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Figures for:
Guide to a Systematic Physical Assessment in the Infant With Suspected Infection and/or Sepsis

[Adv Neonatal Care 4(3):141-153, 2004. © 2004 W.B. Saunders]


Figure 1. Note the opisthotonos exhibited by this infant. Ospithotonic positioning may be a sign of meningitis, or alternatively, may be seen in an infant who is attempting to compensate for airway edema or stridor. Reprinted with permission from Clark D. Atlas of Neonatology. Philadelphia, Pa: WB Saunders; 2000:134.

Figure 2. Hypotonia. Note the generalized symmetrical hypotonia in an infant with suspected sepsis. Photograph courtesy of Dr. David Clark, Albany Medical Center, Albany, New York.

Figure 3. (A) Petechiae. Infant with an infected plastibell circumcision; the responsible organism was Group B streptococcus. Note the scattered petechiae surrounding the penis and extending upward to the periumbilical area. Photo courtesy of Dr. William Edwards, the Children's Hospital at Dartmouth. (B) Purpura. Note the area of small hemorrhages on the right leg of this infant compared to the petechiae (minute, pinpoint-sized hemorrhages) in Figure 3A. Purpura is often associated with decreased platelet counts.

Figure 4. Note the diffuse mottled, bluish-gray appearance of this infant's skin suggestive of systemic poor perfusion. Photograph courtesy of Dr. David Clark, Albany Medical Center, Albany, New York.

Figure 5. Abdominal distension is a nonspecific sign of infection and sepsis. Note the presence of bowel loops that are visible through the abdominal wall. Reprinted with permission from Clark D. Atlas of Neonatology. Philadelphia, Pa: WB Saunders; 2000:183.

Figure 6. The umbilical stump is necrotic tissue in the process of separating from the abdominal wall. Omphalitis can present as periumbilical erythema, warmth, or drainage; the infection may be localized or may be a source for a systemic infection. Reprinted with permission from Clark D. Atlas of Neonatology. Philadelphia, Pa: WB Saunders; 2000:63.

Figure 7. Palpate the fontanel in the upright position, or with the head supported in a semiupright position. A bulging fontanel may be associated with meningitis. Reprinted with permission from Clark D. Atlas of Neonatology. Philadelphia, Pa: WB Saunders; 2000:135.

Figure 8. Note the swollen subcutaneous tissue and shiny edematous skin, often called sclerema; this is a late sign often associated with positive fluid balance in sepsis. Reprinted with permission from Clark D. Atlas of Neonatology. Philadelphia, Pa: WB Saunders; 2000:65.

Figure 9. Systematic evaluation of the infant's joints may reveal a swollen joint associated with osteomyelitis. Photograph courtesy of Dr. David Clark, Albany Medical Center, Albany, New York.