•

ca t as
f
hi
Anita M. C. Li and Chap-Yung Yeung
A Clinical Atlas
of Chinese Infants

Anita M .e. Li
MO BS (HK), FRCI' (Edin), 001 (Lon d)
Formerly Senior Lecture r
Department of Paediatrics
University of Hong Kong

C h ap~ Yung Yeung

MBBS (HK), FRcr (Lond, Edi n, Glas, Irel),
FRcr (C), FRAcr, DCH (Lond)
Proft'ssor and Chairman
Department of Paediatrics
Unh'crsity of H ong Kong

S"'
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,
Hong Kong Universi t y Press
'i'!!-**.!:I:'.;I,l4!.
Hong Kong University Press
139 Pokfulam Road, Hong Kong

© Hong Kong University Press 1996

ISBN 962 209 390 6

All rights reserved. No portion of this publication

may be reproduced or transmitted in any form or
by any means, electronic or mechanical, including
photocopy, recording, or any information storage or
retrieval system, without permission in writing from
the Publisher.

Printed in Hong Kong by Nordica Printing Co. Ltd.

CONTENTS

Preface iv

Acknowledgments v

Section 1 The Newborn

(photos 1-27)

Section 2 The Preterm Baby 15

(photos 28-40)

Section 3 Trauma 23
(photos 41-52)

Section 4 Infection 30
(photos 53-70)

Section 5 Congenital Conditions 40

(photos 71-106)

Section 6 Syndromes 59
(photos 107-135)

Section 7 Jaundice 72
(photos 136-144)

Section 8 Development in the First Year 77

(photos 145-160)

References 86

Index 87
PREFACE

A well known Chinese idiom states: 'seeing once is better than

hearing a hundred times'. From our teaching experience, we have
certainly found that 'seeing' is the most effective way for medical
students to learn about child health and clinical paediatrics. In
situations when the real clinical condition is not available for
viewing, a good picture is the best alternative. Many excellent
paediatric atlases have bel'n published, and some have been very
popular, but to our knowledge this atlas is the first one in which all
the illustrations are of Chinese infants. Whenever possible, we have
tried to point out the ethnic difference which may exist in certain
areas. It is also interesting to note that in general, the Iwalth problems
seen in Chinese infants are similar to those reported from other
geographical regions. In our endeavour to include representative'
photographs, we are aware that some are not of ideal quality. It is
our hope that this atlas should be useful to medical students and
all medical and health workers who p!'()vide health care for infants,
and Chinese infants in particular.

Anita M.e. Li
Chap-Yung Yeung
January 1996
ACKNOWLEDGMENTS

We wish to express our sincere thanks to Mr. C.S. Leung and his
staff for their invaluable assistance in the preparation of this atlas.
We are grateful to Dr. Flora Baber for providing many of the excellent
photos in the section on development, and to Dr. Henrietta Ip and
Dr. Barbara Lam for their permission to use twelve photographs
from their own collections. Our gratitude is due to Dr. Paul Ko and
Dr. Francis Ho for their encouragement and constructive advice in
the preparation of this book, and to Dr. Yc. Tsao, Dr. Louis Low,
Professor Ye Yi-Yan and Dr. Albert Wou for their valuable
suggestions and comments on the manuscript. We thank Teresa
Wong, Anita Ho, Constance Chau and their colleagues for their
competent secretarial assistance, and to all our colleagues in the
department for their help in different ways. Finally, we would like
to thank the staff of Hong Kong University Press for their patience
and meticulous attention to detail in this publication.
SECTION 11
THE N EWBORN
(photos 1-27)
1

1_. 2 Vernix caseosum is the cheesy white deposit seen around

the fa ce (1 ), and .lit over the body (2 ), in most fullterm babies at
the time of birth. It dries and flakes off within a few hours.
Clinical significance (CIS ): Vernix may be stained by meconium if
there has been foetal distress. It is nol seen in post-term babies.
3

3 Erythem a neonatorum is an angry red flush that can often be

seen all over the body a few hours after birth (boiled lobster effect),
and it fades within 24 hours.
C IS: [I should not be mistaken for skin infection or cellulitis which
would be accompanied by signs of inflammation.

4 4-G Physical fea tu res

of th e term baby.
(Compare with features
in the preterm baby 29-
31 .)

4. Breas t areolae are

well developed .

..
 5 Scro tal rugae are
prominent.

6 6 Sole creases can be

clearly seen.
 7 Sucking and rooting reflexes in the newborn can be easily
elicited by to uching either the cheek or the mouth. This baby has
turned to the direction of touch and started sucking.
CIS: Baby who has neurological abnormality, such as that caused
by severe birth asphyxia, may show sluggish or absent response to
sudl stimulation in the initial hours after birth.

8 Visuil.l fixation observed in the newborn indicates the ability

to see and focus. This day 4 newborn baby is looking intently at her
mother.
C IS: Failure to show visual fixation may indicate abnormality in
vision.
9 9 Pretenn baby is one who
is born before 37 weeks'
gestation and is usually less
than 2.5 kg. This l -kg baby al
26 weeks' gestation has
bright red transparent skin
which is slightly oedemal-
ous. The pos ture is sprawled
with extended upper limbs.
She nee ds a ssis ted
respiratio n.
C IS: This baby is closely
monitored for problem s
ar ising from organ im -
maturity (see Section 2). The
ve ry low b irth weight
( VLBW) baby, <1500g,
usually requires intensive
care.

lO 10 Intra uteri ne g rowth

reta.rd ed (IUCR) baby has
birth weight below the 10th
(colile for gestational age.
This 2-kg baby, al 39 weeks'
g es tati on , is lon g, thin,
was ted, sc ragg y with dr y
pee ling s kin. Hi s he ad
circumfere n ce, facial
appearance and neurological
behav iour are co mpatible
with ges tati o n, not birth
weight. His placenta is small
a nd infarcted , indica ti n g
placental insufficiency. An·
other type of IUGR baby is
unifo rml y small due to
chronic causes, e.g. maternal
toxaemia, e mbryo path y, or
intrauterine infection, and
the phys ical appearance
differs from thc above.
CIS: This baby should be
closely watched for evidence
of birth as phyxia , h yp o·
g lycaemia, and less commonly, pulmonary haemo rrhage. In the
uniformly small baby, one should carefully search for presence of
~ congenital disorders.
1.1

11 Large-for-dale baby is generally regarded as one whose birth

weight is over 90th ('n tile for gestation. I-I e or she may be
constitutionally big, or horn of mothers who either arc known
diabetics, or have gestational diabetes. This baby, infant of a diabetic
mothe r, is big (5.5 kg at birth), plethoric, and has truncal obesity. In
Hong Kong, the number of babies bom of insulin dependent diabetic
mothers is much lower than that reported in Caucasians becauseof
the low incidence o f juvenile diabetics (unpublished data).
CIS: This baby should be carefully watched fo r the development
of respiratory distress sy ndrome, hy p oglycaem ia, and
hypocalcaemia in the first 24 hOUTS, and examined for the presence
of sacral agenesis.

