317

Perineum Infant

Transillumination of the head of the same infant with hydranencephaly. Note the jack-o-lantern appearance of the eyes indicating the lack of neural tissue behind the globe. Figure 3.18. Autopsy view of the skull of the same infant with hydranencephaly. Note the empty cranial vault with lack of development of the cerebrum. Figure 3.19. Lateral view of the head of an infant with macrocephaly due to a large porencephalic cyst.

2104

Optic Disc With Vertical Tilt

A persistent and engorged tunica vasculosa lentis occurs in those infants who are very immature and develop severe active retinopathy of prematurity. Cicatricial (Spontaneous Regression) Retinopathy of Prematurity The anatomical macular outcome which correlates with final visual acuity is measured by two parameters macular ectopia and vessel traction. Figure 2.105. This is the grading system for macular ectopia. The normal macular position is between 2 and 3 disc diameters from...

271

Breastfeeding Premature Infants

The affected eye of the same infant exhibits minimal corneal enlargement, clouding secondary to corneal edema, and ectropion uvea with displacement of the pupil temporally. Figure 2.70. These photographs are of the optic nerves of the patient in Figure 2.69. The optic nerves reveal asymmetrical cupping, reflecting the increased intraocular pressure in the right eye (on the left) and the normal intraocular pressure in the left eye (on the right). Figure 2.71. The affected eye of the...

1164

Cystic Hygroma Pictures

The subtle finding of a branchial sinus may be missed if examination of the infant is not thorough. Figure 1.164. Branchial remnants tend to occur along the course of the sternomas-toid muscle. Figure 1.164. Branchial remnants tend to occur along the course of the sternomas-toid muscle. Figure 1.165. The large cystic hygroma (lymphan-gioma) presented in this infant as a large soft fluctuating mass. These are located most commonly in the neck and consist of proliferation of lymph...

1149

Downs Infants Ears Pic

Bilateral microtia with absence of external auditory canals in the infant of a mother treated with retinoic acid during the first trimester of pregnancy. Figure 1.151. In this premature infant of 29 weeks' gestation and birthweight 1120 g there is a branchial arch embryopathy resulting in agnathia, microsto-mia, and small posteriorly positioned hypoplastic tongue. The ears are very low set and the lower lobes may be fused to the neck which was short and thin. Aural ascent does not...

Posterior Cervix

Tuft Hair Spina Bifida

This infant has a thoracic myelo-meningocele which presents as an open midline defect. Although myelomeningoceles occur most commonly at the lumbosacral level, they may affect the neural tube at any level. The posterior elements covering the spinal canal fail to form, but in this type of defect the cystic mass that bulges out posteriorly contains neural tissue and the surface of the meninges is exposed to the exterior with no skin covering. Large lesions may incorporate a large...

Active Retinopathy of Prematurity

Abnormal Retinal Screenings

There are three parameters to the classification system known as the International Classification of Active Retinopathy of Prematurity (ICROP) location of the disease (zone), extent of the disease (clock hours), and severity of abnormal vascular response (stage). Screening for active retinopathy of prematurity should begin after 4 weeks but before 6 weeks following birth. The critical time for screening is from 32 to 42 weeks postconceptual age. Follow-up examinations vary depending on the...

357

Tethered Spinal Cord Fetal

A cervical meningocele may be difficult to differentiate from an occipital encephalocele. Further study in this infant showed that this was a cervical meningocele. Figure 3.57. A cervical meningocele may be difficult to differentiate from an occipital encephalocele. Further study in this infant showed that this was a cervical meningocele. Figure 3.58. A midline hair tuft in the lum-bosacral area. This infant had a tethered cord on MRI study. Hair tufts, skin tags, sinuses, and...

1144

Goldenhar Syndrome

Multiple preauricular skin tags in an infant with a normal ear. Note that skin tags may be pedunculated. Figure 1.145. Preauricular skin tags in an infant with cupping of the ear. Figure 1.145. Preauricular skin tags in an infant with cupping of the ear. Figure 1.146. Preauricular skin tags and skin tags along a line connecting the oral commissure with the external auditory canal are seen in syndromes involving the first and second branchial arch, as in this infant with...

