Abnormal neonatal findings in primary care settings. Dr. Mohamed Ahmed MD, MSc, MEd, MRCPCH, RCPSC Neonatology. Assistant professor, Pediatric, University of Toronto Important finding to rule out

• Dysmorphic features. • Red Reflex/Cataract. • Cleft plate. • Murmur. • Hypospadias/ undescended testes. • DDH. • Imperforate /. • Spinal anomalies. • Femoral pulses. • Anus. Colour

• Cyanosis generalized/ differential /acrocyanosis • Jaundice • Pallor/plethora • Meconium 2014 Health Fixit https://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/difference-between-caput-succedaneum-and-cephalhematoma Mosby's Medical Dictionary, 9th edition. © 2009, Elsevier. Mosby's Medical Dictionary, 9th edition. © 2009, Elsevier. s-media-cache-ak0.pinimg.com http://mediphotos.blogspot.com/2012/01/illustrated-cephalohematoma-vs-caput.html https://emedicine.medscape.com/article/1110134. Head examination

• Molding/caput and cephalohematoma • subgaleal hematoma • overlapping suture • AF/PF • Cutis aplasia https://en.wikipedia.org/wiki/Congenital_cataract https://med.stanford.edu/newborns/professional-education/ photogallery/eyes.html#subconjunctival_haemorrhage. https://www.pinterest.ca/pin/104075441362357819. Eyes

• Conjunctival hge • Leukocoria/Cataract • Glaucoma Ears

• Pits • Tags • Low set ears • Malformation https://www.skintagsgone.com/skin-tags-on-the-ear-at-birth. https://www.mdmag.com/journals/family-practice-recertification/2014/june-2014/congenital- skin-lesion-in-a-newborn https://med.stanford.edu/newborns/professional- education/photo-gallery https://med.stanford.edu/newborns/professional- education/photo-gallery https://med.stanford.edu/newborns/professional- education/photo-gallery https://howardjbennett.com/2014. https://www.consultant360.com/articles/intraoral-ranula https://www.breastfeedingbasics.com/articles/tongue-tie. Mouth

• Cyanosis • Epicanthal inclusion cyst/Epstein pearls • Natal tooth • Cleft lips / palate • tie • • Micrognathia / Pierre Robin syndrome https://openi.nlm.nih.gov/detailedresult. https://www.consultant360.com. Neck

• Webbing • Thyroid enlargement • Sternocledomastoid tumour. • Clavicle. N Engl J Med 2009; 360:1445 DOI: 10.1056/NEJMicm0707832. Chest

• Gynecomastia • Widely spaced nipples

• Murmur 1/12 https://quizlet.com/24316234/chp-9-neonatology-disease-and- disorder https://emedicine.medscape.com/article/975422-clinical. https://www.slideshare.net/baselzaid1/omphalitis-2 https://community.babycenter.com/post/a59261542/los_umbilical_hernia . Abdomen

• Liver 2cm • Lower pole of the • Spleen tip • Diaphragmatic hernia • Mass • • Omphalitis • Stump vessels. http://creogreview.wikifoundry.com/photo/11497550/ambiguous+genitalia Extremeties

• Erb’s • Hips • Polydactyly • Talipes • Metatarsus varus Back

• Scoliosis • Sacral dimple. Natal cleft line Austin Neurosurg Open Access. 2014;1(4): 1016. Sacral Dimple–the Role and Yield of Imaging. Sy C, Nyame V https://med.stanford.edu/newborns/professional-education/photo gallery/back.html#sacral_dimple. Anus

• Imperforate anus. • Perianal fistula. Neurological

• Muscle tone • Primitive reflexes https://community.whattoexpect.com/forums/june-2014-babies/topic/hemangioma- strawberry-birthmark.html https://www.healthline.com/health/milia http://www.atlasdermatologico.com. Mosby's Medical Dictionary, 9th edition. © 2009, Elsevier. https://www.webmd.com/skin-problems-and-treatments/port- wine-stain-birthmarks. skin

• Mongolian spots • Milia • Erythema toxicum • Pustular melanosis

• Neonatal acne • Hemangioma • Amniotic bands Take home message

DON’T MISS: • Dysmorphic features. • Res Reflex/Cataract. • Cleft plate. • Murmur. • Hypospadias/ undescended testes. • DDH. • Imperforate anus/fistula. • Spinal anomalies. • Femoral pulses. • Anus. Take home message Omphalitis is a fatal condition.