1.2 ] .2 Post-tern, baby is

the infant born afte r 42
weeks' gesta tion. Note
the dr y, c racked and
desqua mating s kin .
Vernix caseosu m is
absent, and the cord is
some tim es yellowish
g reen from meconi u m
staining.
CIS: They are prone to
birth asphyxia , and
pneumonia from meco-
nium aspi ration.
 13

I3 Harlequin colour change is a rare vasomotor phenomenon in

the newborn. Ln this baby, the demarcation line is transverse with
different skin colours above and below the groin. Colour change
along the midline of the body is more common.
CIS: No treatment is required.

I4 Twin-twin transfusion through placental vessels ma y account

for the marked colour difference observed in uniov ular twins after
birth. This picture shows marked pallor in one, and plethora in the
other.
CI S: In extreme situation, replacement transfusion for the anaemic
twin, and partial exchange transfusion to reduce viscosity in the
• •:1 other polycythaemic one are required.
J5 J6 Foetal-matem al trans-
fu s io n occurs primarily
during labour and p ar-
turition. Uti lizing the
Kle ihaue r's test,~ the
peripheral blood smear
made from maternal blood
shows under the microscope
(low powe r view,
• haematoxylin-eosin stain)
int act foetal cells among
• denatured maternal cells
which appear as 'ghost cells'.
• CIS: The baby may need
• transfusion if blood loss is

~ .. • significant. The mother may

thus be iso-immunized
resulting from Rh~· or ABO
blood group incompatibility.
• Kleihaue r's test (acid
elution slide test) is based on
the fact that red cells containing Hb A (maternal cells) are denatured
by acid, but those with high concentration of Hb F (foetal cells) are
resistant .
•• Rhesus incompatibility is rarely seen among Cantonese (southem
Chinese), because 99.73% are Rhesus 0 positive. (Mak et al., 1993)

16

l6 Naevus at the nape is the light colour capillary dilatation

commonJy seen at the back of neck. It may appear along the midline
of the face.
CIS: This g radually fades off within the fi rst two years.
17

18

17.18 Mongolian b lue spot are bluish pa tches on the ;ikin

commonly seen in Chinese babies in the lower lumbar region (17).
(18 ) shows the bathing trunk distribution.
CIS: The pigment gradually disappears with age. This should
not be mistaken for bruising or non-accidental injury.
,9 19. 20 The umb ili ca l
cord is tied with sterile
strings or clamped with a
clip (19) before it is cut. In
(20 ). the meconium
stained cord is suggestive
of foetal d istress.
CIS: The cord should be
kept dry and clean with
special attention to the cord
base. It d ries up and drops
off in about a week.

20

21

21 Erythema toxicum appears in the fi rst few days of life as

papules which are surrounded by an area of mild erythema on the
trunk and limbs. This is a common phenomenon but the cause is
not known.
CIS: Distinction fro m skin sepsis can be made by the absence of
inflammatory markers. No trea tment is required.

Ii
22

22 Breast enlargement is commonly seen in both sexes of the

newborn. In this infant it is unilateral. Sometimes lactation occurs.
It is attributed to the effect of maternal hormone.
CIS: Enlarged breasts will subside with no treatment. However,
treatment is required if there is mastitis.

23

23 Natal teeth in the newborn commonly occurs in the central

[ower incisor region as shown . It is usually associated with
deciduous dentition. The incidence is about 1 in 5000.
CIS: If loosely attached, they need to be removed to avoid
aspiration.
 24 Umbilical hernia is the herniation of bowel into the central
abdominal wall defe<:t and the size varies. II is more prominent
when the baby is crying, and is easily reduced. This appears after
the first week of life, and is especially common in preterm babies.
CIS: It usually subsides after the first few years.

25 25 Hydrocele is the
cystic lesion anterior to the
testis and its presence can
be demonstrated by the
lighted torch (2 5 ). This is
commonly found in
newborn infants and is
often bilateraL
CIS: The majority
resolves spon taneously
within the firs t year. This
should not be confused
with inguinal hernia
which extends d own-
ward from the ingui nal
canal.
26 r

26 Meconium is the sticky, dark green stools passed by the

newborn before feeding is fully established. It contains bile, mucus,
and epithelial cells.
C IS: Presence of meconium in the amniotic fl uid is indicative of
foetal distress. Failure to pass meconium within 48 hours suggests
pathologica l conditions and should be investiga ted.

27

:t7 Stools from fully breast-fed infants are soft, or liquid-like

(27), and is mustard yellow in colour. They are less bulky than
stools from formula-fed infants and have a distinct odour.
CIS: Breast-fed babies tend to pass frequent liquid stools, which
should not be confused with diarrhoea. Occasionally some have
infrequent bowel motion which shou ld not be mis taken for
constipation.
SECTION 2

THE P RETERM B ABY

(photos 28-40)
 .!Ii Lanugo hair is the soft, woolly hair that can be seen a.ll over
the body in preterm babies after 30 weeks of gestation, especially
over the back.
CIS: This is less commonly seen in the very premature, or in
babies over 36 weeks of gestation, the notable exception being the
mature baby of a d.iabetic mother.

29-a. Physical/t;'atures of the pretenn baby. (Compare with

features in the tenn baby, photos 4-6.)
29

29 Breast areolae are inconspicuous if <35 weeks.

16
 30 Smooth scrotal sac if <33 weeks.

31

.n Little skin crease over

the sole if <34 weeks.

17
32

a2 Hypotonia is evident in this 3D-week prelcrrn baby who is

unable to maintain the head in the same p lane as the trunk (head
lag) on the pull-la-sit manoeuvre. Most term newborn babies can
do this momentarily.

~IS Hyaline membrane di sease (or respiratory distress

syndrome, RDS), the commonest cause of respiratory distress in
pre terms of <32 weeks' gestation, presents wi th respiratory
p roblems within 4 hours of bi rth. The baby has tachypnoea,
retraction of chest wall on inspiration, and expiratory grunting. X-
ray chest film (33) shows the characteristic air bronchogram, ground
glass appearance, or 'while out' lung fields. Assisted ventilation,
e.g. continuous positive airway pressure (CPAP), or mechanical
ventilation, is required in severe cases (34).
CIS: The progressive respi ratory d ifficulty is due to surfactant
deficiency in the immature lung, and replacement therapy can bring
about marked improvement (35, film taken 4 hours after surfactant
therapy; same baby as 33). Other condi tions such as Group B
streptococcal pneumonia and massive pulmonary haemorrhage
may closely mimic RDS.

18
33

34

3 -3

19
3G

36 Bronchopulmonary dys plas ia is Ihe sequelae seen in babies,

typically preterrns, who require p rolonged oxygen therapy and
mechanical ventilation for severe respiratory disorders. This chest
film shows honey-comb appearance of the lung fields with penhi!ar
fibrosis.
CIS: The eventual outcome varies from respira tor y failure,
chronic lung disease, recurrent 'wheezy bronchitis', or apparent
recovery. The use of dexamethasone appears to improve prognosis.

