1. maternal drug use
2. chromosomal abnormalities
3. exposure to intrauterine viral infection
4. multiple gestation
5. advanced maternal age >35
6. placental insufficiency
7. lack of maternal weight gain

1. color
2. temperature
3. rashes or lesions
4. edema
5. hair distribution

• common; first appears 3-5 days after birth as small pustules with erythematous bases
• spontaneous resolution within 1-2 weeks is norm

• very small, white papules concentrated on nose, cheeks, forehead, chin (tiny sebaceous retention cysts)
• resolve without intervention in 1-2 months
• equivalent of Epstein pearles on palate

• caused by blockage of eccrine sweat glands, resulting in flushed, macular appearance frequently involving neck, face, scalp, and diaper area
• light clothing and decreased humidity speed resolution

• common in dark-skinned infants and involve small to large, blue-black macules concentreated on the back and buttocks
• frequently misdiagnosed as bruising;document d/t child abuse allegations
• most will resolve spontaneously within 4 years, although may persist for life

• occur secondary to areas of surface capillary dilation and are frequently found on the eyelids, nape of neck, and forehead
• these almost always resolve spontaneously by age 2, although some may persist into adolescence
• tx: laser therapy

• greasy covering/white material
• after 35 weeks
• shed after 40-41 weeks
• more abundant in preterm infants
• *dry, cracked, and peeling skin is more likely in postterm infants

• fine hair, especially on shoulders
• increases with prematurity

• initially a period of rapid breathing
• if asphyxia continues, respirations cease, tone diminishes, and heart rate falls
• REVERSIBLE by mild stimulation and exposure to oxygen

• if asphyxia continues during primary apnea, then the infant develops gasping respirations, the heart rate, BP, and tone ALL diminish
• UNRESPONSIVE to stimulation
• REQUIRES assisted ventilation and oxygen or death will result

1. place on pre-heated radiant warmer
2. dry thoroughly and remove wet linens
3. position-shoulder roll, remember big occiput, neutral airway position
4. suction mouth, then nose
5. stimulate and evaluate

1. no effort
2. gasping
3. spontaneous crying

• heart rate is directly related to respiratory function
• umbilical artery pulse or apical pulse-count for 6 seconds and multiply by 10
• above 100bpm = good-->assess color
• below 100bpm = oxygen/PPV

• below 60bpm = compressions and reevaluate
• between 60-100 = continue ventilation
• over 100 = evaluate color

• pink = good
• blue = bad

• if blue/cyanosis- provide oxygen
• if pink/acrocyanosis- observe and perform newborn exam

• the first intestinal discharge of the newborn
• composed of epithelial cells, fetal hair, mucus, bile
• over 99% of infants will pass first stool within the first 24-48 hours
• passed in utero by term and post-term infants in approximately 8-20% of births
• may be a sign of distress
• imperforate anus?

• prevention of meconium aspiration is key!
• can be thin and watery, or thick and particulate
• suctioning of the airway prior to initiation of spontaneous respirations is crucial, DO NOT STIMULATE

1. ET tube
2. umbilical vein catheter
3. IV

1. epinephrine
2. NaBicarb
3. narcan
4. fluids
5. dextrose

A = appearance/color

P = pulse

G = grimace/reflex irritability

A = activity/muscle tone

R = respirations

*most common score = 9

• taken at 1, 5, 10 minutes

1. plethora = deep, rosy red (polycythemia, over-heated)
2. extensive bruising from birth trauma
3. harlequin coloration = line of demarcation, transient
4. mottling = lacy pattern
5. pallor = washed out or whitish (asphyxia, shock, aneamia, PDA)
6. central cyanosis = low oxygen sat., congenital heart disease, lung pathology
7. acrocyanosis = blue hands and feet, after birth or with cold stress

• hyperbilirubinemia
• pathological or physiological
• abnormal if within 24 hours
• abnormal or physiological if after 24 hours
• estimate mg/dL by degree of jaundice
• head = 5mg/dL
• head-abdomen = 10mg/dL
• head-knees = 15mg/dL
• tx = UV light

• staining of basal ganglia
• have severe form of cerebral palsy

• cheeks, chin, forehead
• comedones and papules
• no tx usually
• may be a/w acne vulgaris in adolescents
• very common

• white patches on tongue and buccal mucosa
• yeast
• look for diaper rash
• boil nipples
• tx = nystatin orally, apply 1mL to each side of mouth 4x day x 7 days, dispense 60mL, no refills
• very common

• a true vascular nevus (stork bite, angel's kiss)
• occipital, eyelids, glabella
• disappear within one year,  neck lesions may persist into adulthood

• non-blanching
• seen at birth
• does NOT regress
• if over the forehead and lip, must consider Sturge-Weber Syndrome (glaucoma, seizures, port wine stain)-->get CT

• flat, bright red, sharply demarcated lesion
• commonly on face
• regression 50% by age 5, 70% by age 7, 90% by age 9
• not present at birth
• develops over first 6 months of life
• may begin as bruise-like lesion
• should refer to pediatric ENT specialist--vocal cord lesions
• may require laser surgery

• macular
• coffee color
• about 15% of babies will have at least one lesions
• if >6 and >1cm a/w neurofibromatosis

• diamond-shaped
• 1-4cm in size
• closes by 4-26 months of age (9-12 months)

• triangular
• 1cm in size
• closes around 1-3 months (2-4 months)

bulging = increased ICP, meningitis, hydrocephalus

depressed/flat = dehydration

• premature fusion of one or more sutures
• referral to neurology