This document provides an overview of common conditions seen in newborns during a pediatrics rotation. It discusses topics like the APGAR score, common physical exam findings, neonatal screening, jaundice, respiratory disorders, gastrointestinal disorders, genitourinary disorders, neonatal fever, TORCH infections, and conjunctivitis. For each topic, it provides brief descriptions of important conditions, their typical presentations, diagnostic steps, treatments, and other relevant details. The document aims to prepare medical students and residents for cases they may encounter during a pediatrics rotation or shelf exam.

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Pediatrics Rotation and Shelf Review
Nicholaus Josey

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The Newborn
 APGAR
 Calculated at 1 and 5 minutes
 Appearance
 Pulse
 Grimace
 Activity
 Respiration
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3. +
The Newborn
APGAR
 1 minute reading
 Tells how the newborn tolerated labor
 5 minute reading
 Tells the newborn’s response to resuscitation
 Does NOT predict neurological outcome
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4. +
The Newborn
APGAR
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5. +
The Newborn
On Physical Exam
 Asymmetric Moro Reflex on a large for gestational
age infant and…
 Left arm extended and medially rotated
 Erb-Duchenne (C5-C6)
 Refer if not better by 3-6 mo for neuroplasty
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6. +
The Newborn
On Physical Exam
Asymmetric Moro Reflex on a large for
gestational age infant and…
Palpation of the clavicles shows crepitus
Clavicular fracture
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7. +
The Newborn
On Physical Exam
 Edema CROSSING suture lines
 Caput Succedaneum
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8. +
The Newborn
On Physical Exam
 Edema NOT CROSSING suture lines
 CephalNOhematoma
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9. +
The Newborn
On Physical Exam
 Dermatologic findings
 Mongolian Spots
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10. +
The Newborn
On Physical Exam
 Dermatologic findings
 Milia
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11. +
The Newborn
On Physical Exam
 Dermatologic findings
 Nevus Simplex
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12. +
The Newborn
On Physical Exam
 Dermatologic findings
 Seborrheic Dermatitis
 Tx: Mild shampoo
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13. +
The Newborn
On Physical Exam
 Dermatologic findings
 Nevus Sebaceous
 Tx: Remove before adolescence
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14. +
The Newborn
 Neonatal Screening
 Screening varies by state
 Two disorders checked for in every state
 Phenylketonuria
 Deficient Phenylalanine Hydroxylase
 Tx: Low phenylalanine diet
 Galactosemia
 Deficient G1P-uridyl-transferase
 Tx: No lactose for life
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15. +
The Newborn
 Neonatal Jaundice
 The following are scenarios designed to mimic patient
presentations in question stems
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16. +
The Newborn
 Yellow Babies
 Three day old
 Elevated Total Bilirubin and regular Direct Bilirubin
 Baby is eating and pooping well!
 Physiologic jaundice
 Gone by 5th day
 Liver conjugation not yet mature
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The Newborn
 Yellow Babies
 Nine day old
 Total Bilirubin less than 15 but Direct Bilirubin of 0.5
 Dry mucous membranes and no weight gain
 Breast feeding jaundice
 Inadequate feeding = dehydration
 Tx: Increase the number of feedings or duration
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18. +
The Newborn
Yellow Babies
 18 hour old
 Elevated Total Bilirubin and Direct Bilirubin
 No major complaints
 Pathologic Jaundice
 Jaundice under 24hr old is ALWAYS pathologic
 Must rule out SEPSIS or other possible causes
 Next best test: Coombs test
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19. +
The Newborn
 Yellow Babies
 Eight day old
 Normal Total Bilirubin but Markedly Elevated Direct Bilirubin
 Dark urine with pale stool
 Biliary atresia
 Bile ducts cannot drain
 Eventual liver failure
 Increased liver function tests
 Tx: Surgery
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20. +
The Newborn
 Yellow Babies
 Jaundice’s major complication?
