Routine Newborn Examination Research Articles

Neonatal Neurological Dysfunction in a Cohort of Very Preterm and/or Very Low Birthweight Infants - Relation to Other Perinatal Factors and Outcome at 2 Years*

Neonatal neurological dysfunction was found in only a small part of 1192 infants enrolled in an epidemiologic survey on very preterm (less than 32 weeks) and very low birthweight (less than 1500 gram) infants. A routine neurological examination was performed in the neonatal period by the attending paediatrician throughout all levels of care. The incidence of obvious neurological dysfunction was 8.1% and incidence of suspect neurological dysfunction was 6.1%. Multivariate analysis showed that gestational age, birthweight, low Apgar score, IRDS and, most of all, ICH were significantly associated with neonatal neurological dysfunction (N.D.). The mortality rate was very high in obvious and suspect ND infants (81.1% and 35.6% respectively) compared to neurologically normal infants (17.8%). This phenomenon was also found regarding the handicap rate at two years of age. Only 6% (n = 6) of the 96 infants with obvious ND survived without handicap. Using routine physical examination, a quarter of the very preterm or VLBW infants with later neurological disturbances were identified. A more standardized neurological examination, incorporated in the routine examination of newborns in all levels of care, might improve early identification of infants at risk for handicaps.

Submandibular Adenitis in a Newborn Caused by Mycoplasma hominis

Despite frequent colonization of the newborn infant with genital mycoplasmas, morbidity due to these organisms has been cited on few occasions. This report describes an infant with suppurative submandibular lymphadenitis from whom Mycoplasma hominis was isolated in pure culture. CASE REPORT A 2,580-gm, firstborn, black, female twin was the product of a 36-week pregnancy in a 15-year-old primigravida in whom mild preeclampsia and fever developed one day prior to delivery. After spontaneous rupture of the membranes and a 12-hour labor, the infant was delivered without complication by low forceps and vacuum extraction. Apgar scores were 7 and 9 at one and five minutes, respectively; findings on routine newborn examination were unremarkable.

Audit of clinical documentation of external genitalia examination findings in the newborn: The Benin-city experience

Background: Over the years, poor medical documentation is a well known phenomenon in medical practice but the magnitude of the problem in our setting has not been defined.Objective: To assess the overall frequency of missed detection of anomalies of external genitalia following the routine newborn physical examination and to describe the general pattern of its documentation.Methods: In this hospital-based descriptive cross-sectional study, 915 full-term newborn infants in an open population survey were systematically screened for anomalies of the external genitalia, using a checklist derived by modifying parameters in the Prader scoring system and the External masculinization score charts. The pattern of documentation was assessed in 915 case files. The findings of the researchers were then compared to those previously documented by the attending physician/midwife. The study was conducted in two Nigerian hospitals (University of Benin Teaching Hospital and St Philomena Catholic Hospital) in Benin City. All members of staff of the two hospitals were blinded to the fact that the previous examination findings documented in the case files were being assessed during this study.Results: Of the 915 infants, 19 (2.1%; 95% CI= 1.2-3.0) had anomaly of the external genitalia at birth. The overall frequency of missed diagnosis of external genital anomalies was 68.4% with undescended testes (UDT) being the most frequently missed. The level of documentation of the findings of the external genital examination was poor in both hospitals. Combining the two hospitals, the external genital examination findings were not documented in 76.1% of case files.Conclusions: The routine newborn examination as currently practiced in the two hospitals was weak in detecting external genital anomalies. Poor documentation of the external genital findings is a common occurrence in the setting where we practice, irrespective of whether the health institution is tertiary or secondary.Key words: Audit, clinical documentation, external genitalia anomalies, missed diagnosis, routine newborn examination.

Toxoplasmosis, antibody level, and pregnancy outcome

A significantly greater incidence of abortions occurred in patients whose postpartum blood sera had a high antibody titer for toxoplasmosis than in those with low or negative serum levels. This finding, as well as the identification of 3 women who habitually aborted for unknown cause, out of 89 subjects with titers of 1,024 or more, gives further support to the need for isolation studies to document the role of Toxoplasma gondii in spontaneous abortion.This survey revealed approximately 25 per cent incidence of infection with Toxoplasma gondii in women in the childbearing age in the Los Angeles metropolitan area. Routine pediatric newborn examination yielded one infant with a congenital anomaly who was suspect for acute congenital toxoplasmosis. At least 9 other subjects in the high antibody titer group had pregnancy histories suggesting the possible relation of the parasite to abnormal pregnancy outcome. Review of total pregnancy history of patients having antibody level of 1,024 or more has identified a series of infants for follow-up investigation for subclinical congenital toxoplasmosis.