35

Fontanels The Fetal Skull

Extreme hypotonia in a term infant who appears to slip through die hands of her examiner when held upright under the arms. Most term newborns can maintain the head in the same plane as the trunk when lifted by the arms or ventrally suspended. Extreme head lag is a sign of hypotonia that can be seen in infants with Down syndrome, prematurity, or brain damage. Figure 3.7. Microcephaly in a term infant with congenital rubella. Microcephaly may be idiopathic or acquired as a result of...

Infant Micrognathia

Photos Premature Infants

In this premature infant of 29 weeks' gestation and birthweight 1120 g there is a branchial arch embryopathy resulting in agnathia, microsto-mia, and small posteriorly positioned hypoplastic tongue. The ears are very low set and the lower lobes may be fused to the neck which was short and thin. Aural ascent does not occur due to the lack of development of the jaw, hence the low position of the ears. These infants typically have hypoplastic lungs. (C.Langston) Figure 1.152. Another...

Trauma Iatrogenic

Infant Normal Female Genitalia

The ocular photograph on the left shows acute linear corneal edema which is transient but is usually associated with permanent corneal damage. The ocular photograph on the right shows the same eye, 2 weeks later, with breaks in Descemet's layer of the cornea which marks the axis of severe myopic astigmatism. Figure 2.2. On the left is a mark on the face, directly over the eye, indicating the exact location that forceps were applied. On the right, the eyelids have been opened to...

278

Heterochromia Infant

This patient demonstrates heterochromia of the irides which is occasionally seen in tuberous sclerosis, an autosomal dominant (9q33-34 16p13) disorder. Sector iris pigmentation is also seen in tuberous sclerosis due to abnormal neural crest migration of melanocytes into the iris stroma. Figure 2.77. This patient demonstrates heterochromia of the irides which is occasionally seen in tuberous sclerosis, an autosomal dominant (9q33-34 16p13) disorder. Sector iris pigmentation is also...

Cloaca In Preter4m Infants

Premature Vagina

A close-up view of the exstrophy of the cloaca. Note the ureteral openings. Figure 3.75. A close-up view of the exstrophy of the cloaca. Note the ureteral openings. Figure 3.76. Another infant with the cloacal exstrophy sequence. Associated anomalies include imperforate anus, ambiguous genitalia, cloacal exstrophy, and lumbosacral myelocele. Figure 3.77. Transillumination of the lumbosacral mass of the same infant shows the myelocystocele. Figure 3.78. Radiograph of another infant...

315

Neonate Scalp Veins

Transillumination of the lateral view of the head of another infant with hydranencephaly. Note the large head size compared with that of the face. Typically infants with hydranencephaly present with heads that are macro-cephalic. Infants with hydrocephalus will also have transillumination of the skull, but this would become readily apparent only if there was massive enlargement of the head. Figure 3.14. Transillumination of the lateral view of the head of another infant with...

Infection Acquired

Chemical Conjunctivitis

Trachoma inclusion conjunctivitis TRIC or chlamydial conjunctivitis usually does not become clinically apparent before the 6th day of life. This shows a dense white membrane which developed over a period of a week. TRIC is one of the few infections which cause the formation of conjunctival membranes, shown on the conjunctival surface of the upper eyelid of this eye. Tetracycline and erythromycin have been used for Crede prophylaxis in some nurseries because of the increasing...

Choroidal Coloboma Periferial

Photos Premature Infants

This is another term infant with severe bilateral microphthalmia. The globes are small, and vision is extremely poor. There are several forms of microphthalmia including those associated with congenital infection, chromosomal abnormalities, and the CHARGE syndrome. Figure 2.47. At term birth, the normal ocular sagittal length is 17.5 mm, and the normal corneal diameter is 10 mm. This is a term infant with very severe bilateral microphthalmia. The globes are virtually absent and the...

