recovery.

The fatty cushion of the feet gives a false impression of flat feet.

The shins are often curved and these "bracketed" legs should not worry you.

The paralysis of the brachial plexus is linked to elongation during difficult childbirth (shoulder dystocia, etc...). The diagnosis from birth is obvious: the child's gesticulation is asymmetrical, the arm is immobile along the body, stretched out and turned inwards. Early treatment by a physiotherapist is essential.

When you see the pediatrician moving your baby's thighs in all directions, it is because he is practicing the Ortolani maneuver in order to detect a possible congenital hip dislocation. This research is all the more important because there are some factors that can help (Breton origin, breech birth, malposition of the feet, etc.). If he perceives a jump during his manipulations, he will ask for an ultrasound scan of the hips. 

All vertebrae are then checked by palpation.

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