37 37 Nec ro ti zing en tero-

colitis (NEe) is more
commonly seen in preterm
baby of less than 1.8 kg birth
weight, but it can also occur
in term babies with severe
sepsis. This plain abdominal
X-ray film shows the typical
findings of pneumatosis
intestinalis (air in the bowel
wall), sandy-foamy appear-
ance of bowels, and marked
abdomina l dis tension.
Clinical signs include a
distended abdomen, blood in
stools, and vomiting.
C IS : Th e aetiology is
probably related to ischaemic
bowel injury and infection.
Su rgeons s hould be
consulted if s urgical
complications arise.
20
38

38 Intraventricu.l ar haemorrhage (lVH) is a serious complication

in the prelerm who is <32 weeks' gestation. This 24-week-old baby
had sudden clinical deterioration after being stabilized on the
ventilator for 1-2 days. This ultrasonogram (coronal view ) shows
blood dot in the L ven tricle with s hifting of the midline, and bleeding
into the R ventricle.
CIS: Hydroce phalus and neurological sequelae are common
among survivors.

39

as Jaundice is usually more prolonged due to immature liver

func tion, and made worse in the presence of other factors like
respiratory distress syndrome, perinatal hypoxia, and sepsis. This
prelerrn baby is receiving phototherapy and the eyes are shielded
and protected from light.
CIS; Unconjugated bilirubin levels considered harmless for term
babies can cause kernicterus or death in the pretenn.
21
40

40 Cellulitis developed quickly (within hours) al the site of a

minor skin abrasion over the lumbosacral region in this baby
because of impaired resistance to bacterial infections.
C IS: Prompt medical treatment must be instituted on theslighlesl
sus picion of infection.
SECTION3 1

TRAUMA
(photos 41 -52)
41 4J Bl eedin g sca lp
wound. This baby had
foe tal blood sampling
taken on the sca lp
du ring early labour to
mon itor for foetal
distress. The bleeding
from the tiny puncture
site had pers isted
leading to significant
blood loss. An urgent
blood transfusion was
given after d elivery.

42

42 Facial palsy, R. This picture shows facial asymmetry and

inability to dose the R eye when the baby cries. Unilateral facial

.. palsy is a fa irly common complication after forceps delivery. The

compression effect of the forceps on the branch of the facial nerve is
often transient, and total recovery is usually anticipated .
43

44

43, 44 Erb's palsy. This picture shows the typical position of the
arm wilh Erh's palsy in the baby who has gone through a difficult
breech delivery (43). This resulted from vigorous stretching of the
uppe r brachia 1 plexus (~ to C5) in the manipulation. The palsy
resolved after one week, but the ipsilateral paralysis of the R hemi-
diaphragm showed no change even after three months (44).
45

46

45. 46 Complications of vacuum extraction. This baby had a

difficult vaginal delivery and vacu um extraction had been applied
three times. Skull X-ray film taken immediately aftcrdclivcry (45)
demonstrated marked elevation of the pa rietal bones. A repeat x-
fa y film ta ken 8 days later s howed thai the s ku ll was almost normal
in appearance (46). The baby remained asymptomatic.
47 47 Cephalhaematoma.
This picture shows a
large swelling over the R
par ietal hone which
became obvious on day 3
in this baby who was
delivered vaginally.
Cephalhaematoma is
caused by the accu-
mulation of blood from
the ruptured small
vesse ls in the sub-
periosteal region, and is
not to be confused with
caput succedaneum. A
large cephalhaematoma
can give rise to anaemia
and it aggravates jaun-
dice.

48

48 Subaponeurotic haemorrha ge. This newborn baby was

delivered by vacuum extraction, and he was later found to develop
extensive swelling and discoloration behind the R ear due to
subaponeurotic haemorrhage. This is an uncommon complication
of vacuum extraction and blood loss can be marked; significant
hype rbilirubinaemia often follows. Causes for ble.!ding tcndcncy
in the newborn need to be excluded in the investigation.
49

49 Skull fracture. This newborn baby was accidentally dropped

on the floor and X-ray skull film revealed a linear fracture in the R
parietal bone. The baby remained well and was discharged home
after 3 days.

50 50 Pneumothorax. The
baby was in se rious
respi ratory distress and
X-ray chest film s howed
R tension pneumothorax,
med iastinal shift, and
colla pse of L lung.
Pneumothorax can occur
spontaneously, or as a
complication of hyaline
membrane di sease,
es pecially common
following mecon ium
aspiration. In this infant
w ith tension pneumo-
tho rax, ra pid insertion
of either a chest drain
or a 19-9auge nced le-
intracath is a life saving
measure.
31

52

51. 52 Bruising and tissue necrosis due to iatrogenic cause. The

bruise over the baby's forehead (51) is the extravasated sile of
sodium bicarbonate which has been infused into the scalp vein.
Tissue necrosis, and later scarring, may follow (52) if fluid contains
irritants such as calcium g]uconate, hypertonic glucose solution, or
solutions used in hyperalimentation.
II
SECTION 4
kEenoN
(photos 53-70)
53

sa Ophthalmia neonatorum. This day 2 baby has profuse

purulent eye discharge and periorbital oedema due to gonococcal
conjunctivitis. nus could lead to systemic infection, and JatercomeaJ
scarring. Treatment should be prompt with systemic and topical
penicillin, and parents should also be investigated and treated.
Similar picture may be seen in infection by Chlamydia trachomatis,
but symptoms appear several days later. Mi lder form of
conjunctivitis can be caused by pneumococcus, Staphylococclls,
viruses, and chemicals such as silver nitrate eye drops.

54 Napkin dennatitis. This skin rash around the perineum

(napkin area) has satellite lesions and peeling edges, compatible
with secondary monilial infection. In infants who had infrequent
napkin changes, stool urease acted on the urea in the urine to form
ammonia which irritated the skin. Measures to keep the skin dry,
like frequent napkin changes, exposure of buttock, use of barrier
cream e.g. zinc oxide, and topical antifungal agent can control the .,.,__
situation. 31
55 55 Umb ili ca l a nd
skin infection. This 5-
day-old circumc ised
baby s hows multiple
skin pustules and
umbilical sepsis. Both
skin swabs and blood
cultu re yiel ded Sta-
phylococcus a/m!us and
Group A streptococCl/ s.
Examination of cere-
brospinal fluid showed
raised protein level and
increased number of
white cells compatible
with ea rly changes in
meningitis. Predi s-
posing factors to
infections included poor
skin hygiene and lower
resistance in the new-
born. Vigorous systemic
treatme nt wi th the
appropriate antibiotics
controlled the septicaemia and prevented the baby from developing
the full blown picture of meningitis.

32
57

56-38 Neonatal m ening iti s. This 5-day-old baby has an attack

of generalized convulsion and is found to have bulging anterior
fontanelle (56) and arching of the back (57). His cerebrospinal flu id
(CSF) appears turbid (58). Glasssmears made from CSF show under
the microscope numerous pus cells and Gram negative rods.
Neonatal meningitis is usually the result of septicaemia with Group
B streptococcus, but in this baby, Salmollella s pecies w hich has caused
gastroenteritis is responsible. Prompt systemic treatment with the
appropriate antibiotics which penetrate into the CSF has important
bearing on the outcome of the the rapy.