Assessing Newborn

Mandibulofacial Dysostosis

Marked micrognathia in an infant with Treacher-Collins syndrome mandibulofacial dysostosis . In addition to the micrognathia, note the antimongoloid slant of the eyes, prominent nose, and malar hypoplasia. Figure 1.157. Marked micrognathia in an infant with Treacher-Collins syndrome mandibulofacial dysostosis . In addition to the micrognathia, note the antimongoloid slant of the eyes, prominent nose, and malar hypoplasia.

281

Infants With Marfan Syndrome

This is the same patient shown in Figure 2.81 following bilateral removal of cataracts and immediate fitting with aphakic contact lenses. The infant developed perfect vision and binocular fusion. Figure 2.83. Cataracts are present in Lowe syndrome oculocerebrorenal syndrome which is an X-linked recessive disorder Xq25 . In this syndrome, glaucoma is also frequently present. Figure 2.84. In the rhizomelic chondrodysplasia punctata syndrome, an autosomal recessive disorder, cataracts...

260

Brushfield Spots

Aniridia with cerebellar malformation is an autosomal recessive disorder which seems to be associated with little variability in expression. On the left is a rather complete aniridia with corneal clouding due to glaucoma. On the right is another virtually complete aniridia with minimal iris remnants. Figure 2.58. Aniridia with cerebellar malformation is an autosomal recessive disorder which seems to be associated with little variability in expression. On the left is a rather...

321

Normal Head Ultrasound Preemies

Another view of the head of the same infant showing the marked distortion of the posterior occiput and the engorged scalp veins. Figure 3.20. Another view of the head of the same infant showing the marked distortion of the posterior occiput and the engorged scalp veins. Figure 3.21. Transillumination of the skull of the same infant. The fluid-filled lobulated space-occupying cyst results in marked distortion of the cranial vault. Figure 3.21. Transillumination of the skull of the...

Retinavitreous

Pupil Disorders Humans

Persistent hyperplastic primary vitreous PHPV results from a failure of the embryonic hyaloid artery system to involute. In this eye, the persistence is primarily anterior with formation of a large cataract. Figure 2.88. In this eye, the PHPV is primarily posterior with the presence of a large stalk to the optic nerve. Figure 2.89. Tay-Sachs disease GM, gangliosidosis Type I is an autosomal recessive 12q22-25 disorder which develops a macular cherry-red spot due to deposition of...

26

Infant Female Genitalia

Retinal hemorrhages occur frequently in the neonate, especially following vaginal delivery. In some studies, the incidence of small retinal hemorrhages is as high as 25 irrespective of whether the delivery was spontaneous or required the application of forceps. These retinal hemorrhages resolve spontaneously without any consequences. In contrast, hemorrhages into the vitreous gel may prevent light from getting through to the retina for several days or even weeks and will cause a...

Fissure Of The Nipple

Branchial Sinuses And Cysts

Micrognathia in an infant with Goldenhar's syndrome hemifacial microsomia . In addition, note the preauricular skin tags, unilateral macrostomia, and skin tags due to the extra branchial arch anomalies. Figure 1.158. Micrognathia in an infant with Goldenhar's syndrome hemifacial microsomia . In addition, note the preauricular skin tags, unilateral macrostomia, and skin tags due to the extra branchial arch anomalies. Figure 1.159. A congenital midline cervical cleft is a rare...

Ophthalmologic Examination Of The Newborn

Examination of the Eyes should take place A. During the initial routine examination 1st day of life of all infants by the pediatrician neonatologist to exclude obvious anomalies must include bilateral red reflexes . B. Following an initial period of stabilization 1st week of life in all preterm infants lt 1250 grams at birth by the pediatrician neonatologist to exclude obvious anomalies and to assess gestational age. C. Following an initial period of retinal development from 4 to 6 weeks of...

Wide Spaced Eyes

Pictures Skin Tags And Pregnancy

Capillary hemangiomas of the lids most frequently arise nasally from either the superior or the inferior palpebral fissure. They are poorly defined soft swellings of the eyelid with purple red-blue discoloration of the skin. They require treatment when rapid growth threatens the visual axis which can lead to irreversible deprivation amblyopia. Figure 2.29. Ankyloblepharon filiforme adnatum is shown in this figure with fusion of the upper and lower eyelids by small filiform...

