Medical Student Curriculum Guide
Knowledge—Issues Unique to the Newborn

Rationale

The transition from intrauterine life to extrauterine independent existence is a major event: physiologically for the baby, emotionally for the family, and medically for the health care team. The events before, during and after delivery can have profound and lifelong effects on the baby, and therefore physicians, whether as primary care providers or as specialists, must have an appreciation for the physiologic changes a newborn experiences. The newborn has unique needs and vulnerabilities which are distinct from other periods of infancy. Most of the information covered in this section is pertinent in the first few hours and days of life. However, the newborn period extends to the first month of life.

Learning Objectives

Describe the important historical information, physical exam findings, and laboratory data helpful in developing the differential diagnosis for the presentations in Table 1.

Table 1: Problems of Newborns
Clinical Presentation	Common Causes*	Others Problems to Consider
Jaundice	physiological jaundice hemolytic disease inadequate intake systemic infection hematoma	billiary atresia inborn metabolic disorders hepatitis
Lethargy or Poor Feeding	sepsis immaturity perinatal asphyxia	neuromuscular problems
Respiratory Distress	respiratory distress syndrome transient tachypna pneumonia meconium aspiration sepsis	congenital heart disease pneumothorax
Cyanosis	cyanotic congenital heart disease airway compromise poor lung expansion pulmonary disorders acrocyanosis	congenital pulmonary defects diaphramatic hernia persistent pulmonary hypertension
Bilious Vomiting	intestinal atresia volvulus
Non-bilious Vomiting	overfeeding gastrointeritis reflux	esophageal atresia sepsis pyloric stenosis CNS problems metabolic errors
Hypoglycemia	IDM (infant of a diabetic mother) prematurity small or large for gestional age perinatal asphyxia	hemolytic disease polycythemia
Sepsis	bacterial infection viral infection	perinatal/mother infectious congenital infections (e.g. TORCH)
Jitteriness or seizures	drug withdrawal hypoglycemia hypocalcemia	intracrainal bleed inborn metabolic disorders

*These diagnoses are not intended to be the limit of conditions to consider but are to help students focus learning on key conditions.

Identify which diseases are detected by neonatal blood screening.
Recognize factors in the maternal and newborn history which may put a neonate at risk for medical problems.
Describe the special methods involved in performing a newborn physical examination (i.e. assessment of hip dysplasia, eye exam).
Identify the key concepts used in the clinical evaluation of gestational ageand stability at birth (e.g. the Dubowitz exam and the APGAR). Use weight and gestational age to categorize potential clinical problems.
Identify what medications are routinely given to all newborns (e.g. vitamin K, Hepatitis B vaccine, ophthalmologic prophylaxis).
Demonstrate knowledge of risk of maternal/fetal HIV transmission and prevention, as well as indications for newborn HIV screening.

Competencies

Gather appropriate history from parents/guardian and chart; perform a physical exam on a well or ill newborn and describe routine issues to counsel parents about.
Develop a reasonable differential diagnosis and evaluation scheme for newborns with clinical presentations as described in objective number 1.


Copyright 2003 Medical College of Georgia All rights reserved.	School of Medicine \| Medical College of Georgia Please email comments, suggestions or questions to: Kenda Rindt, krindt@mail.mcg.edu. May 28, 2003

Medical Student Curriculum Guide Knowledge—Issues Unique to the Newborn

Medical Student Curriculum Guide
Knowledge—Issues Unique to the Newborn