FETAL GROWTH

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TITLE="Phenylketonuria (PKU)"><U>Phenylketonuria (PKU)</U></A>   |   <A HREF="id31.htm" TARGET="_top" TITLE="food poisoning"><U>food poisoning</U></A>   |   <A HREF="id32.htm" TARGET="_top" TITLE="acute otitis"><U>acute otitis</U></A>   |   <A HREF="id33.htm" TARGET="_top" TITLE="immunization"><U>immunization</U></A>   |   <A HREF="id34.htm" TARGET="_top" TITLE="craniofacial anomaly"><U>craniofacial anomaly</U></A>   |   <A HREF="id35.htm" TARGET="_top" TITLE="chiari malformation"><U>chiari malformation</U></A>   |   <A HREF="id36.htm" TARGET="_top" TITLE="PEDIATRIC RESPIRATORY DISORDERS"><U>PEDIATRIC RESPIRATORY DISORDERS</U></A>   |   <A HREF="id37.htm" TARGET="_top" TITLE="Cephalhematoma "><U>Cephalhematoma </U></A>   |   <A HREF="id38.htm" TARGET="_top" TITLE="Subgaleal Hematoma"><U>Subgaleal Hematoma</U></A>   |   <A HREF="id39.htm" TARGET="_top" TITLE="BIRTH INJURY "><U>BIRTH INJURY </U></A>   |   <A HREF="id40.htm" TARGET="_top" TITLE="infectious in a new born"><U>infectious in a new born</U></A>   |   <A HREF="id41.htm" TARGET="_top" TITLE="jaundice"><U>jaundice</U></A>   |   <A HREF="id42.htm" TARGET="_top" TITLE="INFANT OF DIABETIC MOTHER (IDM) "><U>INFANT OF DIABETIC MOTHER (IDM) </U></A>   |   <B>FETAL GROWTH </B>   |   <A HREF="id44.htm" TARGET="_top" TITLE="Moebius Syndrome"><U>Moebius Syndrome</U></A>   |   <A HREF="id45.htm" TARGET="_top" TITLE="SHORT STATURE"><U>SHORT STATURE</U></A>   |   <A HREF="id46.htm" TARGET="_top" TITLE="MICROCEPHALIA"><U>MICROCEPHALIA</U></A>   |   <A HREF="id47.htm" TARGET="_top" TITLE="PIERRE ROBIN SYNDROME "><U>PIERRE ROBIN SYNDROME </U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Prenatal Diagnosis"><U>Prenatal Diagnosis</U></A>   |   <A HREF="id28.htm" TARGET="_top" TITLE="Febrile Seizures "><U>Febrile Seizures </U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="dvlp bis"><U>dvlp bis</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="DEVELOPMENTAL NEUROLOGIC DISEASES"><U>DEVELOPMENTAL NEUROLOGIC DISEASES</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="GENETIC DISEASES "><U>GENETIC DISEASES </U></A>   |   <A HREF="id26.htm" TARGET="_top" TITLE="angelman syndrome"><U>angelman syndrome</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="TAYSACHS DISEASE"><U>TAY-SACHS DISEASE</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="krabbes disease"><U>krabbe's disease</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="Refsums Disease"><U>Refsum's Disease</U></A>   |   <A HREF="id29.htm" TARGET="_top" TITLE="meningitis"><U>meningitis</U></A>   |   <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=190 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <A HREF="id18.htm" TARGET="_top" TITLE="PEARLS 1"><U><B>PEARLS 1</B></U></A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="pearls2"><U><B>pearls2</B></U></A></div> <div> <A HREF="id30.htm" TARGET="_top" TITLE="Phenylketonuria (PKU)"><U><B>Phenylketonuria (PKU)</B></U></A></div> <div> <A HREF="id31.htm" TARGET="_top" TITLE="food poisoning"><U><B>food poisoning</B></U></A></div> <div> <A HREF="id32.htm" TARGET="_top" TITLE="acute otitis"><U><B>acute otitis</B></U></A></div> <div> <A HREF="id33.htm" TARGET="_top" TITLE="immunization"><U><B>immunization</B></U></A></div> <div> <A HREF="id34.htm" TARGET="_top" TITLE="craniofacial anomaly"><U><B>craniofacial anomaly</B></U></A></div> <div> <A HREF="id35.htm" TARGET="_top" TITLE="chiari malformation"><U><B>chiari malformation</B></U></A></div> <div> <A HREF="id36.htm" TARGET="_top" TITLE="PEDIATRIC RESPIRATORY DISORDERS"><U><B>PEDIATRIC RESPIRATORY DISORDERS</B></U></A></div> <div> <A HREF="id37.htm" TARGET="_top" TITLE="Cephalhematoma "><U><B>Cephalhematoma </B></U></A></div> <div> <A HREF="id38.htm" TARGET="_top" TITLE="Subgaleal Hematoma"><U><B>Subgaleal Hematoma</B></U></A></div> <div> <A HREF="id39.htm" TARGET="_top" TITLE="BIRTH INJURY "><U><B>BIRTH INJURY </B></U></A></div> <div> <A HREF="id40.htm" TARGET="_top" TITLE="infectious in a new born"><U><B>infectious in a new born</B></U></A></div> <div> <A HREF="id41.htm" TARGET="_top" TITLE="jaundice"><U><B>jaundice</B></U></A></div> <div> <A HREF="id42.htm" TARGET="_top" TITLE="INFANT OF DIABETIC MOTHER (IDM) "><U><B>INFANT OF DIABETIC MOTHER (IDM) </B></U></A></div> <div> <B>FETAL GROWTH </B></div> <div> <A HREF="id44.htm" TARGET="_top" TITLE="Moebius Syndrome"><U><B>Moebius Syndrome</B></U></A></div> <div> <A HREF="id45.htm" TARGET="_top" TITLE="SHORT STATURE"><U><B>SHORT STATURE</B></U></A></div> <div> <A HREF="id46.htm" TARGET="_top" TITLE="MICROCEPHALIA"><U><B>MICROCEPHALIA</B></U></A></div> <div> <A HREF="id47.htm" TARGET="_top" TITLE="PIERRE ROBIN SYNDROME "><U><B>PIERRE ROBIN SYNDROME </B></U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="Prenatal Diagnosis"><U><B>Prenatal Diagnosis</B></U></A></div> <div> <A HREF="id28.htm" TARGET="_top" TITLE="Febrile Seizures "><U><B>Febrile Seizures </B></U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="dvlp bis"><U><B>dvlp bis</B></U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="DEVELOPMENTAL NEUROLOGIC DISEASES"><U><B>DEVELOPMENTAL NEUROLOGIC DISEASES</B></U></A></div> <div> <A HREF="id22.htm" TARGET="_top" TITLE="GENETIC DISEASES "><U><B>GENETIC DISEASES </B></U></A></div> <div> <A HREF="id26.htm" TARGET="_top" TITLE="angelman syndrome"><U><B>angelman syndrome</B></U></A></div> <div> <A HREF="id23.htm" TARGET="_top" TITLE="TAYSACHS DISEASE"><U><B>TAY-SACHS DISEASE</B></U></A></div> <div> <A HREF="id24.htm" TARGET="_top" TITLE="krabbes disease"><U><B>krabbe's disease</B></U></A></div> <div> <A HREF="id25.htm" TARGET="_top" TITLE="Refsums Disease"><U><B>Refsum's Disease</B></U></A></div> <div> <A HREF="id29.htm" TARGET="_top" TITLE="meningitis"><U><B>meningitis</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A></div> </td> <td valign="top" height=355 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> FETAL GROWTH </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Most newborn infants weigh between 2 500g and 4 000g at birth. Infants weighing less than 2 500g are called "low birth weight" (LBW). They may have a low birth weight because they are born preterm, because they have had slow intrauterine growth (fetal growth restraint), or because they have soft tissue wasting (recent fetal starvation). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="2"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>The pattern of fetal growth is usually assessed at birth by correlating the infant's weight and size with the gestational age. Weight, crown-heel length and head circumference are measured and plotted on a size-for-gestational age standard. The combined Denver standard for males and females of all parities is most widely used (see page ...). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="3"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Weight for gestational age is usually used to divide newborn infants into different risk categories. Infants born with a birthweight below the 10th percentile for gestational age are referred to as underweight for gestational age (light for dates or small for gestational age). Similarly infants with a birth weight above the 90th percentile are called overweight for gestational age (heavy for dates or large for gestational age). Infants with birth weights falling between the 10th and 90th percentiles are regarded as being appropriate for gestational age. As weight and gestational age are being measured it is more accurate to refer to overweight, underweight and appropriate weight for gestational age. The newborn infant's length and head circumference can also be plotted on similar standards, and reflect the linear growth and brain growth of the fetus. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="4"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Some infants are symetrically underweight and short for their gestational age suggesting a prolonged period of slow intrauterine growth. As they have a length and head circumference below the 10th centile they can be correctly labelled as fetal growth restraint (intrauterine growth retardation). In contrast other infants are wasted with a normal length and head circumference suggesting that their weight has recently fallen due to soft tissue wasting. These wasted infants have suffered recent fetal starvation rather than prolonged slow intrauterine growth. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="5"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Assessing the gestational age and weight and the routine plotting of each infant on a weight for gestational age standard, is of great clinical importance as this information can be used to predict the perinatal risk of that particular fetus/infant. Head circumference is also important as it reflects brain size. Length is difficult to measure accurately and is not routinely recorded. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="6"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Common problems in Preterm and Underweight for Gestational Age Infants </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="711" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="321"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="bottom" WIDTH="321" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="76"><div> <B>Preterm</B></div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> <B>UGA</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Birth asphyxia</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> +</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> ++</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Meconium aspiration</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> -</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> ++</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Polycythaemia</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> -</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> ++</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Hypothermia</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> ++</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> +</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Hypoglycaemia</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> ++</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> ++</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Hyaline membrane disease</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> ++</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> -</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Apnoea</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> ++</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> -</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Poor feeding</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> ++</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> -</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Patent ductus arteriosus</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> ++</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> -</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Birth trauma</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> +</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> -</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Periventricular haemorrhage</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> ++</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> -</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Jaundice</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> ++</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> +</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Infection</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> ++</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> -</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Congenital abnormalities</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> +</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> ++</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="321"><div> Retarded postnatal growth</div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> +</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> ++</div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 ><NOBR><div> Retarded postnatal development</div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="76"><div> +</div> </tD> <tD VALIGN=CENTER WIDTH="304"><div> +</div> </tD> </tR> </TABLE></div> <div>  <A NAME="7"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>WEIGHT, LENGTH AND HEAD CIRCUMFERENCE FOR GESTATIONAL AGE STANDARDS.</B> </div> <div> <B>THE HEALTHY NEONATE AND MINOR DISORDERS</B> </div> <div>  <A NAME="1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Weight</B> </div> <div> A weight loss of up to 10% of birth weight may occur during the first 3 to 5 days of life. Birth weight is usually regained by the seventh day. Subsequent weight gain is usually about 200g a week (25-30 g/day) for the first three months. </div> <div>  <A NAME="2_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Head and neck</B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="3_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Head circumference - 33 to 37 cm (average 35 cm) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Average increase approximately 7.5 mm/week (1 mm a day) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="4_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Shape </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">caput succedaneum: oedematous thickening of the scalp in the presenting area. It disappears within a day or two </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">anterior fontanelle: diamond-shaped and variable size, normally slightly concave and may be seen to pulsate </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">moulding: altered head shape in response to pressure, sometimes with overriding cranial bones </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">plagiocephaly: "parallelogram skull", with flattening of one side of the occiput and the opposite frontal region and face. Distinguish from unilateral craniosynostosis due to premature fusion of one coronal suture with lack of growth on that side (early surgical correction necessary) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">craniotabes (softening of skull bones) is a normal finding in most newborns and many infants up to 3 months. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="5_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Neck </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">the newborn baby generally appears to have a short neck. Midline swellings such as dermoid and thyroglossal cysts are uncommon </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">sternomastoid "tumour" - a hard lump in the body of the sternomastoid muscle appearing some days after birth. Caused by trauma or avascular necrosis. It may cause torticollis which usually improves with physiotherapy. Uncommon. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="6_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Eyes </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">examination difficult at first because of strong reflex closure. Baby often opens eyes if held erect. </div> <bR> <div> pupil should appear black and not grey. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">"red reflex" should be present. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">colour of iris indefinite and not predictable. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">sclerae often have a blue tinge. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">tears rare in first few weeks. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">infants are able to see from birth and should follow a red or bright moving object. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">subconjunctival haemorrhage: a bright red patch, often adjacent to the cornea has no serious significance and disappears within a few weeks. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">abnormally large eye/s may indicate congenital glaucoma (early treatment very important). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="7_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Nose and mouth </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">the newborn infant is an obligatory nose breather. Nasal obstruction, congenital (choanal atresia) or acquired (e.g. nasal secretions), may cause feeding problems or respiratory distress. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">sucking blisters: thickened areas on the upper lip, usually in the midline. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">epithelial pearls are small whitish areas a few mm across, usually visible in the midline on the hard palate. They are of no significance. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">tongue-tie when the frenulum linguae is inserted into or near the tip of the tongue, rarely interferes with sucking or future speech and is usually best left well alone. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="8"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Teeth </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">adventitious teeth may occasionally be present at birth. They are usually loose, do not interfere with sucking, and fall out spontaneously. Rarely, primary teeth may also be present at birth. </div> <div>  <A NAME="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Skin</B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="10"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Vernix caseosa </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Protective greasy white substance secreted by fetal sebaceous glands. Not present in preterm infants, and decreases in quantity after term. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="11"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Traumatic cyanosis of the face </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Due to many small petechial haemorrhages in the skin after congestion of the head with the cord around the neck. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="12"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Superficial skin peeling </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Common during the first week. It is especially marked in post-term or wasted babies. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="13"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Hair </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Colour at birth is poor guide to future shade. Lanugo is fine facial and body hair which is a feature of preterm babies. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="14"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Milia </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">White pin-head size spots mainly on and around nose. These are tiny sebaceous retention cysts and last a few weeks. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="15"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>"Mucus burns" </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Red scald-like lesions around the mouth and cheeks due to regurgitated gastric juice (high hydrochloric acid content). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="16"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>"Mongolian spot" </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Flat blue-black areas over sacrum or buttocks, and occasionally on back, shoulders, hands and feet. Disappear by 4 years. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="17"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Vascular naevi </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Salmon patches: superficial capillary haemangiomata may occur over the upper eyelids and on the nape of the neck (stork-bite). They usually fade by 1 year. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Strawberry naevus: a raised capillary haemangioma with a surface resembling a strawberry. At birth, the strawberry-to-be may show as a white (depigmented) patch of skin. Growth is rapid and it may easily reach 4 cm in diameter. It usually starts to subside by 1 year and most have disappeared by 7 years of age. Surgical removal is rarely necessary. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Port wine mark (naevus flammeus): may cover an extensive area. It persists for life. If situated over the ophthalmic division of the trigeminal nerve it may be associated with a meningeal haemangioma (Sturge-Weber syndrome). Large marks may require laser treatment later. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="18"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Erythema toxicum </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Very common. Red blotchy rash, associated with central pin-head papules (which may look like pustules but contain eosinophils) occurring between the second and eighth days. Seldom seen in preterm infants. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="19"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Fat necrosis </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Localized areas of induration on back, thighs, or face (after forceps delivery). It has a dark red appearance and may fluctuate. Resolves spontaneously but needs to be differentiated from skin abscesses. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="20"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Sclerema </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Very firm rubbery feel to the skin. Associated with severe infection, hypothermia or severe asphyxia. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="21"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Wasting </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Dry, loose skin hangs in folds due to loss of muscle and subcutaneous fat resulting from recent intrauterine starvation. </div> <div>  <A NAME="22"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Breasts</B> </div> <div> Breast enlargement is common in both male and female babies, usually lasting a week or two (but may persist for months). It is due to the effect of oestrogen and progesterone. No treatment is necessary. Handling must be avoided as this may cause true mastitis. </div> <div>  <A NAME="23"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Gastrointestinal tract</B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="24"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Vomiting </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Babies normally swallow a variable quantity of air when feeding and commonly bring up a small amount of milk when winded. Occasional large vomits without cause may occur. Persistent vomiting however, should be assessed carefully and investigated especially if bile is present. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="25"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Serious causes </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">alimentary tract obstruction due to atresia, meconium ileus, volvulus, strangulated hernia, inspissated milk, Hirschsprung's disease and necrotising enterocolitis </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">marked gastro-oesophageal reflux </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">infection (including urinary tract) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">cerebral pathology (including intracranial bleed or meningitis) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">metabolic disorders </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Faeces </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Meconium is passed within 48 hours of birth in the majority of babies. (When passed in utero it usually indicates fetal distress). Obstruction may rarely be caused by a firm meconium plug, and may be relieved by gently inserting a small glycerine suppository into the anus. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Stools replace meconium on day 3 or 4. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Breast milk stools are usually bright yellow (vary from orange to green), may vary from watery to pasty, and may contain mucus or milk curds. Two to five stools are usually passed each day, but the variation ranges from one stool a week to 12 a day. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Cow's milk (formula) stools are pale yellow, firmer and less frequent (up to 5 a day) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">"Starvation stools" which occur in under-fed infants are characteristically small and dark green </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Blood in stools is commonly due to swallowed maternal blood (distinguished from fetal blood by Apt test) </div> <div>  <A NAME="27"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Renal function</B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">newborn infants should pass urine within the first 24 hours </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">boys should pass urine with a good stream (dribbling suggests posterior urethral valves) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">in the first few weeks the infant empties his bladder up to 20 times a day </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">urates may colour the urine heavily leaving a brick-red stain on the nappy (sometimes mistaken for blood) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">the newborn kidney is less able to excrete a solute load and has a reduced concentrating capacity in comparison with the older child </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Urine collection: most easily done using a collecting bag, but contamination is a risk. Uncontaminated urine may be obtained by suprapubic bladder puncture. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="16" ALIGN="bottom" HSPACE="0" VSPACE="0"><A NAME="28"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Genitalia</B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">term male infants usually have testes in the scrotum at birth. The majority of incompletely descended testes come down within the first month </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">preterm babies tend to have incompletely descended testes and a less well-developed scrotum </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">fluid hernia (soft swelling of scrotum which transilluminates easily) is common. Most disappear spontaneously within the first year </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">foreskin is normally adherent to the glans penis and cannot be pulled back without trauma: 90% become fully retractable by the age of 3 years. Pulling back the foreskin in infancy is therefore not advisable and routine circumcision is medically unnecessary </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">a mucoid vaginal discharge is present in nearly all mature female infants at birth </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">vaginal bleeding occasionally occurs at the end of the first week (a hormone withdrawl effect of no pathological significance) </div> <bR> <bR> <div> The physical examination of the newborn infant should be performed in a fixed order to ensure that nothing is forgotten. First basic measurements are made, then the infant is inspected generally. Thereafter the infant is examined by regions starting at the head and ending at the toes. Finally the neurological status is assessed. The step by step examination given below lists what should be done and gives the normal and abnormal findings. </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="590" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="three"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>MEASUREMENTS</B></div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="four"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>BIRTHWEIGHT</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF><NOBR><div> 2500g or above </div> <div> Between 10th and 90th centile for gestational age</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 56 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF><NOBR><div> Low birthweight(below 2500g) </div> <div> Underweight(below 10th centile) </div> <div> overweight.