The female genitalia normally may reveal a milky whiteor blood-streaked vaginal discharge as a result of maternalhormone withdrawal. Mucosal tags of the labia majora arecommon. Distention of an imperforate hymen may produce hydrometrocolpos and a lower midline abdominalmass as a result of an enlarged uterus. Clitoral enlargementwith fusion of the labial-scrotal folds (labia majora) suggests adrenogenital syndrome or exposure to masculinizingmaternal hormones.
Examination of the extremities should involve assessment of length, symmetry, and presence of hemihypertrophy, atrophy, polydactyly, syndactyly, simian creases, absent fingers, overlapping fingers, rocker-bottom feet, clubfoot, congenital bands, fractures, and amputations.
The spine should be examined for evidence of sacral hair tufts, a dermal sinus tract above the gluteal folds, congenital scoliosis (a result of hemivertebra), and soft tissue masses such as lipomas or meningomyeloceles.
The hips should be examined for congenital dysplasia (dislocation). Gluteal fold asymmetry or leg length discrepancy is suggestive of dysplasia, but the examiner should perform the Barlow test and the Ortolani maneuver to evaluate the stability of the hip joint. These tests determine whether the femoral head can be displaced from the acetabulum (Barlow test) and then replaced (Ortolani maneuver).
The neurologic examination should include assessment ofactive and passive tone, level of alertness, primary neonatal
Sepsis, pneumonia Inflammation, pulmonary hypertension, ARDS
Meconium aspiration pneumonia Mechanical obstruction, inflammation, pulmonary hypertension
Persistent pulmonary hypertension of the newborn Pulmonary hypertension
Diaphragmatic hernia Pulmonary hypoplasia, pulmonary hypertension
Cyanotic heart disease with decreased pulmonary Right-to-left shunt as in pulmonary atresia, tetralogy of Fallot blood flow
Cyanotic heart disease with increased pulmonary Mixing lesion as in single ventricle or truncus arteriosus blood flow
Cyanotic heart disease with congestive heart failure Pulmonary edema and poor cardiac output as in hypoplastic left heart and coarctation of aorta
Heart failure alone Pulmonary edema and poor cardiac contractility as in sepsis, myocarditis, supraventricular tachycardia, or complete heart block; high-output failure as in PDA or vein of Galen or other arteriovenous malformations
Maternal sedative drugs Hypoventilation, apnea
Intracranial hemorrhage CNS depression, seizure
Neuromuscular disease Hypotonia, hypoventilation, pulmonary hypoplasia HEMATOLOGIC
Hypoglycemia CNS depression, congestive heart failure
ARDS, Acute respiratory distress syndrome; CNS, central nervous system; PDA, patent ductus arteriosus.