mkdir -p /tmp/workspace/newborn-exam && ls /tmp/workspace/newborn-exam/

cat << 'PYEOF' > /tmp/workspace/newborn-exam/generate_pdf.py from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm from reportlab.lib import colors from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, KeepTogether from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY # ── Document setup ────────────────────────────────────────────────────────── doc = SimpleDocTemplate( "/tmp/workspace/newborn-exam/Newborn_Head_to_Toe_Examination.pdf", pagesize=A4, rightMargin=2*cm, leftMargin=2*cm, topMargin=2.5*cm, bottomMargin=2.5*cm ) # ── Styles ─────────────────────────────────────────────────────────────────── styles = getSampleStyleSheet() title_style = ParagraphStyle( "Title", parent=styles["Title"], fontSize=20, textColor=colors.HexColor("#1a3c5e"), spaceAfter=6, alignment=TA_CENTER, fontName="Helvetica-Bold" ) subtitle_style = ParagraphStyle( "Sub", parent=styles["Normal"], fontSize=11, textColor=colors.HexColor("#2c6fad"), spaceAfter=4, alignment=TA_CENTER, fontName="Helvetica-Oblique" ) h1_style = ParagraphStyle( "H1", parent=styles["Heading1"], fontSize=13, textColor=colors.white, backColor=colors.HexColor("#1a3c5e"), spaceBefore=14, spaceAfter=4, leftIndent=-0.3*cm, fontName="Helvetica-Bold", borderPad=4 ) h2_style = ParagraphStyle( "H2", parent=styles["Heading2"], fontSize=11, textColor=colors.HexColor("#1a3c5e"), spaceBefore=10, spaceAfter=3, fontName="Helvetica-Bold", borderPadding=(0,0,2,0) ) body_style = ParagraphStyle( "Body", parent=styles["Normal"], fontSize=9.5, leading=14, alignment=TA_JUSTIFY, spaceAfter=4, fontName="Helvetica" ) bullet_style = ParagraphStyle( "Bullet", parent=styles["Normal"], fontSize=9.5, leading=13, leftIndent=18, firstLineIndent=-12, spaceAfter=2, fontName="Helvetica" ) subbullet_style = ParagraphStyle( "SubBullet", parent=styles["Normal"], fontSize=9, leading=12, leftIndent=34, firstLineIndent=-12, spaceAfter=2, fontName="Helvetica", textColor=colors.HexColor("#333333") ) normal_bold = ParagraphStyle( "NormalBold", parent=styles["Normal"], fontSize=9.5, fontName="Helvetica-Bold", spaceAfter=2 ) highlight_style = ParagraphStyle( "Highlight", parent=styles["Normal"], fontSize=9, fontName="Helvetica-Oblique", textColor=colors.HexColor("#8B0000"), leftIndent=18, spaceAfter=2 ) source_style = ParagraphStyle( "Source", parent=styles["Normal"], fontSize=7.5, fontName="Helvetica-Oblique", textColor=colors.grey, alignment=TA_CENTER, spaceBefore=6 ) def h1(text): return Paragraph(f" {text}", h1_style) def h2(text): return Paragraph(text, h2_style) def p(text): return Paragraph(text, body_style) def b(text): return Paragraph(f"• {text}", bullet_style) def sb(text): return Paragraph(f"– {text}", subbullet_style) def hl(text): return Paragraph(f"⚠ {text}", highlight_style) def sp(n=6): return Spacer(1, n) def hr(): return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#cccccc"), spaceAfter=4) # ── Build content ───────────────────────────────────────────────────────────── story = [] # Cover block story.append(sp(10)) story.append(Paragraph("NEWBORN HEAD-TO-TOE EXAMINATION", title_style)) story.append(Paragraph("Pediatrics Clinical Exam Reference Guide", subtitle_style)) story.append(sp(4)) story.append(HRFlowable(width="60%", thickness=2, color=colors.HexColor("#2c6fad"), hAlign="CENTER", spaceAfter=8)) story.append(Paragraph("For MBBS / MD / Pediatrics Exit Examinations", subtitle_style)) story.append(sp(20)) # ── 1. OVERVIEW ─────────────────────────────────────────────────────────────── story.append(h1("1. OVERVIEW")) story.append(p("A complete head-to-toe examination of the newborn should be completed within the <b>first 24 hours of life</b> to identify any potential physical abnormalities or medical