(above 90th centile) for gestational age</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="5_2"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>HEAD CIRCUMFERENCE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF><NOBR><div> Between 10th and 90th centile for gestational age.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF><NOBR><div> Small head (below 10th centile) or </div> <div> Large head (above 90th centile) for gestational age</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="6_2"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>CROWN-HEEL LENGTH</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Between 10th and centile for gestational age. Measure accurately with tape or preferably measuring box.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Short (below 10th centile or tall (above 90th centile) for gestational age.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="7_2"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SKIN TEMPERATURE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF><NOBR><div> Abdominal wall 36 - 36.5°C (or axilla 36.5 - 37°C) </div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Hypothermia (below 35°C).</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="8_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>GENERAL INSPECTION</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="9_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>GESTATIONAL AGE</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Physical and neurological features of term infant.Term (37-41.9 wks).</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 57 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Immature features in preterm infant (below 37 weeks). </div> <div> Postterm infants. (42 weeks and above) have long nails and are often wasted</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="10_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>WELLBEING</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Active, alert.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Lethargic, appears ill.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="11_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>APPEARANCE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> No abnormalities.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Gross abnormalities. Abnormal faeces.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="12_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>WASTING COLOUR</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Well nourished. Pink tongue.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF><NOBR><div> Soft tissue wasting. Cyanosis, pallor, jaundice, plethora.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="13_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SKIN</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Smooth or mildly dry. Vernix and lanugo. Stork bite, mongolian spots, milia, erythema toxicum, salmon patches.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 76 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Dry, marked peeling.Meconium staining.Petechiae, bruising.Large or many pigmented naevi.Capillary or cavernous haemangioma. Skin infection. </div> <div> Oedema.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="14_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>HEAD</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="15_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SHAPE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Caput, moulding.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF><NOBR><div> Cephalhaematoma,subaponeurotic bleed. Asymmetry, anencephaly, </div> <div> hydrocephaly, encephalocoele</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="16_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>FONTANELLA</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Open, soft fontanelle with palpable sutures.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 57 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Full or sunken anterior fontanelle. Large or closed fontanelles. Wide or fused </div> <div> sutures.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="17_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>HAIR</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Wide familial variation. </div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Low posterior hair line.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="18_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>EYES</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="19_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>POSITION</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Hypertelorism or hypotelorism.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="20_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SIZE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Microphthalmia or macrocornea (glaucoma).</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="21_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>LIDS</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Mild oedema common.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF><NOBR><div> Marked oedema, ptosis bruising. Narrow palpebral fissures in FAS.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="22_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>CONJUNCTIVAE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> May have small subconjunctival haemorrhages</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF><NOBR><div> Pale or plethoric.Conjunctivitis. </div> <div> Excessive tearing when nasolacrimal duct obstructed.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="23_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>CORNEA, IRIS AND LENS</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Cornea clear, regular pupil, red reflex.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 57 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Opaque cornea,irregular pupil,cataracts, no red reflex, squint, abnormal eye </div> <div> movements.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="24_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>NOSE</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="25_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SHAPE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Small with upturned nostrils.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Flattened in oligohydramnios.