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Figure 7.61. Serial chest radiographs of an infant with left lung and right upper lobe opacification as the result of right mainstem bronchus intubation left . After repositioning the endotracheal tube there was rapid resolution of the atelectasis right . Figure 7.62. Lateral view of the chest and abdomen in an infant who has a swallowed endotracheal tube. Note that the endotracheal tube is a cuffed tube which is rarely used at the present time. During resuscitation instead of endotracheal...
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Figure 7.19. Calcification of the scalp veins following intravenous infusion of sodium bicarbonate and calcium gluconate. Deep areas of necrosis may occur following infiltration from intravenous solutions containing calcium. Figure 7.19. Calcification of the scalp veins following intravenous infusion of sodium bicarbonate and calcium gluconate. Deep areas of necrosis may occur following infiltration from intravenous solutions containing calcium. Figure 7.20. Radiographic series of an infant's...
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Figure 7.41. Severe atrophy and gangrene of the left lower extremity in an infant as a result of umbilical artery catheter placement. This can occur as a result of vasospasm or clot formation in a major vessel with inadequate collateral support in a very low birth-weight infant. Figure 7.41. Severe atrophy and gangrene of the left lower extremity in an infant as a result of umbilical artery catheter placement. This can occur as a result of vasospasm or clot formation in a major vessel with...
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Figure 7.37. Anteroposterior and lateral radiographic views of a free, broken umbilical artery catheter lying in the abdominal and thoracic aorta. The catheter broke at the insertion site during planned removal. The remaining catheter had to be surgically removed. Figure 7.37. Anteroposterior and lateral radiographic views of a free, broken umbilical artery catheter lying in the abdominal and thoracic aorta. The catheter broke at the insertion site during planned removal. The remaining catheter...
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Figure 7.25. Hypopigmentation, alopecia and scarring on the scalp of a former very low birth weight premature infant birth weight 700 g following multiple scalp vein infiltrations. Figure 7.25. Hypopigmentation, alopecia and scarring on the scalp of a former very low birth weight premature infant birth weight 700 g following multiple scalp vein infiltrations. Figure 7.26. Scalp infiltration of total parenteral nutrition fluid and intralipid in an infant at the age of 7 days. This healed without...
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Figure 7.50. Autopsy specimen of the aorta with periumbilical artery catheter thrombosis. Figure 7.49. Autopsy specimen demonstrating thrombosis involving the aorta, iliac arteries and renal arteries following umbilical artery catheteriza-tion at birth. The infant died at the age of 12 days. Figure 7.50. Autopsy specimen of the aorta with periumbilical artery catheter thrombosis. Figure 7.51. Autopsy specimen of the bladder. Note the engorged hemorrhagic bladder wall which was the result of an...
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Figure 7.5. Circular lesions on the back of an infant as a result of skin burns from a faulty tran-scutaneous pO2 electrode. With the advent of pulse oximetry the transcutaneous electrodes are rarely used nowadays. Figure 7.7. Hypopigmentation of the skin of the lower abdomen as a result of scarring from application of tape in the newborn intensive care unit. Trauma to the skin from adhesive tape is not uncommon, especially in very low birth weight infants. The hypopigmentation improves over...
Uterine Rupture
Figure 4.38. This mother had a history of a difficult previous abortion. With this pregnancy she had a spontaneous rupture of the uterus. On laparotomy a large perforation was noted in the uterus through which the infant's lower extremities presented. Note the compression edema and ecchymoses of the left leg and the gangrene of the right foot. Figure 4.38. This mother had a history of a difficult previous abortion. With this pregnancy she had a spontaneous rupture of the uterus. On laparotomy a...
Babies Born In The Caul
Figure 4.21. Fetus born in a caul with a nuchal cord. Cord around the neck once is present in about 20 of deliveries and, in about 2 of deliveries, there is a cord around the neck twice. This common finding generally does not cause problems unless the cord constricts the neck tightly. Klima, T. Figure 4.21. Fetus born in a caul with a nuchal cord. Cord around the neck once is present in about 20 of deliveries and, in about 2 of deliveries, there is a cord around the neck twice. This common...
