A 31 year-old primigravid (39 weeks and

A 31 year-old primigravid (39 weeks and 4 days age of gestation by last menstrual period) arrives at the labor and delivery area with history of regular contractions for 4 hours, followed by bloody vaginal discharge 1 hour prior to admission. She had regular prenatal check-ups c/o a private practitioner. She is non-hypertensive and non-diabetic. VDRL (-), HBSAg (-), HIV 1& 2 non-reactive. She is a non-smoker and nonalcoholic beverage drinker. She has no history of intake of illicit drugs. Both of the patient’s parents are hypertensive and diabetic. After 3 hours at the labor room, a live baby girl was born via spontaneous vaginal delivery. The infant was crying and spontaneously moving her extremities. The baby was dried, and brought to her mother’s chest for skin-to-skin contact. After a successful first latch, the baby underwent her first physical examination with the following findings: Weight 3.2 kgs, Length 48 cm, HC 35 cm Heart rate 120bpm Respiratory rate 44 Temp 36.8 deg C Awake, alert, (+) spontaneous movement of all extremities Pink, (+) vernix, (+) fine hair on upper back and arms, (+) well-demarcated bluish patch on buttocks area (+) molding, (-) eye discharge, (+) white papules on nose, (-) cleft lip/palate Equal chest expansion, (-) grunting/retractions, (+) clear and equal breath sounds, (-) rales/ crackles/ wheezes Distinct heart sounds, (-) murmurs appreciated Soft, globular abdomen, (+) diastasis recti, umbilical stump with 2 arteries and 1 vein Pulses full and equal, (-) grossly deformed extremities, (+) acrocyanosis, (-) pallor, (-) rashes (+) prominent labia majora, (+) whitish vaginal discharge (+) Rooting reflex, (+) Moro reflex, (+) tonic neck reflex Guide Questions: 1) What other components of the maternal history would you have wanted to ask? Explain the importance of conducting a complete perinatal history. 2) Discuss the physiological transition that occurs in the neonate coming from the intrauterine environment to outside the womb. 3) There are certain physical findings in newborns that are still considered normal. Identify at least 3 in the PE of the infant in our case, and include the following: • Description • Expected course • Any red flags that could indicate the finding to be abnormal 4) In what circumstances should the neurological examination be done completely? A unique aspect of the neurological examination in newborns includes testing the developmental reflexes. Enumerate and describe each one.

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