Atlas of the Newborn, Volume 1 - Volume5

921 Pages·1997·42.601 MB·English

by  Arnold Rudolph MD

V O L U M E 1
Neonatal (cid:13)
and (cid:13)
Perinatal (cid:13)
Medicine(cid:13)
(cid:13)
(cid:13)
Atlas of the
Newborn
Rudolph
V O L U M E 1
Neonatal (cid:13)
and (cid:13)
Perinatal (cid:13)
Medicine(cid:13)
(cid:13)
(cid:13)
Atlas of the
Newborn
Arnold J. Rudolph, . .
M D
(Deceased)
Professor of Pediatrics
Baylor Medical College
Houston, Texas
V O L U M E 1
Neonatal (cid:13)
and (cid:13)
Perinatal (cid:13)
Medicine(cid:13)
(cid:13)
(cid:13)
Atlas of the
Newborn
Arnold J. Rudolph, M.D.(cid:13)
(Deceased)(cid:13)
Professor of Pediatrics(cid:13)
Baylor Medical College(cid:13)
Houston, Texas
1997
(cid:13)
B.C. Decker Inc.(cid:13)
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Notice: the authors and publisher have made every effort to ensure that the patient care recommended herein,
including choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of pub-
lication. However, since research and regulation constantly change clinical standards, the reader is urged to check
the product information sheet included in the package of each drug, which includes recommended doses, warnings,
and contraindications. This is particularly important with new or infrequently used drugs.
Foreword
Sir William Osler stated, “There is no more tinentia pigmenti (Bloch-Sulzberger syn-
difficult task in medicine than the art of drome) are among the best that I have seen.
observation.” The late Arnold Jack Rudolph Cutaneous manifestations are associated
was an internationally renowned neonatolo- with many perinatal infections. The varied
gist, a teacher’s teacher, and, above all, one manifestations of staphylococcal infection of
who constantly reminded us about how much the newborn are depicted vividly in photomi-
could be learned by simply observing, in his crographs of furunculosis, pyoderma, bullous
case, the newborn infant. impetigo, abscesses, parotitis, dacryocystitis,
This color atlas of neonatology represents a inastitis, cellulitis, omphalitis, and funisitis.
distillation of more than 50 years of observing Streptococcal cellulitis, Haemophilus influen-
normal and abnormal newborn infants. The zaecellulitis, and cutaneous manifestations of
Atlas begins with a section on the placenta, listeriosis all are depicted. There are numer-
its membranes, and the umbilical cord. Jack ous photomicrographs of congenital syphilis,
Rudolph delighted in giving a lecture entitled showing the typical peripheral desquamative
“Don’t Make Mirth of the Afterbirth,” in rash on the palms and soles, as well as other
which he captivated audiences by showing potential skin manifestations of congenital
them how much you could learn about the syphilis which may produce either vesicular,
newborn infant from simply observing the bullous, or ulcerative lesions. The various
placenta, its membranes, and the umbilical radiologic manifestations of congenital
cord. syphilis, including pneumonia alba, ascites,
In a few more than 60 photomicrographs, growth arrest lines, Wegner’s sign, periostitis,
we learn to read the placenta and gain insight and syphilitic osteochondritis, are depicted.
into such disorders as intrauterine growth Periostitis of the clavicle (Higouménaki’s
retardation, omphalitis, cytomegalic inclu- sign) is shown in a photograph that also
sion disease, congenital syphilis, and congen- depicts periostitis of the ribs. A beautiful pho-
ital neuroblastoma. Congenital abnormalities tomicrograph of Wimberger’s sign also has
of every organ system are depicted along with been included; this sign, which may appear in
the appearance of newborn infants who have an infant with congenital syphilis, reveals
been subjected in utero to a variety of differ- radiolucency due to erosion of the medial
ent drugs, toxins, or chemicals. We also learn aspect of the proximal tibial metaphysis.