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="26_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>NOSTRILS</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Both patent. Easy passage of feeding catheter</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Choanal atresia. Blocked with dry secretions</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="27_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>DISCHARGED</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Mucoid, purulent or bloody secretions</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="28_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>MOUTH</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="29"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>LIPS</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Sucking blisters.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Cleft lip. Long smooth upper lip, no philtrum and thin vermillion border in FAS.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="30"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>PALATE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Epstein's pearls</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> High arched or cleft palate.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="31"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>TONGUE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Pink</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Cyanosed, pale, macroglossia. Posteriorly placed (Pierre-Robin anomaly). </div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="32"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>TEETH</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> None at birth</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Adventitious or primary teeth.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="33"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>GUMS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Small cysts.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Epulis.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="34"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>MUCOUS MEMBRANES</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Pink, shiny.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Thrush, ulcers.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="35"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SALVIA</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Excessive if poor swallowing or oesophageal atresia.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="36"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>JAW</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Smaller than older child</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Micrognathia in Pierre-Robin anomaly.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="37"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>EARS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="38"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SITE</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Pinna vertical at term.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Ears rotated backwards with poorly formed upper pinna (low set).</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="39"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>APPEARANCE</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Familial variation.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Pre-auricular skin tag or sinus. Malformed ears. Hairy ears in I.D.M.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="40"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>NECK</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="41"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SHAPE</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Usually short.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Webbing, torticollis.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="42"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>MASSES</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> No palpable lymph nodes or thyroid</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Cystic hygroma. Goitre. Sternomastoid tumour. </div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="43"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>CLAVICLE</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Swelling or crepitus if fractured.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="44"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>BREASTS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Palpable breast nodules at term 0.5 to 1 cm. Enlarged, lactating breasts</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Accessory or wide spaced nipples. Mastitis.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>HEART</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="46"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>PULSES</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Brachial and femoral pulses easily palpable. 120 - 160 beats per minute.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Pulses weak, collapsing, absent, fast or slow.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="47"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>CAPILLARY FILLING TIME</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Less than 4 seconds over chest and peripheries.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Prolonged filling time if infant cold or shocked.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="48"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>BLOOD PRESSURE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Systolic 50 to 90mm at term. </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Hypertensive or hypotensive. </div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="49"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>PRECORDIUM</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Mild pulsation felt over heart and epigastrium</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Hyperactive precordium.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="50"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>APEX BEAT</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Heard maximally to left of sternum</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Heard best in right chest in dextrocarida.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="51"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SOUNDS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Loud, single 2nd heart sound on day 1</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Gallop, widely split second sound.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="52"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>MURMURS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Soft, short systolic murmur common on day 1.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Systolic or diastolic murmurs.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="53"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>HEART FAILURE</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Oedema, hepatomegaly, tachypnoea or excessive weight gain.