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SUMMARY Hearing tests were made on newborn infants who were crying spontaneously shortly before a feed was due, by vocalisation by the examiner at about 20 cm. distance from the baby's ear. Sound level was about 50 decibels and spectographic analysis showed that the main frequency was about 100c./sec. A quieting response was produced in the majority of infants and was graded into five categories according to the degree of response. If the response is one of attention mediated at cortical level, it may be important in predicting the ultimate cerebral status of the neonate.

Previous studies of changes in lung volume with position in adults demonstrate the efficacy of gravity methods of artificial respiration. In the present study the ventilation was measured that could be achieved by changes in body position of normal new-born infants. In no instance was the volume of air moved equal to a tidal volume. The failure of this method to achieve ventilation in infants may be due to their shorter abdominal length and more compliant rib cage.

Low-birth-weight babies have one and all the distinction of being heir to the greatest terminological mess in the history of medical science. Half a century ago some delegates from the developed countries of the day decided that 2500g decimal measure, being -2SD from the mean at full term, was awfully convenient in coinciding with 5½lbs imperial measure, so these measures of weight came to define a concept of time (“premature”) (Diagram A). In this euphoric moment there was little heed of determinants such as sex, rank, social class, skeletal structure or other variables.

It might on first impression seem excessive to devote even a modest volume just to a single sector of one system over the course of a few days. Justification depends on the fact that routine inspection of the eyes in current neonatal practice is embarrassingly unrewarding, yet easily capable of major improvement. Up to the present, little time seems to have been devoted to teaching the baby’s physiological responses, yet nowhere is there more truth in the paediatric precept that success is founded in a thorough knowledge of the range of normal. If the eyes happened to be well open the aims of inspection, when expressed, may for instance have been pupil size, shape and reaction to light, cataract or coloboma. Such objections are unrealistic, relatively unrewarding and almost unachievable; for instance, to take but one item, coloboma ‘prevalence figures are not available’ (Suryey of Ophthalmology, 1981) … res ipsa loquitur.

What is the Matter? 245 What is the Plan? 313 Why did it Happen? 325 Could it Happen Again? 326 Section 6 Skin Defects Introduction 333 Vascular Birthmarks 337 Pigmented Birthmarks 357 Partial Thickness Defects 369 Keratinisation Disorders 377 Blistering and Bullous Disorders 381 Neuroectodermal Dysplasias 387 Index 401 Introduction What is a normal newborn infant? To answer that question requires an experience large enough to know the many variations that are considered within a normal range. Some of these variations can be measured, such as weight and length. Others are less easily measured, but have come to be recognized as common variants such as molding of the head or temporary deformations of limbs caused by unusual intrauterine positions. One way to recognize deviations from normal that may require intervention is to have a long experience examining many infants. Another way is to enrich a finite experience by access to a superb collection of photographs taken over a long period by a careful observer. No one student can possibly see all the normal and abnormal variations in newborn infants in the time allotted in most curricula, or for that matter in a lifetime. We are dependent on shared information.

The most important part of the routine examination is the doctor’s deliberate overall scrutiny of the fully-undressed baby. The full normal range of external appearances presents an infinite variety as a challenge to clinical alertness. A sound knowledge of the normal features is the safe foundation for effective day-to-day care of the average newborn; the doctor’s confident enjoyment is immediately communicated to all involved. Attention is directed to the postural and compressional effects of prenatal and intrapartum influences, to the skin and its appendages, the mouth, sexual characteristics, and the navel together with the cord.