Ambulatory

Weight gain

• 1st month weight gain: 20g/day

• regain weight at 2 wks, 2x at 4 months, 3x at 12 months

Fontanelle

• big posterior fontanelle: hypothyroidism

• 3rd fontanelle: Down

Red Reflex

no red reflex:

• retinoblastoma

• cataracts

Hip dysplasia

always US at 6 wks, at risk for hip dysplasia

Benign Murmur

• physiological peripheral pulmonary stenosis, reassure parent.

IVH

Layers of scalp:

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• Caput succedaneum: between skin and galea aponeurosis

• subgaleal hemorrhage: between galea aponeurosis and periosteum

• cephalhematoma: between periosteum and bone

Cephalhematoma

• path/pt: subperiosteum hematoma (rupture of blood vessels between skull and periosteum) caused by surgical trauma. Do not cross suture lines. Most common parietal

• symptoms

  • bulging head

  • hyperbilirubin from hemolysis

  • rare: anemia, hypotension

• treatment: observe. Resolve in weeks to months.,

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Subgaleal

• path: bleed between galea aponeurosis and periosteum

• pt: vacuum apply to head in delivery. Insidous growth

• symptoms

  • boggy mass over occiput. Cross sutures and obscure fontanelle

  • hemorrhagic shock

• treatment: resolve in 72 hrs. Observe and support.,

Caput succedaneum

• path: subcutaneous, extraperiosteal, between skin and galea

• pt: pressure against dilating cervix in head first delivery (vertex)

• symptoms

  • extend across midline/sutures

  • poorly defined margins

  • discoloration

• treatment: resolves over the first few days. Observe.,

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Nutrient gain

• 100, 50, 20 kcal for every 10 kg

• 20 kcal/oz

• 1 oz = 30 ml