33
59

59 Neo natal tetanus. This unconscious 6-day-old baby has

recurrent seizures and gen~ra lized muscle spasms on the slightest
stimulation. She was deli vered at sea by her fathe r who was a
fisherman. The umbilical cord has been cut by unsterilized scissors
followed by local application of herbal medicine. It is not possible
to decide which of the above factors caused tetanus in this baby.
Treatment includes putting the baby in a quiet environment, the
u se of anti- te tanu s s erum, sys tem ic penicillin , and recta!
paraldehyde or other drugs to control muscle spasm. Neonatal
tetanus is now rarely seen in Hong Kong, but it is still a common
problem in some developing countries.

60, 61 Congenital syp h-

ilis. This baby was noticed to
have little limb movement,
suggestive of paralys is.
Radiograph shows extensive
periosteal thickening due to
congenital syphilis (GO. 61).
The infected baby may also
have stuffy nose, mu cosal
lesions, and maculopapular
rash; cerebrospinal flu id may
give ab n o rmal findings.
Treatment consists of systemic
penicillin in adequate dosage
for at least ten da ys and
the rap y should include
paren ts if n o t previously
treated. This baby was not
detected because the mother
had no antenata l ca TC.
61

62 62 Co n ge nital ru-
bella syndrome. This
2.S·kg term baby has
cloudy cornea, purpuric
rash and patent ductus
arteriosus. H is liver and
spleen are enlarged on
palpation, but they are
nol visualized in this
photo. Neurosenso ry
deafness and mental
sub normalit y ma y
become obvious later
on. His mother
con tracted rubella
infection in the first
trimester, and this had
affected his intra-
uterine growth (refer to
IUGR baby, photo .0).
Such baby continues to
excrete virus and is a
I health hazard to non-
immunized pregnant women. Management is supportive and
preventive. Immuniza tion of all children is an effective measure to
prevent future occurrence of mbella embryopathy.

35
85

63-65 Congenital cytomegalovirus infection. This IUGR baby

is jaundiced with enlarged liver and spleen, and purpuric rash (Ga.
64). By 3 months of age, intracranial calcification is visible on skull
X-ray film (65). Microcephaly is usually present in such babies,
and virus excretion may persist up to 2 years. Babies with pc.rinatally
acquired infection remain asymptoma tic at birth but may have
hearing and learning problems in later life. Definitive diagnosis
depends on the demonstration of virus in throat washings or in
36 urine. To date there is no treatment that can eradicate this virus.
66
66 Wh oopi n g cou gh and
pneumonia. This 3-week-ol d
baby developed apnoeic attacks
and recurrent choking cough .
Deep nasopharyngeal swab
grew Borde/ella parllprrtJlssis
confirming whooping cough."
X-ray ches t film shows
inte rstitia l pneumonitis with
pneumonic changes. Young
infa nts are not protected by
maternal antibodies, and the
typical 'whoop' is often absent.
Antibiotics given in Ihe early
stage are effective in eradicating
the bac teria , sho rteni ng the
illness, and preventing
pneumonia due to secondary
bacterial im'3sion, otherwise it
takes a protracted course and is
Jocallycal1ed 'the hundred days'
cough'. Nebulized sa lbutamol is
effective in alleviating coughing
spells. Erythromycin used in
contacts has prophylactic value .
• The clil/ical pictrm' of lI'lroopirw
couglr are cat/sed by B. pertussis, B.
paraperlussis mrd B. brollciriseplica.
67
67 Acute bronchiolitis. This
6-month-old infant with feve r
and running nose the night
before was noticed to be short
of breath with exp iratory
wheezes. X- ray film s hows
hyperinflation of lungs, typical
of acute bronchiolitis. This is an
acute respiratory infection by
ei ther respira tory syncytial
virus or other viruses affecting
the bronchioles of young infants
causing inflammation and
swelling of the submucosal
layer. Treatmcnt is supportive
with humidified oxygen and
adequate hydration. Ribavirin,
an antiviral agent, may shorten
the clinical course. Antibiotics
arc ind icated if secondary
bacterial infection occurs and
should not be withheld from
very ilJ babies.
37
68 68
S taph y lococcal
pneumonia. This X-ray
film shows patchy
consolidations, pneu-
matocoeles, and abscess
cavit ies (see arrows),
typical of staphylococcal
pneumonia. The infant
was ser ious ly ill with
high fever, cough,
dyspnoea and irritability.
Staphylococcal infection
occurs in yo un g and
malnouri shed infants.
Potent antistaphy lococcal
agents, to be given parenterally in 'd"q,~'t. dosages, include the
newer erythromycins, cloxacillin and methicillin; vancomycin and
fusidic acid should be used for resistant strains. For hospital staff
who arc ca rriers of Staphylococclls atlrellS, diligent h<lnd washing
before h<lndling each infant in the nursery minimizes the chance of
cross infection in the baby.

6!) 69 Positive tuberculin

test in tuberculosis. In
places such as Hong
Kong where all babies
receive a.c.c. vacc in-
ation after bi rth, a
posit ive tuberculin
reaction is expected ;
however, a very strong
skin reaction to tuber-
culin (induration with
erythem<l >10 mm
diameter) isstill useful in
diagnosis· (6!'). This
baby who showed this
reaction was sub-
seq uently confi rmed to
have tu bercu lous men-
ingitis. Tuberculosis is
still endemic in Hong Kong, and in infancy meningitis is the most
se riou s compli cation . If diagnosed e<lrl y, treatment w ith
combination uf three antituberculous drugs, including rifampicin,
can give good results with complete recovery.
• III/rlll/ermal illjeclioll with 5 i.lI. of tllb£'Tculill for srlspiciollS case, ami
10 i.u.for rOIlUm' kSlil1g.
J8
70

70 Acute ostcomyelities. This X-ray fi lm, taken on an 18-day-

old infant, shows extensive bone destruction and sequestration in
the R femur, characteristic of osteomyelitis. Osteomyelitis is usually
the result of haematogenous spread of staphylococcal infection;
other o rganisms include Group A or B streptococCl/S, Salmonella
species or other Gram negative bacteria. In the early stage radiologic
changes are not evi dent, and technetium bone scan is morc
informa tive. Prompt and vigorous a ntibiotic treatment given
parenterally for 4-6 weeks is necessary. Surgical drainage is
indicated in most.
SECTION 51

CONGENITAL CONDITIONS
(piJotos 71 -106)
71

71 Cleft lip ( L) and p3.i ale.ln this child both the lip and the palate
are affected. This malformation is common, and may be bilateral. It
tends to run in families, and is of polygenic inheritance. Special
dental plate can overcome feeding difficulties. For social and
cosmetic reasons, surgical repair of cleft lip should be done as early
as possible. To minimize speech problems, operation on the palate
is done within the first year.