problems. The examination is best performed when the infant is quietly resting, beginning with a general appearance assessment followed by auscultation of the heart and lungs, then proceeding systematically from head to toe.")) story.append(sp()) story.append(p("<b>History to gather before the examination:</b>")) story.append(b("Complete maternal history (medical problems, medications, drug/alcohol/tobacco use)")) story.append(b("Prenatal serologies and past obstetric history")) story.append(b("Details of labor and delivery, including complications")) story.append(b("Neonatal resuscitation measures performed")) story.append(sp()) # Vital signs table story.append(h2("Normal Vital Signs in the First Days of Life")) vs_data = [ ["Vital Sign", "Normal Value"], ["Heart Rate", "100 – 180 beats/min"], ["Respiratory Rate", "24 – 60 breaths/min"], ["Systolic Blood Pressure", "65 – 90 mm Hg"], ["Diastolic Blood Pressure", "50 – 70 mm Hg"], ["Temperature", "36.0°C – 38.0°C (96.8°F – 100.4°F)"], ["Weight (term)", "2.5 – 4.0 kg"], ["Length (term)", "48 – 53 cm"], ["Head Circumference (term)", "33 – 37 cm"], ] vs_table = Table(vs_data, colWidths=[7*cm, 9*cm]) vs_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#1a3c5e")), ("TEXTCOLOR", (0,0), (-1,0), colors.white), ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (-1,-1), 9), ("BACKGROUND", (0,1), (-1,-1), colors.HexColor("#f0f4f8")), ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.white, colors.HexColor("#e8f0fa")]), ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#aaaaaa")), ("VALIGN", (0,0), (-1,-1), "MIDDLE"), ("LEFTPADDING", (0,0), (-1,-1), 6), ("RIGHTPADDING", (0,0), (-1,-1), 6), ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4), ])) story.append(vs_table) story.append(sp()) # ── 2. GENERAL APPEARANCE ───────────────────────────────────────────────────── story.append(h1("2. GENERAL APPEARANCE")) story.append(p("Begin with assessment of:")) story.append(b("Respiratory effort – should breathe comfortably without distress")) story.append(b("Position and level of activity")) story.append(b("Color – pink trunk and extremities is normal; acrocyanosis (blue hands and feet) is a normal finding in the first 24–48 hours")) story.append(sp()) story.append(p("<b>Respiratory patterns:</b>")) story.append(b("Periodic breathing: irregular pattern with rapid breaths intermixed with pauses of 5–10 sec – <b>normal</b>")) story.append(b("Grunting may appear during the first hour as fetal lung fluid clears; <b>persistent grunting = respiratory distress → further evaluation required</b>")) story.append(b("Retractions, nasal flaring, and stridor are always abnormal")) story.append(sp()) # ── 3. SKIN ─────────────────────────────────────────────────────────────────── story.append(h1("3. SKIN")) story.append(p("Inspect the entire skin surface. Many benign lesions are common and require only parental reassurance.")) skin_data = [ ["Lesion", "Description", "Significance"], ["Vernix caseosa", "White, cheesy coating", "Normal, protective"], ["Lanugo", "Fine downy hair, especially preterm", "Normal"], ["Milia", "White papules on nose/cheeks (keratin cysts)", "Resolve spontaneously"], ["Erythema toxicum", "Red papules/pustules with white center; eosinophils on smear", "Benign, self-limiting"], ["Transient neonatal pustulosis", "Pustules/vesicles, especially in dark skin", "Benign"], ["Mongolian spots", "Blue-grey pigmentation, sacral/gluteal area", "Benign; document to avoid confusion with bruising"], ["Port-wine stain (nevus flammeus)", "Flat red/purple vascular lesion", "May indicate Sturge-Weber if over V1 territory"], ["Strawberry hemangioma", "Bright red, raised; grows in first months", "Usually involutes by 5–7 years"], ["Harlequin color change", "One half body red, other