 Kernicterus
 Bilirubin deposits in the basal ganglia and
brain stem
 Tx: for mild: Phototherapy
 Tx: for severe: Double volume exchange transfusion
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The Newborn
Respiratory Disorders
 Diaphragmatic Hernia
 Baby born with:
 Respiratory distress
 Scaphoid abdomen
 Bowel sounds in thorax
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The Newborn
Respiratory Disorders
 Diaphragmatic Hernia
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The Newborn
Respiratory Disorders
 Diaphragmatic Hernia
 Biggest Complication
 Pulmonary hypoplasia
 Best Tx:
 If Dx prenatally use extracorporeal membrane oxygenation
to let lungs mature prior to surgery
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The Newborn
Respiratory Disorders
 Tracheoesphogeal Fistula
 Baby born with:
 Respiratory distress
 Excess Drooling
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25. +
The Newborn
Respiratory Disorders
 TE Fistula
 Best Dx Test:
 Observation of a coiled feeding tube on CXR
 Associated with:
 VACTERL abnormalities
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26. +
The Newborn
Respiratory Disorders
 Choanal Atresia
 Baby born with:
 Cyanosis when feeding
 Pink when crying
 Associated with:
 CHARGE syndrome
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The Newborn
Respiratory Disorders
 Neonatal Respiratory Distress Syndrome (NRDS)
 Premature baby born with:
 Dyspnea
 High respiratory rate
 Nasal flaring
 Pathophysiology
 Surfactant deficiency
 Tx: 02 therapy with nasal CPAP
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The Newborn
Respiratory Disorders
 Transient Tachypnea of the Newborn (TTN)
 LGA baby born with:
 Dyspnea
 Grunting
 Delivered via c-section
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29. +
The Newborn
Respiratory Disorders
 Transient Tachypnea of the Newborn (TTN)
 Pathophysiology
 Lung fluid not squeezed via vaginal birth
 Tx: Oxygen therapy
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The Newborn
Respiratory Disorders
 Meconium Aspiration Syndrome
 Baby born with:
 Dyspnea
 Low Oxygen saturation
 Rupture of Membranes shows greenish-brown fluid
 Next Best Step:
 Intubate and suction
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The Newborn
Respiratory Disorder Review
 Diaphragmatic Hernia
 Bowel sounds in thorax
 Pulmonary hypoplasia
 TE Fistula
 Labored breathing
 Coiled feeding tube on CXR
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The Newborn
Respiratory Disorder Review
 Choanal Atresia
 Cyanotic when feeding Pink when crying
 NRDS
 Premature Babies
 Surfactant deficiency
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The Newborn
Respiratory Disorder Review
 TTN
 Occurs in LGA infants
 Transient excess pulmonary fluid retention
 Meconium Aspiration Syndrome
 Rupture of Membranes yields a green-brown fluid
 Tx: intubation and suction
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The Newborn
GI Disorders
 Gastroschisis
 Defect lateral to the umbilicus
 No sac covering GI contents
 High maternal AFP
 Complications:
 Removal will lead to short gut syndrome
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The Newborn
GI Disorders
 Omphalocele
 Defect in the midline
 Sac covering GI contents
 High maternal AFP
 Associated with:
 Trisomies
 Beckwith-Wiedemann Syndrome
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The Newborn
GI Disorders
 Vomiting Babies
 Pyloric Stenosis
 Non-bilious and projectile
 Palpable olive mass
 Hypochloremic, hypokalemic, metabolic alkalosis
 Tx:
 Stabilize electrolyte imbalance
 Surgical myotomy
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The Newborn
GI Disorders
 Vomiting Babies
 Intestinal Atresia
 Bilious
 Pregnancy complicated by POLYhydramnios
 Associated with Down’s
 Tx:
 Surgery
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The Newborn
GI Disorders
 Vomiting Babies
 Malrotation and volvulus
 Bilious
 Baby draws legs towards abdomen
 Abdominal distention
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The Newborn
GI Disorders
Vomiting Babies
 Malrotation and volvulus
 Pathophysiology
 Gut does not rotate fully around the superior
mesenteric artery (SMA)
 Tx:
 Surgery
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The Newborn
GI Disorders
 Pooping Problems
 Meconium ileus
 Delayed passage of meconium
 Consider association with Cystic Fibrosis
 Tx:
 Gastrograffin enema is both Dx and Tx
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41. +
The Newborn
GI Disorders
 Pooping Problems
 Hirschsprung’s Disease
 Failure of neural crest cells migration