Sclerema Neonatorum

Open Neural Tube Defect

Radiograph of the same infant with inien-cephaly. Note absence of the laminal and spinal processes of the cervical, dorsal, and sometimes lumbar vertebrae. The vertebrae are reduced in number and are irregularly fused. Figure 3.31. Iniencephaly is the most severe form of a closed neural tube defect. It results in enlargement of the foramen magnum and fusion of the posterior occiput with the cervicothoracic spine. It is incompatible with survival. Figure 3.32. Radiograph of the same...

Dermoid Cyst On Baby

Dermoid Cyst Infant

The same patient showing a residual right upper lid ectropion after five days of bilateral pressure patches. If this occurs as a unilateral condition, it is essential to tape both eyes closed to prevent deprivation amblyopia. Figure 2.41. Congenital ectropion occurs as a result of intrauterine prolapse of the conjunctiva. This may require temporary taping or suturing of the lid margins. In the absence of microphthalmos, buphthalmos, or eyelid defects, primary eyelid eversion is...

Lacrimal Abnormalities

Premature Female Maturity

A dacryocystocele may occur as an autosomal dominant in families as exemplified by these twins. The lacrimal sac is blocked at both ends and a sterile swelling appears as a purplish swelling adjacent to the base of the nose. Simple lacrimal probing allows for a swift resolution of this problem however, if there is anything atypical about the location or the appearance of the swelling, an ultrasound of the brain should be obtained to exclude an encephalocele. Figure 2.28. If a...

1122

Normal Female Genitalia Newborns

Bilateral cleft lip and cleft palate with a severe total cleft palate and incomplete bilateral cleft lip. A midline nubbin of tissue is seen attached to the col-umella of the nose. This represents the remnant of the intermaxillary segment, the unpaired median structure that normally would have formed the floor of the philtral groove, the center of the upper alveolar ridge, and the primary palate. Figure 1.121. Cleft palate in an infant with a unilateral cleft lip. Note the...

The Central Nervous System

Cleidocranial Dysostosis Child

Central nervous system disorders are among the three major causes of mortality in neonates. All of the conditions that affect the infant's brain do so in part because this system is developing at a rapid rate. The neurologic examination of the newborn must thus be interpreted in the context of the child's brain maturation gestational age and level of alertness. The examination should be brief so as to avoid hypoxemia and fluctuations in arterial blood pressure. Head circumference is a useful...

New Born Mixed Race

Black And Mixed Race Premature Babies

Transverse earlobe creases are a feature of some syndromes as in this infant with Beckwith-Wiedemann syndrome. Figure 1.140. This otherwise normal infant had bilateral cleft ear lobes. This occurs as a result of incomplete fusion between the most medial embryonic hillocks. Figure 1.140. This otherwise normal infant had bilateral cleft ear lobes. This occurs as a result of incomplete fusion between the most medial embryonic hillocks. Figure 1.139. Transverse earlobe creases are a...

Beckwith Wiedemann Syndrome Ears

Newborn Folded Ear

A high arched palate in an infant with a cleft of the soft palate. Figure 1.127. On the left, note the marked microstomia and on the right note the cleft palate, in an infant with a mosaic trisomy 8. Figure 1.127. On the left, note the marked microstomia and on the right note the cleft palate, in an infant with a mosaic trisomy 8. Figure 1.129. Normal ears with lack of good cartilage development may appear as large flattened ears bilaterally. These are often caused by prolonged...

1114

Surgical Resection Teratoma

A mass involving the tongue was noted at birth in this term infant. Upon surgical removal, the diagnosis of teratoma of the tongue was confirmed. This was a benign teratoma and the infant did well. Figure 1.116. The large mass in the posterior mouth and nasopharynx in this term infant, with a cleft palate, was friable and bled easily. At surgery it was found to be a benign teratoma of the nasopharynx. Figure 1.117. Cleft lip may be unilateral or bilateral and is often associated...