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Figure 4.66. Left radial nerve palsy in a neonate presents as a typical wrist-drop. The condition probably results from interference with blood supply to the nerve if there is abnormal compression or traction during a difficult labor. With the wrist-drop there is ability to grip with the fingers and voluntary extension of the fingers. A similar appearance may occur in an infant with a postural deformity, or a pseudo wrist-drop may be seen in a floppy, hypotonic infant hence it is important to...
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Figure 4.51. Radiograph of the neck showing the cervical cord and spinal injury following breech delivery. Note the fracture dislocation and separation involving C5 and C6. Figure 4.52. Congenital torticollis is usually not apparent at birth but within the first week a swelling is noted over the sternoclei-domastoid muscle stenomastoid tumor . This is thought to occur as a result of spasm, hemorrhage or fibrosis. It results in shortening of the sternocleidomastoid muscle and tilting of the...
Asymmetric Crying Facies
Figure 4.59. Facial nerve palsy occurred in this infant as a result of application of forceps. It may also occur following prolonged labor in a mother with a prominent sacral promontory. Note the ptosis and drooping mouth on the right side. Figure 4.60. This shows the same infant crying. The facial palsy becomes readily apparent. This demonstrates how easily the diagnosis may be missed in a quiet or sleeping infant. There is diminished movement of the affected side of the face, the eye...
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Figure 4.50. Cervical cord injury. This very rare complication is invariably associated with breech delivery. Note the crying infant lying flat on the bed in the pithed-frog position with abdominal distention due both to lack of muscle tone and to an enlarged bladder. Figure 4.49. This infant had depression on both sides of its skull from its intrauterine position. Note that this is not traumatic and requires no treatment. Figure 4.50. Cervical cord injury. This very rare complication is...
Forceps Delivery
Figure 7.2. After delivery of the infant, radiography showed the presence of the BB pellet at the distal end of the femur. The infant had a normal course. Figure 7.2. After delivery of the infant, radiography showed the presence of the BB pellet at the distal end of the femur. The infant had a normal course. Figure 7.3. This infant developed swelling and some erythema over the frontal area. Radiography of die skull shows periosteal elevation of the frontal bone. This resulted from die...
Caudal Regression Syndrome
Figure 5.57. Frontal view of another infant with arthrogryposis. Extreme intrauterine compression over an extended period of time can produce such severe distortion in multiple joints that supporting ligaments become contracted and opposing tendons stretch. The muscles acting across these joints may atrophy, creating a picture indistinguishable from the intrinsic forms of arthrogryposis multiplex congenita. Figure 5.56. This infant with arthrogryposis demonstrates the severe congenital joint...
Umbilical Artery In Adults
Figure 7.9. Percutaneous alcohol absorption with resultant erythema and burns to the buttocks of a premature infant. During placement of an umbilical arterial catheter, alcohol or iodine may track down the sides of the abdomen and soak the underlying sheet. Evaporation is restricted from the skin in contact with the underlying sheet and this may result in irritation, erythema, and severe burns, especially in a premature infant with very sensitive skin. Figure 7.9. Percutaneous alcohol...
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Figure 7.43. Discoloration with gangrene of the right buttock following umbilical artery catheter placement. Figure 7.43. Discoloration with gangrene of the right buttock following umbilical artery catheter placement. Figure 7.44. The same infant 10 days later showed marked improvement of the buttock. Figure 7.44. The same infant 10 days later showed marked improvement of the buttock. Figure 7.45. Gangrene of the left buttock following umbilical artery catherization. The umbilical artery...
Fetal Qrowth and Assessment of Gestational Age
The normal term infant has completed a gestation of gt 37 weeks and has a birth weight gt 2500 g. Accurate dating of pregnancy is important in evaluating the abnormally grown infant at birth. There are two different populations of low birthweight infants, those who are 1 born premature in gestation i.e, at lt 37 weeks or 2 small for gestational age SGA . Infants are SGA for one of two reasons 1 a normal intrauterine environment but abnormal development due to fetal factors i.e., chromosomal...