 Explosion of meconium on digital rectal exam
 Rectal biopsy is GOLD STANDARD for Dx
 No ganglia present
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42. +
The Newborn
 GI Disorders
 Pooping Problems
 Necrotizing Enterocolitis
 Common in prematurity
 Bloody diarrhea
 Pneumocystis intestinalis seen on x-ray
 Tx:
 Nil per os “nothing per mouth”
 Total parenteral nutrition
 Antibiotics and possible resection of necrotic bowel
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The Newborn
GI Disorders
 Pooping Problems
 Intussusception
 Currant jelly stool
 Sausage shaped mass in Right Upper Quadrant
 Colicky abdominal pain
 Tx:
 Barium enema
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44. +
The Newborn
GI Disorder Review
Gastroschisis
 Defect lateral to the umbilicus
 No sac covering GI contents
Omphalocele
 Defect in the midline
 Sac covering GI contents
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45. +
The Newborn
GI Disorder Review
Pyloric Stenosis
 Palpable olive mass
 Hypochloremic, hypokalemic, metabolic alkalosis
Intestinal Atresia
 Pregnancy complicated by POLYhydramnios
 Associated with Down’s Syndrome
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46. +
The Newborn
GI Disorder Review
 Malrotation and volvulus
 Bilious Vomiting
 Baby draws legs towards abdomen
 Meconium ileus
 Delayed passage of meconium
 Consider association with Cystic Fibrosis
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The Newborn
GI Disorder Review
Hirschsprung’s Disease
 Failure of neural crest cells migration
 Rectal biopsy is GOLD STANDARD for Dx
Necrotizing Enterocolitis
 Common in prematurity
 Bloody diarrhea
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48. +
The Newborn
GI Disorder Review
 Intussusception
 Currant jelly stool
 Sausage shaped mass in Right Upper Quadrant
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49. +
The Newborn
GU Disorders
 Cryptorchidism
 Male with no palpable testes
 Usually found in the inguinal canal
 Next best step: Ultrasound to confirm
 Tx: Surgery if not descended by one year
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50. +
The Newborn
GU Disorders
 Hypospadias
 Urethral opening on VENTRAL side of penis
 Do NOT circumcise
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51. +
The Newborn
GU Disorders
 Epispadias
 Urethral opening on Dorsal side of penis
 Can lead to bladder Extrophy
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52. +
The Newborn
Neonatal Fever
 Sepsis
 Less than 28 days old
 Fever greater than 100.4
 Symptoms include irritability and poor feeding
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53. +
The Newborn
Neonatal Fever
 Sepsis
 Diagnostic tests include:
 CBC with differential
 CXR
 Cultures
 LP
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54. +
The Newborn
Neonatal Fever
 Sepsis
 Most common causes:
 Group B Strep
 E. Coli
 Lysteria monocytogenes
 Empiric Tx:
 Ampicilin and gentamycin until 48 hr CXR are negative
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55. +
The Newborn
TORCH Infections
 Toxoplasmosis
 Hydrocephalus
 Intracranial calcifications
 Chorioretinitis
 Tx:
 Sulfadiazine and leucovorin
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56. +
The Newborn
TORCH Infections
 Syphilis
 Maculopapular rash on palms and soles
 Runny nose
 Periostitis
 Tx:
 Penicillin
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57. +
The Newborn
TORCH Infections
 Rubella
 Cataracts
 Deafness
 PDA or VSD
 Extramedullary hematopoeisis
 Tx:
 No treatment
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58. +
The Newborn
TORCH Infections
 CMV
 Microcephaly
 Periventricular calcifications
 Deafness
 Thrombocytopenia
 Petechiae
 Tx:
 Gancycilovir
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59. +
The Newborn
TORCH Infections
Herpes
 Encephalitis
 Herpetic lesions
 Tx:
 Acycilovir
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60. +
The Newborn
Conjunctivitis
 First – Third Day of Life
 Chemical conjunctivitis
 Red and tearing
 Caused by silver nitrate drops
 Uncommon because erythromycin now used
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61. +
The Newborn
 Conjunctivitis
 Third – Fifth Day of Life
 Gonococcal conjunctivitis
 Bilateral purulent discharge
 Can cause corneal ulceration
 Tx:
 Topical erythromycin
 IV 3rd generation cephalosporin
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The Newborn
Conjunctivitis
 Seventh Day – 2nd Week of Life
 Chlamydia conjunctivitis
 Red conjunctiva
 Mucoid discharge
 Lid swelling
 Can cause chlamydial pneumonia
 Tx:
 Oral Erythromycin
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