72

72 Accessory auricles. These areasymptomatic pedunculated skin

tag, or small rod-like cartilage covered with skin that situates at the
junction between the maxillary and the mandibular processes of
the firs t branchial arch. They arc removed surgically fo r cosmetic
reasons.
73

73 Capillary haemangioma. Present at birth, the lesion is flat or

slightly raised. It is caused by dilated capillaries in the superficial
dermis. These lesions do not regress; the only exception is the pale
one at the back of the neck (16). Laser therapy gives encouraging
results in some cases.

74

74 Strawberry naevus. It is a duster of di lated capilla ries which

appears within the first month after hirth. It is raised, bright red,
with discrete edges, and can occur in any part of the body. It usually
regresses over the subsequent years.
73

75 Giant pigmented naevus. This baby was born with this giant
pigmented naevus which covered most of the trunk - 'the bathing
trunk naevus'. Multiple skin grafts are required in treatment.

7G

76 Accessory nipple. This is not uncommon and it is situated

below the breast on a line drawn from the nipple to the symphysis
pubis; the number ma y vary. For this no treatment is required.
Opinions vary as to whether this is associated with renal anomalies.
77

77 Phocomelia. This term means 'seal limb' and isa rare condition.
Maternal ingestion of the sedative thalidomide during pregnancy
is a known cause. In this abandoned baby, only the upper limbs are
affected, and the aetiology cannot be determined.

78 78 Con s tri ction ring

around t h e l eg. This is
uncommon. Ring-like
constrictions may affecl
any part of a limb, but legs
are more commonly
involved than arms. The
cons trictions may be
multiple, shallow, or deep.
It is generally believed to
be due to contracting
amniotic bands. Deep
bands may need surgical
division.
79

79 Talipes equina-varus (club foot) . The R fool in the picture is

in fixed plantar flex ion and turns inward. This is a relatively
common deformity, more so in males, and may affect both sides.
Familial cases suggest an autosomal dominant inheritance with
partial penetrance. Orthopaedic management ranges from
physiotherapy, splinting, to surgery.

80 81

SO. 81 Lobster-claw. This is also known as split hand, split fool

defed which occurs either spontaneously. or as a dominant inherit-
ance. Other types of malformations may coexist. In this baby both
the lower and upper limbs are affected (SO. 81). The uppe r limbs
have reasonable function, in spite of the abnormal form (81).
Corrective surgery (.1n help the infant to walk at a later dale.
82

82 Congenital hemihypertorphy. In this baby hypertrophy

involves the R side of the body. Hypertrophy of the ipsilateral
in ternal orga ns may also occur. The aetiology is unknown.
Conditions should be distingu ished from hemiatrophy. Rarely
hemihypertrophy is associated with mental retardation, Wilm's
turnouT, or adrenal carcinoma.

83

83 Cloudy cornea. This baby with cloudy cornea is blind because

of congenital glaucoma, or buphthalmos which is an autosomal
recessive condition. Another cause for the abnormal cornea is
congenital infection.
84

85

84. 85 Hydranencephaly. Although this baby had a normal head

size at birth (84), rou tine ultrasound examination identified an
abnormal brain. In 11 dark roo m, the head lit up like a lantem when
illuminated from behind (85). In hydranencephaly, there is failun:-
of cerebral development. The ventricles are grossly dilated and filled
with flu id . The prognosis .is poor.
86

86 Microcephaly. This baby's head circumference is the only

measurement that is below the 3rd centile for the gestational age
and the cause cannot be determined. Known causes for
microcephaly include prenatal infection, perinatal injury, or rarely,
familial (autosomal recessive). Most have impaired intellect but a
minority are neurologically normal.

87 87 Hydrocephalus. This baby

has a huge head, down-turned
eyes (setting-sun appearance),
and generalized rigidi ty
indicating brain damage (87). In
hydrocephalus there is excessive
collection of cerebrospinal fluid
(CSF) associated with markedly
distended ventricles. Hydro-
cephalus frequently occurs after
intraventricular haemorrhage in
the preterm infants. Congenital
hydrocephalus in a boy may be
due to X-li n ked aqueduct
stenosis. U lt rasound a nd
computerized axial tomography
(CAT) scan are useful diagnos tic
tools, and surgical treatment, if
indicated, often involves
s hunting the CSF to the
peritoneal cavity.
88 88 Anencephaly. This is a
severe defect with absence of
skull vault and gross
malformation of the brain. The
visible brain tissue is covered
by a vascular me mbrane.
Hydra m nios is com monly
found in such pregnancies and
alpha foetoprotein level is
raised in both the maternal
serum and the amniotic fluid.

89

90 8.9. 90 Encephalocoele.
There is herniation of the
brain tissue and the
meninges through a skull
defect which commonly
occurs at the occipital
region (8"). Surgical
excision was d one on this
baby to close the skull
defect (90 ). Prognosis
depends on the amount of
brain excised.
91

91 Mcningomyelocoele. Failure of neural tube fusion results in

a dcfcctivespinal arch with protrusion of meningeal sac containing
neural tissues, most commonly found in the lumbosacral region
(91). Associated complications include hyd rocephalus, paralysis
of lower limbs, with urine and faecal incon tinence. Good
rehabilitation measures can significantly improve the quality of life.
This malformation is uncommon among southern Chinese (personal
com munication ). The inheritance is polygenic with familial
tendency. in areas of high incidence, antena tal screening with
ultrasonogram, and assessment of alpha foetopro lein level in
amniotic Auid and maternal serum have dramatically reduced the
number of births of such babies.
92 92. 93 Hypothyroidism
(c re tinism), The two
untreated babies shown here
demonstrate coarse fac ial
fea tu res and umbilical hernia
in one (92 ), and large
pro truding tongue with
sa ll ow co m p lexion in the
other (93). They may also
have prolonged neonatal
ja undice. constipation, and
poor weight gain. Affected
hab ies have abnormalities
either in the thyroid gland
development or in thyroxine
synthesis. The characteristic
features of cretinism are not
usually obvio us in the
newborn period, but develop
late r. Routine biochemical
screening of all newborn is
most effective in early
detection, and early treatment
can prevent the development
of menial retardation.

93
94 94 C ongenital h e art
disease. In Hong Kong, the
incidence is around 7 per
1000 live births (Sung et aI.,
1991). Bahieswith trisomy 13,
18 or 21 are frequently
associated with malfo rm-
ation of the heart. This baby
is cyanotic since hirth, and a
heart mu rmur can be
detec te d. The baby with
congenital heart disease may
be acyanotic, or symptom-
lessi others feed poorly, fail to
p ut on weight and d evelop
heart failure. Subsequent
management depends on the
condition of the baby, and the
type of heart lesion. They
are bes t managed by
cardiologists.

95 96

95, 9G Persistent urachus. The mass at the base of this baby's

umbilicus is discharging clear fluid (95), Retrog rade urogram
confirms the presence of persistent urachus (96). Treatment is
s urgica l. A more common cause for umbilical discharge is the
persistent vitelline duct but the discharge is mucoid.
97 97 Oesophageal atresia.
This developmental anomaly
is often associated with
tracheo-oesophageal fistula.
Maternal hydramnios occurs
in over 1/3 of all cases. Soon
afte r birth the baby has
drooling of saliva, cyanosis,
or choking attacks. In
s uspec ted case, fa ilure to
pass a radio-opaque tube into
th e sto mach gives an
important clue. In this baby,
contras t media ha d been
used to outline the blind end
of the oesophageal pouch.
Suction to avoid aspiration
pneumonia is important and
urgent surgical treatment is
indicated.