Introduction

Although several texts provide extensive written descriptions of the newborn infant, the senses of touch, hearing, and especially sight, create the most lasting impressions. Over a period of almost five decades, my brother Jack Rudolph diligently recorded, in pictorial form, his vast experiences in physical examination of the newborn infant. Atlas of the Newborn reflects his selection from the thousands of color slides in his collection, and truly represents the art of medicine as applied to...

Foreword

Sir William Osler stated, There is no more difficult task in medicine than the art of observation. The late Arnold Jack Rudolph was an internationally renowned neonatolo-gist, a teacher's teacher, and, above all, one who constantly reminded us about how much could be learned by simply observing, in his case, the newborn infant. This color atlas of neonatology represents a distillation of more than 50 years of observing normal and abnormal newborn infants. The Atlas begins with a section on the...

Eruption Cyst In Infants

Ectopic Tooth Eruption Infants

This infant with a left cleft lip and cleft palate has a neonatal tooth in the upper jaw. Figure 1.84. If a central eruption cyst or central mandibular incisor is present in the lower jaw, the diagnosis of median cleft syndrome must be excluded. This infant had median cleft syndrome. A single central maxillary incisor also may be seen in growth hormone deficiency. Figure 1.86. Frenulum frenum labialis superior. The frenulum is a continuation of the fibrous median raphe of die...

Female Infant Genitalia

Congenital Macroglossia

Macroglossia in a 2-month-old infant with Type II glycogen storage disease Pompe's disease . Macroglossia is also seen in infants with congenital hypothyroidism and hemangioma or lymphangioma of the tongue. Figure 1.107. Macroglossia associated with unilateral hypertrophy of the right side of the tongue. This may be idiopathic or due to a hemangioma or lymphangioma of the tongue. Figure 1.107. Macroglossia associated with unilateral hypertrophy of the right side of the tongue....

Beckwith Wiedemann Syndrome

Beckwith Wiedemann Syndrome Photos

Macroglossia in an otherwise normal infant. The most common cause of macroglos-sia is idiopathic hypertrophy of the muscles of the tongue. Figure 1.104. Macroglossia associated with Beckwith-Wiedemann syndrome. These infants have exomphalos omphalocele or large umbilical hernia , macroglossia, and gigantism EMG syndrome . Figure 1.104. Macroglossia associated with Beckwith-Wiedemann syndrome. These infants have exomphalos omphalocele or large umbilical hernia , macroglossia, and...

Pictures Of Skin Tags In Mouth

Postmature Baby

Neonatal teeth causing ulceration of the undersurface of the tongue by vigorous sucking Riga-Fede disease . Neonatal teeth are more likely to cause this because the mucous membranes are still very delicate. These teeth require extraction to permit healing of the ulceration. Figure 1.79. Neonatal teeth causing ulceration of the undersurface of the tongue by vigorous sucking Riga-Fede disease . Neonatal teeth are more likely to cause this because the mucous membranes are still very...

Traumatic Lower Lip Ulcer In Infants

Hypoglossia

Note the mucoceles on the lower lip of this premature infant birthweight 1200 g . Mucoceles are not true cysts but rather collections of mucus surrounded by connective tissue. They usually occur on the lower lip, are not common, and require no treatment. Differential diagnosis includes herpetic lesions. Figure 1.98. Congenital epulis may occur as a small or very large mass that protrudes from the mouth as a large tumor. They may be pedunculated and are of firm consistency. They...

Normal Frenulum

Lingual Frenulum Infants

Lingual ankyloglos-sia tongue tie in a premature infant birthweight 1700 g . Note the indentation of the tip of the tongue. The lingual frenulum limits the movement of the tip of the tongue. True tongue tie is rare. If the tongue can be protruded beyond the lips, no intervention is necessary as the tongue grows more rapidly than the frenulum and soon becomes freely mobile. Figure 1.87. Lingual ankyloglos-sia tongue tie in a premature infant birthweight 1700 g . Note the indentation...

Fused Temporal Lobe

Holoprosencephaly Newborn Images

Another example of the median cleft syndrome with a normal karyotype and a head ultrasound showing holoprosencephaly. The close-up view shows clefting of the alveolar ridge which is also seen in this syndrome. Holoprosencephaly results from maldevelopment of the forebrain prosencephalon . It may occur as an alobar type in which there is a horseshoe-shaped single ventricle a semilobar type in which there is partial differentiation of the ventricles, especially at the...

