Clinical assessment

Abstract

Although the infant’s main problem is in their respiratory system, it is obviously important to observe and examine the whole infant. This is not only to assess their general status and need for supportive therapy, but also to detect abnormal signs that could suggest or help to confirm the diagnosis of the respiratory problem. For example, Potter’s facies and/or contractures can be seen in infants with pulmonary hypoplasia (Chapter 32), meconium staining in infants with meconium aspiration syndrome (Chapter 23), the presence of petechiae could indicate congenital infection with pneumonia (Chapter 21) and an abnormal posture is suggestive of a neuromuscular disorder (Chapter 36). Similarly, on examination, the finding of hepatosplenomegaly might indicate congenital infection. It is important, however, to distinguish an enlarged liver and spleen from organs which have been pushed down by the diaphragm in a tension pneumothorax (p. 312); in the latter scenario there may also be a color change above and below the diaphragm. The great vessels can be ‘nipped’ as they go through the diaphragm distorted by a tension pneumothorax; as a consequence the bottom half of the body is very pale and the top half cyanosed. The adequacy of the infant’s perfusion should be assessed. This is particularly important in infants with persistent pulmonary hypertension of the newborn (PPHN) (p. 9). The rate of capillary refill after blanching the skin should be determined;9 delayed refill suggests that the infant is hypovolemic.