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Figure 1.139. Transverse earlobe creases are a feature of some syndromes as in this infant with Beckwith-Wiedemann syndrome. Figure 1.140. This otherwise normal infant had bilateral cleft ear lobes. This occurs as a result of incomplete fusion between the most medial embryonic hillocks. Figure 1.140. This otherwise normal infant had bilateral cleft ear lobes. This occurs as a result of incomplete fusion between the most medial embryonic hillocks. Figure 1.139. Transverse earlobe creases are a...
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Figure 1.126. A high arched palate in an infant with a cleft of the soft palate. Figure 1.127. On the left, note the marked microstomia and on the right note the cleft palate, in an infant with a mosaic trisomy 8. Figure 1.127. On the left, note the marked microstomia and on the right note the cleft palate, in an infant with a mosaic trisomy 8. Figure 1.129. Normal ears with lack of good cartilage development may appear as large flattened ears bilaterally. These are often caused by prolonged...
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Figure 1.115. A mass involving the tongue was noted at birth in this term infant. Upon surgical removal, the diagnosis of teratoma of the tongue was confirmed. This was a benign teratoma and the infant did well. Figure 1.116. The large mass in the posterior mouth and nasopharynx in this term infant, with a cleft palate, was friable and bled easily. At surgery it was found to be a benign teratoma of the nasopharynx. Figure 1.117. Cleft lip may be unilateral or bilateral and is often associated...
Introduction
Although several texts provide extensive written descriptions of the newborn infant, the senses of touch, hearing, and especially sight, create the most lasting impressions. Over a period of almost five decades, my brother Jack Rudolph diligently recorded, in pictorial form, his vast experiences in physical examination of the newborn infant. Atlas of the Newborn reflects his selection from the thousands of color slides in his collection, and truly represents the art of medicine as applied to...
Foreword
Sir William Osler stated, There is no more difficult task in medicine than the art of observation. The late Arnold Jack Rudolph was an internationally renowned neonatolo-gist, a teacher's teacher, and, above all, one who constantly reminded us about how much could be learned by simply observing, in his case, the newborn infant. This color atlas of neonatology represents a distillation of more than 50 years of observing normal and abnormal newborn infants. The Atlas begins with a section on the...
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Figure 1.111. This infant presented with moderate respiratory distress and was noted to have a large cyst, especially on the left side at the base of the tongue. The cyst which was removed was diagnosed as an epithelial cyst in that it was lined by squamous epithelial cells. Figure 1.111. This infant presented with moderate respiratory distress and was noted to have a large cyst, especially on the left side at the base of the tongue. The cyst which was removed was diagnosed as an epithelial...
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Figure 1.83. This infant with a left cleft lip and cleft palate has a neonatal tooth in the upper jaw. Figure 1.84. If a central eruption cyst or central mandibular incisor is present in the lower jaw, the diagnosis of median cleft syndrome must be excluded. This infant had median cleft syndrome. A single central maxillary incisor also may be seen in growth hormone deficiency. Figure 1.86. Frenulum frenum labialis superior. The frenulum is a continuation of the fibrous median raphe of die...
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Figure 1.106. Macroglossia in a 2-month-old infant with Type II glycogen storage disease Pompe's disease . Macroglossia is also seen in infants with congenital hypothyroidism and hemangioma or lymphangioma of the tongue. Figure 1.107. Macroglossia associated with unilateral hypertrophy of the right side of the tongue. This may be idiopathic or due to a hemangioma or lymphangioma of the tongue. Figure 1.107. Macroglossia associated with unilateral hypertrophy of the right side of the tongue....
Beckwith Wiedemann Syndrome
Figure 1.103. Macroglossia in an otherwise normal infant. The most common cause of macroglos-sia is idiopathic hypertrophy of the muscles of the tongue. Figure 1.104. Macroglossia associated with Beckwith-Wiedemann syndrome. These infants have exomphalos omphalocele or large umbilical hernia , macroglossia, and gigantism EMG syndrome . Figure 1.104. Macroglossia associated with Beckwith-Wiedemann syndrome. These infants have exomphalos omphalocele or large umbilical hernia , macroglossia, and...
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Figure 1.79. Neonatal teeth causing ulceration of the undersurface of the tongue by vigorous sucking Riga-Fede disease . Neonatal teeth are more likely to cause this because the mucous membranes are still very delicate. These teeth require extraction to permit healing of the ulceration. Figure 1.79. Neonatal teeth causing ulceration of the undersurface of the tongue by vigorous sucking Riga-Fede disease . Neonatal teeth are more likely to cause this because the mucous membranes are still very...
Traumatic Lower Lip Ulcer In Infants
Figure 1.97. Note the mucoceles on the lower lip of this premature infant birthweight 1200 g . Mucoceles are not true cysts but rather collections of mucus surrounded by connective tissue. They usually occur on the lower lip, are not common, and require no treatment. Differential diagnosis includes herpetic lesions. Figure 1.98. Congenital epulis may occur as a small or very large mass that protrudes from the mouth as a large tumor. They may be pedunculated and are of firm consistency. They...