Protruding Forehead

Infant Toe Malformation

In this infant with Apert's syndrome acrocephalosyndactyly , note the high steep frontal bone, protruding forehead, flat midface, small pinched nose, and the downward slanting of the palpebral fissures. The acrocephaly is due to premature fusion of the coronal sutures, resulting in bilateral coronal craniosynostosis. This infant also had the typical finding of a high arched palate. Figure 1.26. In this infant with Apert's syndrome acrocephalosyndactyly , note the high steep frontal...

Flat Occiput Frontal Bossing

Flat Occiput Down Syndrome

Note the typical long narrow skull of a premature infant with hypsicephaly. Hypsicephaly is a term used by anthropologists for high heads that are not pathologic or due to craniosynostosis. This term is used interchangeably with that of dolicho-cephaly when associated with prematurity. Figure 1.13. Note the typical long narrow skull of a premature infant with hypsicephaly. Hypsicephaly is a term used by anthropologists for high heads that are not pathologic or due to...

Micrognathia Infant Pictures

Goldenhar Syndrome Image

Another variant of the median cleft syndrome holoprosencephaly is cebocephaly in which there is a small nose with a single nostril above or below the eyes. Note the single orifice and aplasia of the nasal septum and philtrum. Figure 1.63. Buccal fat pads sucking cushions are pads of fat tissue between the fibers of the masseter muscle. When the infant is sucking they prevent collapsing of the cheeks during indrawing. These fat pads remain unaltered despite loss of adipose tissue in...

Inclusion Cyst Infant

Alveolar Cyst Infants

Gum hypertrophy in an infant born to a mother treated with phenytoin during pregnancy. Figure 1.91. The components for each individual tooth bud can often be seen on the alveolar ridges of the maxilla and mandible in normal infants. Note the milia on the nose and the demarcation on the lip where the skin meets the mucous membrane. The sucking calluses occur on the mucous membrane part of the lip and are most prominent on the central portion. Figure 1.92. Gum hypertrophy in an...

Holt Oram Syndrome

Bilateral Proboscis Lateralis

A more severe example of a lateral nasal cleft in an otherwise normal infant. Figure 1.51. Proboscis lateralis is a congenital abnormality in which the nose fails to develop normally. Figure 1.49. Although lateral nasal clefts, in general, are isolated findings, this infant in addition to the cleft had Holt-Oram syndrome heart disease, in this case coarcta-tion of the aorta, and absence of left radius and thumb . Figure 1.50. In this infant with bilateral clefting of the alae nasi,...

Holoprosencephaly

Cebocephaly

In holoprosencephaly when there are separate orbits with a proboscis above the eyes and a lack of nostril with a single or double proboscis above or below the eyes, the condition is called ethmo-cephaly. Note also the small mouth. Figure 1.61. In holoprosencephaly when there are separate orbits with a proboscis above the eyes and a lack of nostril with a single or double proboscis above or below the eyes, the condition is called ethmo-cephaly. Note also the small mouth. Figure...

Clover Leaf Skull

Trigonocephaly Pictures

Trigonocephaly is due to premature fusion of the metopic suture and is represented clinically by a triangular-shaped head. This condition may occur in utero or in the first months of life. It may occur in otherwise normal infants, but is also seen in infants with chromosomal anomalies or the median cleft syndrome. Figure 1.20. Another example of less severe trigonocephaly. Figure 1.20. Another example of less severe trigonocephaly. Figure 1.21. Note the asynclitism of the skull...

Head and Neck

Infant Skull Fractures

Examination of the head should include visual inspection, palpation, auscultation for bruits over the temporal arteries and anterior fontanelle , assessment of the shape and size relative to the rest of the body and face, distribution and character of the hair and underlying scalp, and measurement of head circumference. The hair is inspected for color, texture, distribution and directional patterns. The shape of the cranial vault reflects interaction of internal anatomy, volume, pressure and...