pale", "Benign, vasomotor instability"], ["Jaundice", "Yellow skin; visible ≥5 mg/dL bilirubin", "Physiologic vs. pathologic – evaluate timing"], ["Caput succedaneum", "Diffuse scalp edema crossing sutures", "From birth trauma; resolves quickly"], ["Cephalhematoma", "Subperiosteal blood, does NOT cross sutures", "Resolves weeks–months; can cause jaundice"], ] skin_table = Table(skin_data, colWidths=[4.5*cm, 6.5*cm, 5*cm]) skin_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#2c6fad")), ("TEXTCOLOR", (0,0), (-1,0), colors.white), ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (-1,-1), 8), ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.white, colors.HexColor("#e8f0fa")]), ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#aaaaaa")), ("VALIGN", (0,0), (-1,-1), "TOP"), ("LEFTPADDING", (0,0), (-1,-1), 5), ("RIGHTPADDING", (0,0), (-1,-1), 5), ("TOPPADDING", (0,0), (-1,-1), 3), ("BOTTOMPADDING", (0,0), (-1,-1), 3), ])) story.append(skin_table) story.append(sp()) # ── 4. HEAD ─────────────────────────────────────────────────────────────────── story.append(h1("4. HEAD")) story.append(h2("Skull and Fontanelles")) story.append(b("Molding: overriding sutures are common from compression through the birth canal; usually resolve within days")) story.append(b("Anterior fontanelle: diamond-shaped, 1–4 cm; closes by 9–18 months")) story.append(b("Posterior fontanelle: triangular, fingertip-sized; closes by 6–8 weeks")) story.append(b("<b>Bulging fontanelle</b> → raised ICP (meningitis, hydrocephalus)")) story.append(b("<b>Sunken fontanelle</b> → dehydration")) story.append(b("Craniotabes: ping-pong ball sensation on parietal bones – may indicate rickets or hydrocephalus")) story.append(b("Craniosynostosis: premature fusion of sutures → abnormal head shape")) story.append(sp()) story.append(h2("Face")) story.append(b("Examine for symmetry")) story.append(b("Asymmetry → facial palsy (birth trauma) or congenital abnormalities")) story.append(b("Dysmorphic features may suggest chromosomal or syndromic diagnosis")) story.append(sp()) # ── 5. EYES ─────────────────────────────────────────────────────────────────── story.append(h1("5. EYES")) story.append(b("Spacing and symmetry of orbits")) story.append(b("Extraocular movements: intermittent crossing (esotropia) normal in first few months")) story.append(b("<b>Red reflex</b>: must be present bilaterally – absence suggests cataract, retinoblastoma, or retinal detachment → refer ophthalmology")) story.append(b("<b>White reflex (leukocoria)</b>: urgent referral to ophthalmologist")) story.append(b("Sub-conjunctival hemorrhages: from birth trauma, self-resolving")) story.append(b("Nasolacrimal duct obstruction: persistent tearing + debris on lashes; treat with massage; most resolve by 6 months")) story.append(b("Purulent discharge: rule out neonatal conjunctivitis (gonococcal – requires urgent treatment)")) story.append(hl("Tip: Hold infant upright and rotate slowly in a darkened room to stimulate eye opening")) story.append(sp()) # ── 6. EARS, NOSE, THROAT ──────────────────────────────────────────────────── story.append(h1("6. EARS, NOSE, AND THROAT")) story.append(h2("Ears")) story.append(b("Evaluate position, shape, and rotation")) story.append(b("Low-set or malformed ears → associated with renal anomalies and chromosomal syndromes (e.g., Turner, Down, Treacher Collins)")) story.append(b("Ear canal should be patent; tympanic membrane difficult to visualize due to vernix")) story.append(b("Hearing: observe startle/blink response to sudden sound; universal hearing screen (OAE/ABR) before discharge")) story.append(sp()) story.append(h2("Nose")) story.append(b("Inspect shape; verify patency of nares")) story.append(b("<b>Choanal atresia</b>: test by passing small feeding tube