98

98 M econium peritonitis. In-utero bowel perforation, often

coexisting wi th bowel atresia, results in the presence of meconium
in the peritoneal cavity which can bc<:omecakified. This X-ray film
shows linear calcification in the R peritoneal cavity and calcified
spots over the hepatic region which are characteristic features of
this condi tion. Meconium peritonitiS is also associated with
meconium ileus in cystic fibrosis, but the latter is rare amung
southern Chinese.
99

99 Diaphragmatic h ernia. There is herniation of abdominal

content into the thorax through a defect in the diaphragm,
common ly the L (foramen of Bochdalek). AI birth, the baby is
usually cyanotic, in severe respira to ry dis tress, and has a scaphoid
abdo men. Radiograph of chest shows gu t shadows which is
diagnostic (99). The respira tory problem needs to be dealt w ith
first before surgical intervention. In suspected case, the infant must
be intubated, and res uscitation with bag and mask shou ld be
avoided to prevent inflating the bowel.
100 100.101
Achondroplasia. This is
the most common form of
chondrodysplasia which is
autosomal dominant, but
most cases are sporadic
mutations. This baby has
short limbs, large head,
prominent forehead, and
normal intelligence (100).
Mental development may
be affe<:ted when hydro-
cephalus d evelops. The
thanalophoric dwarf. a
rare and lethal form which
resembles achondroplasia
(101), is autosomal
recessive in inheritance.
This baby succu mbed
within the first week.

101
102

102 Osteopetrosis (Marble bone disease). This is a rare disorder

with defective bone metabolism and presents in two forms. The
early infancy form, an autosomal recessive condition, is a serious
disease, and on radiological films, bones appear thick and dense
(102). Prognosis is grave with pancytopenia. Bone marrow
transplantation offers the only hope for survival. The autosomal
dominant form is relatively benign.

103

103 Haemoglobinuria and erythrocyte glucose-6-phosphate

d ehydrogenase (G-6-PO) defici ency. This enzyme deficiency,
inherited as an X-linked condition, is found in 4-5% of local southern
Chinese males (Yeung & Lee, 1985). Haemoglobinuria (103) is a
fea ture of acute haemolysis which can be triggered by various
infections, certain herbs, naphthalene (moth balls), chemicals, or
some drugs. The heterozygous females are generally asymptomatic.
104 104 H ydro p s foelalis.
This picture shows a stillborn
with generalized oedema.
In southern China ct-
thalassaemia is an important
cause (Todd el aI., 1967).
Haemoglob in elec tro-
phoresis of cord blood shows
mainly Hb Ba rt's with
absence of Hb A. Parents are
carriers of ct-thalassaemia
trait, and in future
pregnancies an tena tal
d iagnosis can prevent
recu rrence through thera-
peutic abortion of similarly
affected foetus.

lOS

103 ~thalassaemi a major (Cooley's anaemia), This is a serious

condition characterized by failure in synthesis of adult haemoglobin.
Such babies are normal at birth, but develop progresSive anaemia
after 4-5 months (105). Their liver and spleen are usually enlarged
due to extra-medullary haemopoiesis. Diagnosis is confirmed by
haemoglob in elect ropho resis. For couples w ho are bot h
heterozygous for ~- thalassaemia (in Hong Kong, the incid ence is
3-4%, Li & Cheng, 1990), the risk of producing an affected offspring
is 25% for each pregnancy. Antenatal diagnosis is available in the
first trimester.
106

JOG Conjoined twin. This tw in is jo ined from the neck

downwards. Surgical separation is not possible because there is only
onc functioning heart. This condition is uncommon, and can be
considered to be non-separated twins. The degree and the type of
fusion vary in different cases.
SE CTIO N 6

SYNDROMES
(pilotos 107-135)
107 J07-U.2 Down's syn-
drome (Trisomy 21, or DIG
tran s locat ion, previous ly
called Mongolism), This is
the commonest ch romo-
somal disorder and the
incidence in Hong Kong is 1
in 600 live births, similar to
that reported elsewhere. The
incid ence increases with
maternal age. Babies have
characteristic fea tu res such as
flat OCciput, out-slanting eyes
(107), prominent epicanthic
folds, single transve rse
palma r crease, in-curving
fifth finge rs (108), widely
separa ted first and second
toes, hypotonia ( IOU),
congenital heart disease, and
108 gastrOintestinal abno r-
mal ities, the best known
be in g duodenal alresia
(1.10). Mental retardation is
a constant feature. Non-
disjunction type occurs in
93% ( Ll1 ), translocation in
5% (ll2), and mosaicism or
other types in the res t (Li et
aI., 1992). Prenatal diagnOSis
is now available to women at
high risk.

109

60
110

111
(r n, Ii, II• II, II
•
II . ..••
".. .. •
II

.•
II
u
II
"

" " " "" "" II

u

. ... .
112
" • ~
·
•
"
, ,

[\ II II II Ii
'I:" ,
Il u n II ••" I'
II
"
/ "
II
,
" ! ~

"
..
"

.' o.,. " It,

61
11 3

lla-116 Edward 's syndrome (Trisomy 18). Incidence of this

is second to Down's syndrome, and is also associated with advanced
maternal age. This baby has low birth weight (2.1 kg), is stiff and
rigid w ith flexion deformity of limbs (113). Characteristic features
include receding chin, 'trisomy hands' (114), and prominence of
the heels (rocker-bottom feet) (115). The baby has severe mental
subnor mality and abnormalit ies of hear t, kidneys, and
gastrointestinal tract. Most die within the first year. The majority
are the resuJt of non-disjunclion. Karyo type is shown in (116).
1I4

liS
117 119

118 120
II II II
" ".. •
/I

II
"..
... . . ..
II Ii
• "
"
II
"
•
"
.." .
"
• "
" "
.."
"
I •,

117-1.2 0 Palau's syndrome (Trisomy 13). This is much rarer

than trisomy 18. Such baby is born small, and has median facial
abnormalities such as bilateral cleft lip and palate (1]7), broad
flattened nose, flexed limbs, polydactyly (118, note L foot), and
cryptorchism in the male (119). Other features, similar to trisomy
18, include trisomy hands, rocker-bottom feet, congenital heart
disease, renal and a limentary abnormalities, and severe mental
retardation. Most succumb within the first year. It has been reported
that 20% of the cases are caused by translocation which occurs
sporadically. The karyotype of regular trisomy 13 is shown in (120).
121 121_.122 e ri du cha t
s yndrome (5p- l. This
syndrome is associated with
multiple congeni tal mal-
formations. The affected
new-born may be of low
birth weight, produces a cry
that sounds like a ca t
mewing, and is inev itably
micro-cep hal ic, menially
retarded, and may have
congenital heart disease like
the baby in (J.21 ). The
karyo type shows pa rtial
deletion of the short arm of
chromosome 5 (122). One of
Ih e parents may be a
balanced carrier.