to appreciate the manifestations of birth trau- The Atlas also includes a beautiful set of
ma and abnormalities caused by abnormal photographs which delineate the ophthalmo-
intrauterine positioning. logic examination of the newborn. Lesions
More than 250 photographs are used to which may result from trauma, infection, or
illustrate the field of neonatal dermatology. congenital abnormalities are included. There
The collection of photographs used in this are numerous photographs of the ocular man-
section is superior to that which I have seen ifestations of a variety of systemic diseases,
in any other textbook or atlas of neonatology such as Tay-Sachs disease, tuberous sclerosis,
or dermatology; this section alone makes this tyrosinase deficiency, and many more.
reference a required addition to the library of Photographs of disturbances of each of the
any clinician interested in the care of infants various organ systems, or disorders affecting
and children. Photographs of the Kasabach- such organ systems, also are included along
Merritt syndrome (cavernous hemangioma with numerous photographs of different forms
with thrombocytopenia), Klippel-Trénaunay of dwarfism, nonchromosomal syndromes and
syndrome, Turner’s syndrome, Waardenburg’s associations, and chromosomal disorders. In
syndrome, neurocutaneous melanosis, mas- short, this Atlas is the complete visual
tocytosis (urticaria pigmentosa), and incon- textbook of neonatology and will provide any
v
physician, nurse, or student with a distillation Nevertheless, Jack Rudolph continued to
of 50 years of neonatal experience as viewed work extraordinarily long hours in the care of
through the eyes of a master clinician. the newborn infant, and was at the bedside
Arnold Jack Rudolph was born in 1918, teaching both students and house staff, as
grew up in South Africa, and graduated from well as his colleagues, on a daily basis until
the Witwatersrand Medical School in 1940. just a few months before his death in July
Following residency training in pediatrics at 1995.
the Transvaal Memorial Hospital for Although Dr. Rudolph was the author or
Children, he entered private pediatric prac- co-author of more than 100 published papers
tice in Johannesburg, South Africa. After that appeared in the peer-reviewed medical
almost a decade, he left South Africa and literature, his most lasting contribution to
moved to Boston, where he served as a Senior neonatology and to pediatrics is in the legacy
Assistant Resident in Medicine at the of the numerous medical students, house staff,
Children’s Medical Center in Boston, fellows, and other colleagues whom he taught
Massachusetts, and subsequently pursued fel- incessantly about how much one could learn
lowship training in neonatology at the same from simply observing the newborn infant.
institution and at the Boston Lying-In This Atlasis a tour de force; it is a spectacular
Hospital, Children’s Medical Center and teaching tool that has been developed, collat-
Harvard Medical School under Dr. Clement ed, and presented by one of the finest clinical
A. Smith. neonatologists in the history of medicine. It is
In 1961, Dr. Rudolph came to Baylor an intensely personal volume that, as Dr.
College of Medicine in Houston, Texas, the Rudolph himself states, “is not intended to
school at which he spent the remainder of his rival standard neonatology texts,” but rather
career. He was a master teacher, who received to supplement them. This statement reveals
the outstanding teacher award from pediatric Dr. Rudolph’s innate modesty, since with the
medical students on so many occasions that exception of some discussion on pathogenesis
he was elected to the Outstanding Faculty and treatment, it surpasses most neonatology
Hall of Fame in 1982. Dr. Rudolph also texts in the wealth of clinical information
received numerous awards over the years from that one can derive from viewing and imbib-
the pediatric house staffs for his superb teach- ing its contents. We owe Dr. Rudolph and
ing skills. those who aided him in this work a debt of
He was the Director of the Newborn gratitude for making available to the medical
Section in the Department of Pediatrics at community an unparalleled visual reference
Baylor College of Medicine for many years, on the normal and abnormal newborn infant.
until he voluntarily relinquished that posi-
tion in 1986 for reasons related to his health.
Ralph D. Feigin, M.D.