Amyoplasia Congenita Disruptive Sequence
Figure 5.63. The same infant showing a close-up of the right wrist and hand. Note the dimples at the contracture site. In this condition there may be cord wrapping of the limb and amniotic bands. Figure 5.61. Lateral view of the same infant shows the marked underdevelopment of the hips, the arthrogryposis, webbing, and the dimples at the joints due to lack of movement. Note the talipes calcaneovalgus. Figure 5.62. An infant with an amyoplasia congenita disruptive sequence. In this condition the...
Severe Scoliosis
Figure 5.91. The early amnion rupture spectrum caused a limb body wall deficiency with spine and central nervous system defects in this infant. Note the hydrocephalus. Figure 5.92. The limb body wall deficiency in this infant caused a severe thoracoabdominal wall defect. Note the severe scoliosis and kyphosis and the short umbilical cord with the placenta attached to the abdominal viscera. Figure 5.92. The limb body wall deficiency in this infant caused a severe thoracoabdominal wall defect....
Amniotic Band Syndrome
Figure 5.69. Another example of the amniotic band syndrome in which the amputated digits, raw areas and strand of amnion on the right hand can be seen. Figure 5.69. Another example of the amniotic band syndrome in which the amputated digits, raw areas and strand of amnion on the right hand can be seen. Figure 5.70. This figure of the same infant as shown in Figure 5.69 shows the involvement of the left hand as a result of the amniotic band syndrome. Figure 5.70. This figure of the same infant...
Frank Breech Position
Figure 4.33. Typical position-of-comfort of an infant who was a frank breech presentation. Note the mild genu recurvatum. This infant kept her legs in extension with the knees flexed for several days. Position-of-comfort deformations are common in breech presentations and improve in a few days. These infants should all be checked for congenital dislocation of the hip. Figure 4.33. Typical position-of-comfort of an infant who was a frank breech presentation. Note the mild genu recurvatum. This...
Genu Recurvatum
Figure 5.2. A close-up of the postural deformities involving the feet. Figure 5.1. The infant in the following five figures was referred to hospital with a diagnosis of multiple congenital malformations. It should be noted that these malformations represent examples of congenital postural deformities. Note the position of the hands, lower extremities and the feet occurring as a result of this infant's position in utero. Figure 5.2. A close-up of the postural deformities involving the feet....
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Figure 5.80. Another example of congenital amputation of the left leg and the toes of the right foot by amniotic bands. In primary limb reduction defects, the skin at the amputation is smooth and there is underlying subcutaneous tissue. In secondary limb reduction deformities, the skin shows ulceration or scarring and has no underlying subcutaneous tissue. Radiography shows the stump of the bone is smooth in primary limb reduction defects and the stump of the bone is jagged in secondary...
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Figure 6.12. The breast analog does not respond to hormonal stimulation until near the 35 th week and thus the size of the nodule can be correlated with development. Before 34 weeks the nipple and areola are identifiable, although they are immature-looking and non-pigmented. Between 34 and 36 weeks the nipple becomes erectile and a small nubbin of breast tissue can be felt under the areola. By 36 to 38 weeks, there is usually a palpable nodule and, by term, the nodule has enlarged to 5 to 10 mm...
Cephalhematoma And Caput
Figure 4.7. Cephalhematoma over the right parietal bone. A cephalhematoma is a subperiosteal hemorrhage occurring as a result of vessel rupture at birth. It is generally not apparent at birth but is noted in the first day or two of life. It should be distinguished from a caput succedaneum. It is most commonly seen over the parietal bones and more commonly over the right parietal than the left. A caput succedaneum and cephalhematoma may occur concurrently. Figure 4.8. Large left parietal...