1,2 2

II, Ii,
,
"
n, It, II"" .'
•
U
II' \ U,
II

It t'
•
•• ."
,I
"
n
"

"
"
"
.
"

'"
., ,. •,
"

"
"
~
" "
•,
123

125
1/ II II, u <
II
•
\I

1/ II II II ••
•• II

. .. .. . . II
• w
" "

..
.<
" " " " "
" •
•
"
• .." I,
•
IJ~3-125 Turner's syndrome (45, X). This condition should be
considered if a female newborn has lymphoedema of hands and
feet (123), redwldant skin over the lower neck (124), or coarctation
of aorta, but most have no abnormality. In late childhood, short
statuTe and failure of menarche are common presenting fea tures.
Karyotype is shown in (125).
126

126. 127 Cornel ia de

Lange syndrome (Amster-
dam dwarfism). The
syndrome was first reported
in 1933. These babies have
marked growth retardation
even at the time of birth, and
characteristically they have
hirsutism, bushy eyebrows
(126), downward curve of
the angle of the mouth
(127), and other anomalies.
They are mentally retarded
and fail to t hrive.
Abnormalities in chromo-
some 3 can be demonstrated
in some.

61
128

U9

130 l28-1_30 Os teoge nes is

imperfecta. This newborn
with deformed limbs al birth
due to multiple fractures
(128), and blue scle ra
(129), has the severe form
which isaulosomai recessive
in inheritance. The skull bone
is soft due to poor mineral-
ization, and radiograph film
shows fractures of long bones
(130). The less severe [ann
is autoso mal dominant with
symptoms appearing after
infancy, and they aTe less
debilitating.

68
131

131 Adrenogenital syndrome (congenital adrenal hyperplasia).

This is an autosomal recessive condition with enzyme defects in
the cortico-steroid pathway. In the commonest type with 21-
hydroxylase deficiency, the resu lting androgen excess causes
viriliz.ltion of the femaie genital ia and the baby may be mistaken
to be a male (131); affected male looks normal. Adrenal crisis soon
develops aftt;'r birth in both sexes.
132

1_33

1;:12. l33 Beckwith-Wiederman syndrome. This isa sporadic

condjtion and is also called 'exomphalos-macroglossia-gigantism
syndrome' (1_32), The typical baby is 'largc-for-date'. Macroglossia
may lead to feeding difficulty, and hypoglycaemia often occurs due
to pancreatic hy per plasia. The exomphalos is managed
conservatively by surgeons. The survival rate in such babies has
improved in recent years. One older baby is shown in (13:.' ).
134 134. 135 Collodion bab y.
This is a form of congenit,lJ
ichthyosis and isan autosomal
recessive condition, The baby
was horn encased in a
me m b rane with distorted
facial appearance such as
ect ropion and fish mou th
(134). The membrane started
to peel off after birth, but it may
take wee ks o r months to
complete. The underlying skin
mayor may not be nanna1. The
baby (135) is now two months
old, bu t the skin arou nd the
eyes and mouth isstill taut. The
most severe form, called
harlequin foetus, is often fa tal.

135
SECTION7 1

JAUNDICE
(photos 136-144)
137

138 136-138 Neo n a ta l

jaundice. This is a prevalent
problem among Chinese
newborn in Hong Kong
within the first few weeks of
life (Yeung & Field, 1969; Li
et aI., 1978). In most cases, the
ca use is 'non-specific', but
some develop seve re
jaundice ( 136 ) that can
cause brain damage. The
bab y in ( l37 ) shows
opisthothonus and rigid
posture as eviden ce of
bilirubin encephalopathy.
Long term sequelae includes
athetoid cerebral palsy (138) and high frequency nerve deafness

..
in later life. Factors which aggravate unconjugated bilirubinaemia
include haemolysis, infection, and absorption of blood pigments.
Male babies with erythrocyte glucose-6-phosphate dehydrogenase
deficiency should be closely monitored for haemolysis .
139

. 40

139. 140 Phototherapy. The picture shows a jaundiced neonate

receiving phototherapy with the light coming from around, as well
as above and below the incubator (139). Light at a wavelength
between 300 and 600 run, with an intensity of 2ClO-400 ft candles of
light has been proven to beeffective treatment. During phototherapy
the baby's eyes should be shielded. In some newborns, a peculiar
bronze colour develops after light exposure (140).
141

141 Exchange transfusion. In this picture the baby is undergoing

exchange transfusion beca use the unconjugated biliru bin level
greatly exceeds 20 mg% (or 340 umol/ L) which ma y resul t in brain
damage. Exchange transfusio n wi th 200 m L of fresh donor blood
per kilogra m baby's weight is still the fastest way to curb the further
rise in bilinlbin level, and is a safe procedure in experienced hands.

142 142 Biliaryatresia. 11Us2-

month-old baby with biliary
atresia develops a yellowish
green colour distinct from the
neonatal jaundice commonly
seen, and her liver and spleen
are enlarged. It is no t always
easy to d istinguish biliary
atresia from neonatal
hepatitis. Nevertheless it is
impor tant to make the
distinction because early
surgery, including the Kasai
operation, can minimize the
chance of developing liver
cirrhosis. Some centres now
offer liver transplantation as
a new treatment modality to
babies with cirrhosis.
144

.143. 1.44 Choledochal cyst. This female infant has recurrent

jaundice since birth due to undiagnosed choledochal cyst (143).
In barium meal film , a large cyst can be seen (1.44). Nowad ays,
ultrasound and opera live cholangiogram are useful ways to confirm
the diagnosis. Treatment is surgical. The cause for the dilatation of
part, or all of the extrahepatic d ucts in this condition is unknown.
There is a female predominance. Untreated patients may develop
biliary cirrhosis.
SECTION 81

D EVELOPMENT IN THE FIRST YEAR

(pholos 145-160)
145

145 Atl month. The normal newborn can lift chin off couch
momentarily when put in the prone position.

146

146 Atthe end of 3 months. The baby characteristically watches

movement of its own hands (hand regard ), but this stops a t 5
months.
147

147 At 3 to 4 months. Baby laughs aloud.

148

148 AI" months. When pulled to sit, the baby shows no head
lag, and has good head controL (This baby is older, which explains
the flexed legs not normally seen in a 4-month-old baby.)
<49

14H At 4-5 mo nths. The baby exp lores everything with his
mouth, which is, at that time, the chief organ of tactile sense.
'Mouthing' persists lill12 months of age.

150

15(l-H;2 At 6 months. (a) In the prone position, theches! and

upper part of the abdomen are lifted off thc couch, and the baby
supports the body on straight arms ( 150). (b) The baby grasps his
feet ( 151) and may take toes to mouth (152).

80
8J
IS3 IS3. JS4 At 6-7
months. The baby smiles
at its own mirror image
(1.S3), and caresses the
image of itself in the
mirror (134).