through each nare; newborns are obligate nose-breathers – bilateral choanal atresia is a neonatal emergency")) story.append(sp()) story.append(h2("Mouth / Throat")) story.append(b("Inspect and palpate palate for cleft (including submucosal clefts)")) story.append(b("<b>Epstein pearls</b>: white retention cysts on hard palate – benign, resolve within weeks")) story.append(b("<b>Bohn nodules</b>: similar cysts on gums – benign")) story.append(b("Natal teeth: isolated finding but may be associated with congenital syndromes; risk of aspiration")) story.append(b("Ankyloglossia (tongue-tie): short frenulum limiting protrusion; may affect breastfeeding")) story.append(b("Macroglossia: Down syndrome, Beckwith-Wiedemann syndrome")) story.append(sp()) # ── 7. NECK ─────────────────────────────────────────────────────────────────── story.append(h1("7. NECK")) story.append(b("Inspect for symmetry, range of motion, webbing")) story.append(b("<b>Torticollis</b>: head tilted to one side; palpate sternocleidomastoid for mass (fibromatosis colli from birth trauma)")) story.append(b("Webbed neck → Turner syndrome (45,X)")) story.append(b("Cystic hygroma (lymphatic malformation): soft compressible mass, transilluminates")) story.append(b("Thyroid: not normally palpable; enlarge in congenital hypothyroidism")) story.append(b("Branchial cleft cysts/sinuses: along anterior border of SCM")) story.append(sp()) # ── 8. CHEST AND LUNGS ─────────────────────────────────────────────────────── story.append(h1("8. CHEST AND LUNGS")) story.append(h2("Inspection and Palpation")) story.append(b("Inspect chest wall symmetry and structure")) story.append(b("<b>Gynecomastia</b>: present in both male and female infants from maternal estrogen; may have white 'witch's milk' discharge – normal")) story.append(b("Clavicles: palpate for crepitus or tenderness (clavicle fracture – common with shoulder dystocia); asymmetric Moro reflex is a clue")) story.append(sp()) story.append(h2("Auscultation")) story.append(b("Breath sounds: clear and equal bilaterally")) story.append(b("Decreased breath sounds unilaterally → pneumothorax, diaphragmatic hernia")) story.append(b("Crackles may be present in first few hours as lung fluid clears")) story.append(b("Grunting, retractions, nasal flaring → neonatal respiratory distress syndrome")) story.append(sp()) # ── 9. CARDIOVASCULAR ──────────────────────────────────────────────────────── story.append(h1("9. CARDIOVASCULAR")) story.append(b("Palpate precordium: heaves or thrills suggest structural heart disease")) story.append(b("Auscultate all four areas: aortic, pulmonic, tricuspid, mitral")) story.append(b("Soft systolic murmurs in first 24 hours may reflect closing ductus arteriosus or peripheral pulmonary stenosis – reassess")) story.append(b("Louder, harsh murmurs or diastolic murmurs are always pathological")) story.append(b("Femoral pulses: must be palpated bilaterally; weak/absent femoral pulses → coarctation of aorta")) story.append(b("Brachial-femoral pulse delay → coarctation")) story.append(sp()) story.append(h2("Critical CHD Screening (Pulse Oximetry)")) story.append(p("Perform after 24 hours of life. Place probe on right hand AND either foot.")) story.append(b("Positive screen if: SpO2 < 90% in either extremity, OR")) story.append(sb("SpO2 < 95% in both extremities on 3 measurements 1 hour apart, OR")) story.append(sb("SpO2 difference > 3% between upper and lower extremity")) story.append(b("Positive screen → echocardiogram referral")) story.append(p("<b>Targets:</b> HLHS, pulmonary atresia, tetralogy of Fallot, TAPVR, TGA, tricuspid atresia, truncus arteriosus")) story.append(sp()) # ── 10. ABDOMEN ────────────────────────────────────────────────────────────── story.append(h1("10. ABDOMEN")) story.append(b("Inspect: should appear mildly protuberant; marked distension suggests obstruction")) story.append(b("Umbilical cord: should have <b>2 arteries + 1 vein</b> (AVA); single umbilical artery → screen for renal anomalies")) story.append(b("Umbilical hernia: common, especially in Black infants; most resolve by 3–5 years")) story.append(b("Auscultate bowel sounds")) story.append(b("Palpate: liver normally palpable 1–2 cm below right costal margin; spleen tip may be felt")) story.append(b("Masses: Wilms tumor, neuroblastoma, hydronephrosis → immediate investigation")) story.append(b("Meconium: should be passed within <b>first 24–48 hours</b>")) story.append(hl("Failure to pass meconium > 48 h → consider Hirschsprung disease, cystic fibrosis, hypothyroidism, anal atresia")) story.append(sp()) # ── 11. GENITALIA ──────────────────────────────────────────────────────────── story.append(h1("11. GENITALIA")) story.append(h2("Male")) story.append(b("Inspect penis: phimosis (physiologic) is normal; hypospadias (urethral meatus displaced ventrally)")) story.append(b("Do NOT circumcise if hypospadias is present – foreskin may be needed for repair")) story.append(b("Testes: should be palpable in scrotum bilaterally")) story.append(b("<b>Cryptorchidism</b>: undescended testis – monitor; if not descended by 6 months, refer for orchidopexy by 18 months")) story.append(b("Scrotal swelling: hydrocele (transilluminates – benign), inguinal hernia (does not transilluminate)")) story.append(b("<b>Neonatal torsion</b>: hard, non-tender scrotal mass – surgical emergency")) story.append(sp()) story.append(h2("Female")) story.append(b("Labia majora should cover labia minora in term infants")) story.append(b("Vaginal discharge: milky, white, or blood-tinged – normal in first weeks due to maternal hormone withdrawal")) story.append(b("Vaginal tag/hymenal tag: normal, resolves spontaneously")) story.append(b("Ambiguous genitalia: requires urgent multidisciplinary evaluation (endocrinology, genetics, urology)")) story.append(sp()) # ── 12. ANUS AND RECTUM ────────────────────────────────────────────────────── story.append(h1("12. ANUS AND RECTUM")) story.append(b("Verify anal patency (visual inspection or gentle probe)")) story.append(b("Position of anus: anterior displacement common in females")) story.append(b("Anal fissures from meconium passage")) story.append(b("Rectal exam is not routinely performed")) story.append(sp()) # ── 13. SPINE ──────────────────────────────────────────────────────────────── story.append(h1("13. SPINE")) story.append(b("Inspect and palpate entire spine for midline defects")) story.append(b("<b>Spina bifida occulta</b>: skin-covered, often with tuft of hair, dimple, or hemangioma over lumbar/sacral area")) story.append(b("<b>Meningocele / Myelomeningocele</b>: open neural tube defect – requires urgent neurosurgical referral")) story.append(b("Sacral dimple: benign if < 5 mm, < 2.5 cm from anal verge, and no other markers; otherwise ultrasound spine")) story.append(b("Scoliosis: check for lateral curvature")) story.append(sp()) # ── 14. EXTREMITIES ────────────────────────────────────────────────────────── story.append(h1("14. EXTREMITIES")) story.append(h2("Upper Limbs")) story.append(b("Count digits: polydactyly (extra) or syndactyly (fused)")) story.append(b("Single palmar (simian) crease → Down syndrome (but present in 5% of normal population)")) story.append(b("<b>Erb's palsy</b>: C5–C6 injury; arm adducted, internally rotated, 'waiter's tip'; from shoulder dystocia")) story.append(b("<b>Klumpke's palsy</b>: C8–T1 injury; claw hand")) story.append(sp()) story.append(h2("Lower Limbs")) story.append(b("Inspect for foot deformities: talipes equinovarus (clubfoot) – rigid, requires physiotherapy/casting (Ponseti