Chapter 92 Clinical Manifestations of Diseases in the Newborn Period

The wide varieties of disorders that affect the newborn originate in utero, during birth, or in the immediate postnatal period. These disorders may be due to prematurity, genetic mutations, chromosomal aberrations, or acquired diseases and injuries. Recognizing disease in newborn infants depends on knowledge of the disorder and evaluation of a limited number of relatively nonspecific clinical signs and symptoms.

Central cyanosis has respiratory, cardiac, central nervous system (CNS), hematologic, and metabolic causes (Table 92-1). Respiratory insufficiency may be due to pulmonary conditions or may be secondary to CNS depression from drugs, intracranial hemorrhage, or anoxia. If respiratory insufficiency is caused by pulmonary conditions, respirations tend to be rapid and may be accompanied by retraction of the thoracic cage. If it is due to the CNS depression, respirations tend to be irregular and weak and are often slow. Cyanosis unaccompanied by obvious signs of respiratory difficulty suggests cyanotic congenital heart disease or methemoglobinemia. Cyanosis resulting from congenital heart disease may, however, be difficult to distinguish clinically from cyanosis caused by respiratory disease. Episodes of cyanosis may also be the initial sign of hypoglycemia, bacteremia, meningitis, shock, or pulmonary hypertension. Peripheral acrocyanosis is common in neonates and does not usually warrant concern unless poor perfusion is suspected.

Pallor, in addition to anemia or acute hemorrhage, should suggest hypoxia, asphyxia, hypoglycemia, sepsis, shock, or adrenal failure.

Hypotension in term infants suggests shock from hypovolemia (hemorrhage, dehydration), the systemic inflammatory response syndrome (bacterial sepsis, intrauterine infection, necrotizing enterocolitis), cardiac dysfunction (left heart obstructive lesions—hypoplastic left heart syndrome, myocarditis, asphyxia-induced myocardial stunning, anomalous coronary artery), pneumothorax, pneumopericardium, pericardial effusion, or metabolic disorders (hypoglycemia, adrenal insufficiency–salt-losing adrenogenital syndrome). Hypotension is a common problem in sick preterm infants and may also be due to any of the problems noted in a term infant. Hypotension may develop in preterm infants with severe respiratory distress syndrome. Strategies used to support blood pressure include volume expansion (normal saline is equally as effective as 5% albumin), pressors (dopamine, dobutamine, epinephrine), and corticosteroids. Hypotension in some infants weighing <1,000 g does not respond to fluids or inotropic agents but may respond to therapy with intravenous hydrocortisone. Sudden onset of hypotension in a very low birthweight (VLBW) infant suggests pneumothorax, intraventricular hemorrhage, or subcapsular hepatic hematoma.

Convulsions (Chapter 586.7

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