June 13, 1996
vi
Preface
I first became attracted to the idea of pro- been kept to a minimum. Additional space
ducing a color atlas of neonatology many has been devoted to those areas of neonatal
years ago. However, the impetus to synthesize pathology (e.g., examination of the placenta,
my experience and compile this current col- multiple births and iatrogenesis) which pose
lection was inspired by the frequent requests particular problems or cause clinical concern.
from medical students, pediatric house staff, Obviously, because of limitations of space,
nurses and others to provide them with a it is impossible to be comprehensive and
color atlas of the clinical material provided in include every rare disorder or syndrome. I
my “slide shows.” For the past few decades I have tried to select both typical findings and
have used the medium of color slides and variations in normal infants and those found
radiographs as a teaching tool. In these week- in uncommon conditions. Some relevant
ly “slide shows” the normal and abnormal, as conditions where individual variations need
words never can, are illustrated. to be demonstrated are shown in more than
“I cannot define an elephant but I know one one case.
when I see one.”1 As the present volume is essentially one of
The collection of material used has been my personal experience, it is not intended to
added to constantly with the support of the rival standard neonatology texts, but is pre-
pediatric house staff who inform me to “bring sented as a supplement to them. It seems
your camera” whenever they see an unusual logical that references should be to standard
clinical finding or syndrome in the nurseries. texts or reviews where discussion on patho-
A thorough routine neonatal examination genesis, treatment, and references to original
is the inalienable right of every infant. Most works may be found.
newborn babies are healthy and only a rela- Helen Mintz Hittner, M.D., has been kind
tively small number may require special care. enough to contribute the outstanding section
It is important to have the ability to distin- on neonatal ophthalmology.
guish normal variations and minor findings I have done my best to make the necessary
from the subtle early signs of problems. The acknowledgements to the various sources for
theme that recurs most often is that careful the clinical material. If I have inadvertently
clinical assessment, in the traditional sense, is omitted any of those, I apologize. My most
the prerequisite and the essential foundation sincere appreciation and thanks to Donna
for understanding the disorders of the new- Hamburg, M.D., Kru Ferry, M.D., Michael
born. It requires familiarity with the wide Gomez, M.D., Virginia Schneider, PA, and
range of normal, as well as dermatologic, car- Jeff Murray, M.D., who have spent
diac, pulmonary, gastrointestinal, genitouri- innumerable hours in organizing and culling
nary, neurologic, and musculoskeletal disor- the material from my large collection. We
ders, genetics and syndromes. A background wish to thank Abraham M. Rudolph, M.D.,
in general pediatrics and a working knowl- for his assistance in reviewing the material.
edge of obstetrics are essential. The general We also wish to thank the following people
layout of the atlas is based on the above. for their photo contributions to this work:
Diseases are assigned to each section on the Cirilo Sotelo-Avila, Stan Connor, Avory
basis of the most frequent and obvious pre- Fanaroff, Milton Finegold, Brian Kershan,
senting sign. It seems probable that the find- Tom Klima, Susan Landers, Gerardo Cabera-
ings depicted will change significantly in the Meza, Ken Moise, Don Singer, Edward
decades to come. In this way duplication has Singleton.
vii
It is hoped that this atlas will provide and technology. One must bear in mind the
neonatologists, pediatricians, family physi- caveat that pictures cannot supplant clinical
cians, medical students and nurses with a experience in mastering the skill of visual
basis for recognizing a broad spectrum of nor- recall.
mal variations and clinical problems as well 1. Senile dementia of Alzheimer’s type — normal aging or
as provide them with an overall perspective disease? (Editorial) Lancet1989; i:476-477.
of neonatology, a field in which there contin-
ues to be a rapid acceleration of knowledge
Arnold J. Rudolph, M.D.
viii
CONTENTS
Volume I
Neonatal and Perinatal Medicine
1. The Placenta, its Membranes, and the Umbilical Cord 1
2. Multiple Births 23
3. Effects of Maternal Medication 47
4. Birth Trauma 57
5. Deformations and Disruptions 81
6. Fetal Growth and Assessment of Gestational Age 117
7. Iatrogenesis 125
Index 154
ix