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Figure 1.87. Lingual ankyloglos-sia tongue tie in a premature infant birthweight 1700 g . Note the indentation of the tip of the tongue. The lingual frenulum limits the movement of the tip of the tongue. True tongue tie is rare. If the tongue can be protruded beyond the lips, no intervention is necessary as the tongue grows more rapidly than the frenulum and soon becomes freely mobile. Figure 1.87. Lingual ankyloglos-sia tongue tie in a premature infant birthweight 1700 g . Note the indentation...
Fused Temporal Lobe
Figure 1.55. Another example of the median cleft syndrome with a normal karyotype and a head ultrasound showing holoprosencephaly. The close-up view shows clefting of the alveolar ridge which is also seen in this syndrome. Holoprosencephaly results from maldevelopment of the forebrain prosencephalon . It may occur as an alobar type in which there is a horseshoe-shaped single ventricle a semilobar type in which there is partial differentiation of the ventricles, especially at the...
Protruding Forehead
Figure 1.26. In this infant with Apert's syndrome acrocephalosyndactyly , note the high steep frontal bone, protruding forehead, flat midface, small pinched nose, and the downward slanting of the palpebral fissures. The acrocephaly is due to premature fusion of the coronal sutures, resulting in bilateral coronal craniosynostosis. This infant also had the typical finding of a high arched palate. Figure 1.26. In this infant with Apert's syndrome acrocephalosyndactyly , note the high steep frontal...
Flat Occiput Frontal Bossing
Figure 1.13. Note the typical long narrow skull of a premature infant with hypsicephaly. Hypsicephaly is a term used by anthropologists for high heads that are not pathologic or due to craniosynostosis. This term is used interchangeably with that of dolicho-cephaly when associated with prematurity. Figure 1.13. Note the typical long narrow skull of a premature infant with hypsicephaly. Hypsicephaly is a term used by anthropologists for high heads that are not pathologic or due to...
Micrognathia Infant Pictures
Figure 1.62. Another variant of the median cleft syndrome holoprosencephaly is cebocephaly in which there is a small nose with a single nostril above or below the eyes. Note the single orifice and aplasia of the nasal septum and philtrum. Figure 1.63. Buccal fat pads sucking cushions are pads of fat tissue between the fibers of the masseter muscle. When the infant is sucking they prevent collapsing of the cheeks during indrawing. These fat pads remain unaltered despite loss of adipose tissue in...
Inclusion Cyst Infant
Figure 1.92. Gum hypertrophy in an infant born to a mother treated with phenytoin during pregnancy. Figure 1.91. The components for each individual tooth bud can often be seen on the alveolar ridges of the maxilla and mandible in normal infants. Note the milia on the nose and the demarcation on the lip where the skin meets the mucous membrane. The sucking calluses occur on the mucous membrane part of the lip and are most prominent on the central portion. Figure 1.92. Gum hypertrophy in an...
Protruding Forehead
Figure 1.31. Another example of acro-cephalosyndactyly in an infant whose mother had the same condition. Note the turribrachycephaly, high steep frontal bones, protruding forehead, flat midface, small pinched nose, and the downward slant of the palpebral fissures. Figure 1.31. Another example of acro-cephalosyndactyly in an infant whose mother had the same condition. Note the turribrachycephaly, high steep frontal bones, protruding forehead, flat midface, small pinched nose, and the downward...
Holt Oram Syndrome
Figure 1.48. A more severe example of a lateral nasal cleft in an otherwise normal infant. Figure 1.51. Proboscis lateralis is a congenital abnormality in which the nose fails to develop normally. Figure 1.49. Although lateral nasal clefts, in general, are isolated findings, this infant in addition to the cleft had Holt-Oram syndrome heart disease, in this case coarcta-tion of the aorta, and absence of left radius and thumb . Figure 1.50. In this infant with bilateral clefting of the alae nasi,...
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Figure 1.61. In holoprosencephaly when there are separate orbits with a proboscis above the eyes and a lack of nostril with a single or double proboscis above or below the eyes, the condition is called ethmo-cephaly. Note also the small mouth. Figure 1.61. In holoprosencephaly when there are separate orbits with a proboscis above the eyes and a lack of nostril with a single or double proboscis above or below the eyes, the condition is called ethmo-cephaly. Note also the small mouth. Figure...
Clover Leaf Skull
Figure 1.19. Trigonocephaly is due to premature fusion of the metopic suture and is represented clinically by a triangular-shaped head. This condition may occur in utero or in the first months of life. It may occur in otherwise normal infants, but is also seen in infants with chromosomal anomalies or the median cleft syndrome. Figure 1.20. Another example of less severe trigonocephaly. Figure 1.20. Another example of less severe trigonocephaly. Figure 1.21. Note the asynclitism of the skull...
Chapter 1 Head and Neck
Examination of the head should include visual inspection, palpation, auscultation for bruits over the temporal arteries and anterior fontanelle , assessment of the shape and size relative to the rest of the body and face, distribution and character of the hair and underlying scalp, and measurement of head circumference. The hair is inspected for color, texture, distribution and directional patterns. The shape of the cranial vault reflects interaction of internal anatomy, volume, pressure and...