Pediatric Primary Care Read Online Free PDF Page A

infant < 37 weeks, late preterm infant> 34 weeks to 36 weeks and 6 days, post-term infant> 42 weeks.
C.  Late preterm infants at greater risk for airway instability when upright, respiratory distress, apnea/bradycardia, excessive sleepiness, excessive weight loss, poor feeding, hyperbilirubinemia, hypoglycemia, hypothermia, sepsis, weak suck, and rehospitalization.
IV.  ABNORMAL PHYSICAL FINDINGS (CONSULT WITH STAFF PHYSICIAN AND/OR REFER FOR EVALUATION, AS INDICATED)
A.  Dysmorphic facies hyper- or hypotelorism, epicanthal folds, symmetrical facies and extremities.
1.  Skin and scalp with plethora, pallor, jaundice, cyanosis, bruising, abrasions, petechiae, hemangioma, port wine stain, café au lait spots.
2.  Shape of skull.
3.  Bruising, hematoma/caput succedaneum.
4.  Size and tone of anterior and posterior fontanels.
B.  Pupils without red reflex and unequal pupillary sizes, nares patent (choanal atresia), mouth with teeth, hypoglossia/macroglossia, palate high arched or missing. External ears with tags or pinhole openings. Neck short/masses (cystic hygroma) or webbing.
C.  More/less than five fingers/toes on each hand/foot.
D.  Check clavicles for fractures. Chest shape with pectus excavatum/carinatum, and supernumerary nipples. Breath sounds that are moist and grunting/ retractions after 4 hours of age, apnea/respirations < 30 or > 60 per minute.
E.  Heart rate with murmur (soft III/IV systolic murmur normal for first 1224 hours since patent ductus may not be closed), or an irregular rate/rhythm < 100 > or 180 bpm, a cuff blood pressure < 65 or > 95 mm Hg of systolic pressure, and diastolic < 30 or > 60 mm Hg. Absent or decreased femoral pulses (coarctation of aorta), slow capillary refill is indicative of poor perfusion.
F.  Temperature instability < 97.7°F (36.5°C) after 4 hours of age.
G.  Abdominal skin thin or missing, asymmetrical, distended, umbilicus with hernia, discharge, redness, odor. Missing or overactive bowel sounds. Lower liver edge 3 cm below costal margin (heart disease), infection, hemolysis, palpable spleen (infection or hemopoiesis), enlarged bladder (1-4 cm above symphysis).
H.  Female.
1.  Masses in labia (hernia, enlarged Bartholin gland), vesicles.
I.  Male.
1.  Meatal opening on penis placed abnormally (hypospadias or epispadius), absence of testes in either inguinal canals or scrotal sac, hydrocele, bifid scrotum, discoloration, or bruising.
J. Anus absent or not patent.
K.  Absent or missing extremities, bands, masses, inequality from side to side. Abnormal Ortolani or Barlow sign. Bowing of extremities, abnormal foot positions, flaccid upper extremity. Lesions or dimpling of lower spine.
L.  Abnormal posturing, floppy or very jittery, abnormal cry. Exaggerated tonic neck, Moro reflex, poor sucking, or poor rooting.
V.  LABORATORY ASSESSMENT OF NEWBORN
A.  Glucose screening (normal 40-90 mg/dL), venous hematocrit (normal 45-65%), cord blood (ABO, Rh). If baby is Rh-, maternal RhoGAM status should be Rh+.
B.  Bilirubin: Determine etiology of any jaundice, i.e., physiologic or pathologic. Obtain baseline total serum bilirubin, plus a direct and indirect level.
Sixty percent of all term newborns and 80% of preterm infants will have some jaundice in the first week of life.
Any jaundice within the first 24 hours after birth is considered pathologic. If the total serum bilirubin (TSB) rises more than 5 mg/dL/day or is higher than 12 mg/dL in full-term infants or 10-14 mg/dL for preterm, further evaluation and treatment is indicated. If the infant has signs of sepsis, irritability, or lethargy, this needs further evaluation. In infants 25-48 hours old, a TSB level above 15 mg/dL is indicative of rapid rise and infant needs further evaluation. In infants 49-72 hours old a TSB above 18 mg/dL or any infants more than 72 hours old with a TcB of 20 mg/dL needs further evaluation and treatment. 7
When obtaining serial bilirubins, utilize noninvasive