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="54"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>LUNGS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="55"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>RESPIRATION RATE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> 40-60 breaths per minute. Irregular in REM sleep. Periodic breathing with no change in heart rate or colour. </div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Tachypnoea - above 60 breaths per minute. Gasping. Apnoea with drop in heart rate, pallor or cyanosis</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="56"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>CHEST SHAPE</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Symmetrical.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Hyperinflated or hypoplastic chest.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="57"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>CHEST MOVEMENT</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Symmetrical.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Asymmetrical in pneumothorax and diaphragmatic hernis.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="58"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>RECESSION</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Mild recession in prems</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Subcostal recession in respiratory distress.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="59"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>GRUNTING</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Expiratory grunt in respiratory distress.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="60"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>STRIDOR</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Inspiratory stridor a sign of upper airway obstruction.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="61"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>PERCUSSION</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Resonant bilaterally.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Dull with effusion or haemothorax. </div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="62"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>AIR ENTRY</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Egual air entry over both lungs. Bronchovesicular.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Unegual or decreased.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="63"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>ADVENTITIOUS SOUNDS</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Transmitted sounds.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=TOP BGCOLOR=#FFFFFF WIDTH="487"><div> Crackles, wheeze or decreased.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>ABDOMEN</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="65"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>UMBILICUS</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> 2 arteries and 1 vein. </div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> 1 artery, 1 vein .Infection. Bleeding or discharge. Hernia. Exomphalos.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="66"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SKIN</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Periumbilical erythema or oedema.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="67"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SHAPE</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Distended or hollow.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="68"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>LIVER</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Palpable 1 cm below costal margin, soft.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Enlarged, firm, tender.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="69"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SPLEEN</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Not easily palpated.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Enlarged, firm.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="70"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>KIDNEYS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Often palpable but normal size.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Enlarged, firm.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>MASSES</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> No other masses palpable. Full bladder can be percussed.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Palpable mass.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="72"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>BOWEL SOUNDS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Heard immediately on auscultation.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Depressed or absent.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="73"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>ANUS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Patent. Skin tags.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Absent or covered. Displaced anteriorly.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="74"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>STOOLS</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Meconium passed within 48 hours of birth. Yellow stools by day 5. Breastfed stool may be green and mucoid.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Blood in or on stool. White stools in obstructive jaundice. Offensive watery stools.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="75"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SPINE</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Coccygeal dimple or sinus. Straight spine.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Sacral dimple or sinus. Scoliosis. Meningomyelocoele.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="76"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>GENITALIA</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="77"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>PENIS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Urethral opeining at centre of glans.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Hypospadias. Micropenis.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="78"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>TESTES</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Descended by 37 weeks</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Undescended.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="79"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SCROTUM</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Well formed at term.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Inguinal hernia. Fluid hernia.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="80"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>VULVA</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Skin tags, mucoid or bloody discharge.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Fusion of labia.