Inspect the patient for cyanosis. If central cyanosis is present within the first hours or days after birth, suspect atresia of one of the right heart valves, transposition of the great vessels, or persistent fetal circulation.

Inspect for evidence of congestive heart failure. In newborns, the most important signs of heart failure are poor feeding, persistent tachycardia of up to 200 beats per minute, tachypnea, pallor, and an enlarged liver. Crackles are not sensitive indicators of heart failure in newborns. Heart failure during the first few days after birth is frequently caused by hypoplastic left heart syndrome.

Palpate for the point of maximum impulse. In newborns younger than 48 hours old, the point of maximum impulse is often in the xiphoid region. After this period and for several years, the point of maximum impulse should be in the fourth left intercostal space just lateral to the midclavicular line. A right-sided point of maximum impulse is suggestive of dextrocardia, a left-sided pneumothorax, or a diaphragmatic hernia (which is usually on the left side, so that the herniated abdominal contents displace the heart to the right.)

Auscultate the heart in the same locations as in adults by using the small diaphragm and bell of the stethoscope. Because the respiratory rate is so rapid in newborns, it is often difficult to distinguish respiratory from cardiac events. Sometimes occluding the nares for a few seconds may help to elucidate the sounds. Auscultation in newborns has a low degree of sensitivity in detecting congenital heart disease. Many ''normal'' murmurs heard in the early neonatal period are related to the marked changes in circulation after birth. It has been suggested that there is less than a 1 in 10 chance that a murmur heard in the neonatal period is the consequence of actual congenital heart disease. A systolic murmur at the upper left sternal border from a patent ductus arteriosus is commonly heard at birth but disappears by the second or third day after birth as the ductus spontaneously closes. In contrast, many severe congenital heart lesions, such as transposition of the great vessels, produce no murmur in the neonatal period. If any murmurs are present, they should be noted and described as indicated in Chapter 14, The Heart.

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Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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