Swollen Labia Majora
Figure 4.28. In this infant who was a breech presentation note the edema, bruising, and ecchymosis. In breech presentations the perineum, buttocks, and thighs may be severely bruised. Figure 4.29. This infant is another example of a breech presentation. Note the extended legs and the equivalent of a caput over the right buttock, which was the presenting part. Figure 4.30. Bruising of male genitalia due to a breech presentation. Note the marked swelling of the scrotum and penis. In rare cases...
Forceps Marks Photos
Figure 4.18. Hematoma of the right cheek and mouth which occurred during a difficult spontaneous delivery. Figure 4.18. Hematoma of the right cheek and mouth which occurred during a difficult spontaneous delivery. Figure 4.19. Trauma from a forceps delivery. Forceps marks on the cheek are fairly common. Rarely, a transient facial palsy may be associated with this type of trauma and occasionally the forceps may actually traumatize the skin, leading to ulceration. Figure 4.19. Trauma from a...
Chapter 4 Birth Trauma
Birth trauma refers to those injuries sustained during labor and delivery. Despite skilled and competent obstetric care, some may be unavoidable. Factors predisposing infants to injury include macrosomia, prematurity, cephalopelvic disproportion, dystocia, prolonged labor, and abnormal presentation. In 1988, birth injuries ranked eight as major causes of neonatal mortality and caused 4.6 deaths per 100,000 live births. The clinician who cares for newborn infants must be familiar with the...
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TffffWlh iif r ' iwilHr Figure 7.39. Discoloration of the great toe and little toes of the left foot in this infant followed umbilical artery catheter placement. Widi removal of die catheter, vasospasm subsided with subsequent normal circulation and appearance. Umbilical artery catheterization may be associated with thrombotic complications. Figure 7.40. On the left, note the discoloration of the toes in an infant 4 hours after placement of an umbilical arterial catheter. There was no...
Subaponeurotic Haemorrhage
Figure 4.15. Massive scalp hemorrhage of the newborn subgaleal hemorrhage . When there is rupture of the capillaries in the subaponeurotic area, there may be massive scalp hemorrhage with spread over the entire scalp and massive blood loss. Disseminated intravascular coagulopathy may ensue rapidly. This condition may occur as a result of a precipitous delivery or poor application of a vacuum extractor. Note the massive soft tissue swelling. Figure 4.16. Frontal view of the same infant who had a...
Chapter 2 Multiple Births
Multiple gestation occurs frequently in pregnancy. The most common is twinning, which occurs in about one in every 80 pregnancies. There are two types of twins monozygous or identical and dizygous or fraternal. The monozygous twin rate is 1 in every 200 pregnancies. It results from a single ovulation with subsequent splitting of the developing egg within the first 14 days. There is no familial tendency. Dizygous twinning results from double ovulation and fertilization and is probably determined...
Footling Breech
Figure 4.34. The characteristic molding of the head of an infant in a breech presentation. The frontal view shows the occipitofrontal head elongation along with a prominent occipital shelf and the neck appears long. Figure 4.35. Lateral view of the head of the same infant shows the flattening of the vertex and the prominent occipital shelf. The plane of flattening is directed upward and forward from the occipital protuberance, which is quite prominent. The characteristic head results from...
Effects of Maternal Medication
During pregnancy, the average fetus is exposed to four physician-prescribed and five self-prescribed drugs. Every drug administered or taken by a pregnant woman presents the mother with both risks and benefits. The risks include the drug's potential as a teratogen or as a cause of toxicity in the fetus. Most human teratogens affect the embryo during a very narrow period of early development as illustrated by the time 24 to 33 days gestation during which the fetus is susceptible to limb...
The Placenta Its Membranes and the Umbilical Cord
The human placenta is a highly sophisticated organ of interface between mother and fetus, often referred to as the gate-keeper to the fetus. Careful examination of the placenta, its membranes, and the umbilical cord can prove to be a valuable aid in the diagnosis and treatment of the neonate. Gross examination of the placenta takes five minutes, and more sophisticated examination should be considered when there is poor pregnancy outcome, recognizable malformations or abnormalities, multiple...