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="81"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>CLITORIS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Uncovered in preterm or wasted infants.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Enlarged in adrenal hyperplasia.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="82"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>URINE</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Passed in first 12 hours.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Poor stream suggests posterior urethral valve.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="83"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>ARMS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Flexed position in term infant.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Erb's palsy.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="84"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>HANDS</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Extra, fused or missing digits. Skin stags. Single palmar crease. Hypoplastic nails</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="85"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>HIPS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Click common. Fully abducted.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Dislocated or dislacatable. Limited abduction.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="86"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>LEGS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Mild bowing of lower legs common</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Dislocatable. Knees in breech.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="87"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>FEET</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Positional deformation.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Clubbed feet. Abnormal toes.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#00FFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="88"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>NEUROLOGICAL STATUS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="89"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>BEHAVIOUR</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Alert, responsive.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Drowsy, irritable, jittery.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="90"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>POSTION</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Flexion of all limbs at term.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Extended limbs or frog position in preterm and ill infants.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="91"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>MOVEMENT</B></div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 38 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Active. Moves all limbs equally when awake. Stretches, yawns and twists trunk.</div> </tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Absent, decreased or asymmetrical movement. Jittery or convulsions</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="92"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>TONE</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Hypotonia in preterm infants.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Hypotonia or hypertonia. Asymmetrical tone.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="93"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>HANDS</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Intermittantly clenched. </div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Permanently clenched.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="94"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>CRY</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Good cry when awake</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Weak, high pitch or hoarse cry.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="95"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>VISION</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Follow a face, bright light or red object.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Absent or poor following.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="96"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>HEARING</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Responds to loud noise.</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> No response.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="97"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>SUCKING</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Good suck and rooting reflexes after 36 weeks gestation.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Weak suck at term.</div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 BGCOLOR=#FFFFFF HEIGHT= 20 WIDTH="584"><div>  <A NAME="98"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>MORO REFLEX</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF><NOBR><div> Full extension then flexion of arms and hands. Symmetrical.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFFF HEIGHT= 19 WIDTH="96"><div> Abnormal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFFF WIDTH="487"><div> Absent, incomplete or asymmetrical response.</div> </tD> </tR> </TABLE></div> <DIV ALIGN="LEFT"></DIV> <div> When the history has been taken and the physical examination completed, an overall assessment of the infant must be made and a list of the problems compiled. The management of each problem in turn must now be addressed. </div> <div>  <A NAME="99"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Examination of the Hips:</B> </div> <div> The hips must be examined in all newborn infants to exclude congenital dislocation or an unstable hip. </div> <div> The infant is examined lying on his back with the hips flexed to a right angle and knees flexed. </div> <div>  <A NAME="100"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Ortolani test :</B> Both thighs are held so that the examiner's fingers are over the greater trochanters and his thumbs rest on the inner aspects of each thigh. The thighs are then abducted: if a hip is dislocated, a 'clunk' can be felt and heard as the femoral head slips forward into its normal position in the acetabulum. </div> <div>  <A NAME="101"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Barlows Test :</B> demonstrates an unstable or dislocatable hip. One hand immobilizes the pelvis (thumb over pubic ramus, fingers over sacrum) while the other hand moves the opposite thigh into mid-abduction. If the hip is unstable, backward pressure on the lesser trochanter with the thumb on the inner side of the thigh causes the femoral head to slip out of the acetabulum. Conversely forward pressure on the greater trochanter with the fingers would tend to cause the head to spring back into the acetabulum. The same procedure is then carried out for the opposite side. </div> <bR> </td> </tr></table></body>