IS4

82
I_55

i56

- \ , ,
155.156 At 8 month s. Normal babies can sit alone
unsupported, with a straight back (155). The baby sta rts crawling
around (.56). However, local parents dislike their babies crawling,
and would stop them from doing this.
83
157 157 At or afte r 8
mo nths. The baby ca n
stand with support with
{eet firmly on the
ground .

'58 HiS At 9-10 mon ths.

The baby has good index
fi nger/ thumb approach
in the pincer grasp
shown in the picture.
159 159 At or after
10 months . Normally
between 10-14 months, a
baby can stand alone.

160 160 At or after 11

months . The no rmal
infant starts to walk with
one hand held.
REFERENCES

1. Li AMC, Cheng MY. Anaemia and thalassaemia in

healthy adolescents from southern Chinese families. J
Paediatr Child Health 1990; 26:339-342.
2. Li AMC, Lee FT, Wong HN. Review of a decade of
chromosome study in Hong Kong. HK J Paediatr 1992;
1:127-132.
3. Li AMC, Yeung CY, Chang WK, 500 HN. Epidemiological
aspects of neonatal jaundice in Chinese infants. Trap Geogr
Med 1978; 31:537-546.
4. Mak KH, Yan KF, Cheng 55, Yuen MY. Rh phenotypes of
Chinese blood donors in Hong Kong, with special
reference to weak D antigens. Transfusion 1993; 33(4):348-
351.
5. Sung RYT, So LY, Ng HK, Ho JKS, Fok TF. Echo-
cardiography as a tool for determining the incidence of
congenital heart disease in newborn babies: a pilot study
in Hong Kong. Int J Cardiol1991; 30:43-47.
6. Todd D, Lai M, Braga CA. Thalassaemia and hydrops
foetalis - family studies. Brit Med J 1967; 3:347-349.
7. Yeung CY, Field CEo Phenobarbitone therapy in neonatal
hyperbilirubinaemia. Lancet 1969; 2:135-139.
8. Yeung CY, Lee FT. Erythrocyte glucose-6-phosphate
dehydrogenase assay on Chinese newborn infants with
an automated method. HK J Paediatr 1985; 2:46-55
IN D EX

(All entries refer to page numbers.)

Achondroplasia 55
Adrenogenital syndrome 69
Alpha foetoprotein 49, 50
Amniotic bands 44
Anaemia 27, S7
Anencephaly 49
Atresia
biliary 7S
bowel S3
duodenal 60
oesophageal S3
Auricles, accessory 41

Beckwith-Wiederman syndrome 70
Birth asphyxia 5, 6, 7~
Breast enlargement 12
Bronchiolitis, acute 37
Bronchopulmonary dysplasia 20
Bruise, forehead 29
Buphthalmos 46

Caput succedaneum 27
Cellulitis 3,22
Cephalhaematoma 27
Choledochal cyst 76
Chondrodysplasia 55
Cirrhosis
biliary 76
liver - 75
Cleft lip, palate 41,64
Collodion baby 71
Cornea, cloudy 35, 46
Congenital a&enal hyperplasia
(see adrenogenital syndrome)
Congenital heart disease 52, 60, 64, 65
Conjunctivitis 31
Constriction ring, leg 44
Cooley's anaemia (see thalassaemia, ~)
Cornelia de Lange 67
Cretinism (see hypothyroidism)
Cri du chat 65
Cystic fibrosis 53
Cytomegalovirus 36

Dermatitis, napkin 31
Dexamethasone 20
Diabetic mother, baby of 7,16
Down's syndrome 52, 60
Dwarf, thanatophoric 55

Edward's syndrome 52,62

Encephalocoele 49
Enterocolitis, necrotizing (NEC) 20
Erythema
neonatorum 3
toxicum 11
Exomphalos 70

Foetal distress 2,11,14,24

Fracture
multiple 68
skull 28

Glaucoma, congenital 46
Glucose-6-phosphate dehydrogenase, erythrocyte 56, 73

Haemangioma, capillary 42
Haemoglobinuria 56
Haemorrhage
intraventricular 21,48
pulmonary 6, 18
scalp wound 24
subaponeurotic 27
Hand regard 78
Harlequin
colour change 8
foetus 7J
Head lag 18, 79
Hemiatrophy 46
Hemihypertrophy, congenital 46
Hepatitis, neonatal 75
Hernia
diaphragmatic 54
inguinal 13
umbilical 13
Hyaline membrane disease 7,18,21,28
Hydramnios 49,53
Hydranencephaly 47
Hydrocephalus 21, 50,55
Hydrocoele 13
Hydrops foetalis 57
Hyperbilirubinaemia (see jaundice)
Hypocalcaemia 7
Hypoglycaemia 6,7, 70
Hypothyroidism 51
Hypotonia 18

Intrauterine growth retarded 6

Jaundice 21,27,51,73,75,76

Kasai operation 75
Kernicterus 21
Kleihauer's test 9

Lanugo hair 16
Large-for-date baby 7, 70
Lobster-claw 45

Marble bone disease (see osteopetrosis)

Mechanical ventilation 18, 20
Meconium 2,14,28
Meningomyelocoele SO
Meningitis
neonatal 33
tuberculous 38
Microcephaly 36, 48, 65
Mongolian blue spot 10
 Mouthing 80

Naevus
giant pigmented 43
nape 9
strawberry 42
Necrosis, tissue 29
Nipple, accessory 43

Ophthalmia neonatorum 37
Osteogenesis imperfecta 68
Osteomyelitis, acute 39
Osteopetrosis 56

Palsy
cerebral, athetoid 73
Erb's 25
facial 24
Pancytopenia 56
Patau's syndrome 52, 64
Peritonitis, meconium 53
Phocomelia 44
Phototherapy 21, 74
Pincer grasp 84
Placenta 6
Pneumonia
aspiration 7, 53
Group B streptococcal 18
staphylococcal 38
whooping cough 37
Pneumothorax 28
Post-term baby 2, 7
Preterm baby 6,13,16-22

Rash, purpuric 35,36

Reflex
rooting 5
sucking 5
Respiratory distress syndrome
(RDS, see hyaline membrane disease)
Rhesus incompatibility, Cantonese 9
Rubella syndrome, congenital 35

Sacral agenesis 7
'I
Sepsis 11, 2IJ, 21
Stools
breast-fed 14
formula-fed 14
Syphilis, congenital 34

T1lipes equino-varus (club foot) 45

Teeth, natal 12
Tetanus, neonatal 34
Thalassaemia, ex 57
Thalassaemia, B
heterozygous 57
major 57
Transfusion
exchange 8, 75
foetal-maternal 9
replacement 8
twin-twin 8
Transplantation
bone marrow 56
liver 75
Trisomy
13 (see Patau's syndrome)
18 (see Edward's syndrome)
21 (see Down's syndrome)
Tuberculosis 38
Turner's syndrome 66
Twin, conjoined 58

Umbilicus
cord 11, 34
discharge 52
infection 32
meconium stained 7, 11
Urachus, persistent 52

Vacuum extraction, complication

Vernix caseosum 2,
Very low birth weight baby 6
Visual fixation 5
Vitelline duct, persistent 52

Whooping cough 37