method)")) story.append(b("Metatarsus adductus: flexible, resolves spontaneously")) story.append(b("Count toes")) story.append(sp()) story.append(h2("Hips (Developmental Dysplasia)")) story.append(b("<b>Ortolani maneuver</b>: hip is FLEXED + ABDUCTED; a clunk of reduction is a positive test (dislocated hip being reduced)")) story.append(b("<b>Barlow maneuver</b>: hip is FLEXED + ADDUCTED with posterior pressure; clunk felt = hip being dislocated")) story.append(b("Unequal skin folds, leg length discrepancy (Galeazzi sign), and limited abduction are additional clues")) story.append(b("Positive Ortolani or Barlow → ultrasound hip at 6 weeks")) story.append(sp()) # ── 15. NEUROLOGICAL ───────────────────────────────────────────────────────── story.append(h1("15. NEUROLOGICAL EXAMINATION")) story.append(h2("Tone and Movement")) story.append(b("Normal term newborn: predominantly flexed posture")) story.append(b("Hypotonia (floppy infant): Down syndrome, hypothyroidism, hypoxic-ischemic encephalopathy, Prader-Willi, neuromuscular diseases")) story.append(b("Hypertonia: HIE, meningitis, metabolic disorders")) story.append(sp()) # Reflexes table story.append(h2("Newborn Primitive Reflexes")) ref_data = [ ["Reflex", "How to Elicit", "Normal Response", "Disappears By"], ["Moro (Startle)", "Sudden head drop (supported), loud noise", "Arms abduct + extend, then adduct; cry", "3–6 months"], ["Rooting", "Stroke cheek toward mouth", "Head turns toward stimulus, mouth opens", "3–4 months (awake)"], ["Sucking", "Place finger/nipple in mouth", "Rhythmic sucking motion", "4 months"], ["Palmar grasp", "Press finger into palm", "Fingers flex and grip", "3–4 months"], ["Plantar grasp", "Press thumb on sole of foot", "Toes flex downward", "9–12 months"], ["Stepping/Walking", "Hold upright, sole touches surface", "Automatic stepping movements", "2 months"], ["Babinski", "Stroke lateral sole heel → toe", "Dorsiflexion of big toe, fan toes", "12–24 months"], ["Tonic neck (ATNR)", "Turn head to one side (supine)", "Arm and leg extend on face side, flex on skull side ('fencing')", "4–6 months"], ["Galant", "Stroke paravertebral area (prone)", "Trunk curves toward stimulus", "3–6 months"], ["Parachute", "Tilt forward rapidly", "Arms extend to protect (appears 8–9 months)", "Persists lifelong"], ] ref_table = Table(ref_data, colWidths=[3.5*cm, 4.5*cm, 5*cm, 3*cm]) ref_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#1a3c5e")), ("TEXTCOLOR", (0,0), (-1,0), colors.white), ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (-1,-1), 8), ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.white, colors.HexColor("#e8f0fa")]), ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#aaaaaa")), ("VALIGN", (0,0), (-1,-1), "TOP"), ("LEFTPADDING", (0,0), (-1,-1), 4), ("RIGHTPADDING", (0,0), (-1,-1), 4), ("TOPPADDING", (0,0), (-1,-1), 3), ("BOTTOMPADDING", (0,0), (-1,-1), 3), ("WORDWRAP", (0,0), (-1,-1), True), ])) story.append(ref_table) story.append(sp()) story.append(hl("Absent or asymmetric Moro reflex: brachial plexus injury, clavicle fracture, or intracranial pathology")) story.append(sp()) # ── 16. ANTHROPOMETRY ───────────────────────────────────────────────────────── story.append(h1("16. ANTHROPOMETRY AND GESTATIONAL AGE")) story.append(h2("Classification by Weight")) anthr_data = [ ["Classification", "Definition"], ["LBW – Low Birth Weight", "< 2500 g"], ["VLBW – Very Low Birth Weight", "< 1500 g"], ["ELBW – Extremely Low Birth Weight", "< 1000 g"], ["LGA – Large for Gestational Age", "> 90th percentile"], ["SGA – Small for Gestational Age", "< 10th percentile"], ["AGA – Appropriate for Gestational Age", "10th – 90th percentile"], ] anthr_table = Table(anthr_data, colWidths=[9*cm, 7*cm]) anthr_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#2c6fad")), ("TEXTCOLOR", (0,0), (-1,0), colors.white), ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (-1,-1), 9), ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.white, colors.HexColor("#e8f0fa")]), ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#aaaaaa")), ("LEFTPADDING", (0,0), (-1,-1), 6), ("RIGHTPADDING", (0,0), (-1,-1), 6), ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4), ])) story.append(anthr_table) story.append(sp()) story.append(h2("Ballard/New Ballard Score (Gestational Age Assessment)")) story.append(p("Assesses <b>neuromuscular maturity</b> (posture, arm recoil, popliteal angle, scarf sign, heel-to-ear) and <b>physical maturity</b> (skin, lanugo, plantar surface, breast, eye/ear, genitals). Each parameter scored 0–5. Total score correlates with gestational age in weeks.")) story.append(sp()) # ── 17. NEWBORN SCREENING ───────────────────────────────────────────────────── story.append(h1("17. NEWBORN SCREENING AND DISCHARGE CRITERIA")) story.append(h2("Newborn Screen (Heel Prick)")) story.append(b("Collected at 24–48 hours via heel prick")) story.append(b("Detects: metabolic disorders (PKU, MSUD, homocystinuria), endocrinopathies (CH, CAH), hemoglobinopathies (sickle cell), cystic fibrosis, immunodeficiencies (SCID)")) story.append(b("Repeat specimen at 10–14 days in some protocols")) story.append(sp()) story.append(h2("Universal Hearing Screen")) story.append(b("OAE (otoacoustic emissions) – preferred initial test, can be done awake")) story.append(b("ABR (auditory brainstem response) – if OAE fails")) story.append(b("Screen before 1 month; audiologic assessment by 3 months if failed; intervention by 6 months")) story.append(sp()) story.append(h2("Discharge Criteria (AAP)")) story.append(b("Stable vital signs for ≥ 12 hours in open crib")) story.append(b("Voided urine at least once")) story.append(b("Passed meconium at least once")) story.append(b("Fed successfully at least twice (observed feeding)")) story.append(b("Maternal blood type/Coombs evaluated; prophylaxis given if indicated")) story.append(b("Hepatitis B vaccine administered")) story.append(b("Vitamin K given (0.5–1 mg IM) to prevent hemorrhagic disease")) story.append(b("Eye prophylaxis (erythromycin ointment) given")) story.append(sp()) # ── 18. EXAM TIPS ───────────────────────────────────────────────────────────── story.append(h1("18. PEDIATRICS EXAM TIPS")) tips_data = [ ["System", "High-Yield Exam Point"], ["Skin", "Mongolian spot vs. bruise – document carefully; erythema toxicum has eosinophils on smear"], ["Head", "Caput crosses sutures; cephalhematoma does NOT cross sutures"], ["Eyes", "Absent red reflex = emergency referral; leukocoria = retinoblastoma until proven otherwise"], ["Heart", "Absent femoral pulse = coarctation of aorta"], ["Abdomen", "Single umbilical artery → renal screen; no meconium > 48 h → Hirschsprung"], ["Genitalia", "Do not circumcise with hypospadias; scrotal non-tender mass = neonatal torsion (surgical emergency)"], ["Hips", "Ortolani = reduces dislocated hip; Barlow = dislocates unstable hip"], ["Neuro", "Absent/asymmetric Moro = brachial plexus injury or clavicle fracture"], ["Reflexes", "Persistence of primitive reflex beyond expected age → CNS pathology"], ["Screening", "Pulse oximetry for CHD after 24 h; OAE for hearing; heel prick 24–48 h"], ] tips_table = Table(tips_data, colWidths=[4.5*cm, 11.5*cm]) tips_table.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#8B0000")), ("TEXTCOLOR", (0,0), (-1,0), colors.white), ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"), ("FONTSIZE", (0,0), (-1,-1), 8.5), ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#fff8f8"), colors.white]), ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#aaaaaa")), ("VALIGN", (0,0), (-1,-1), "TOP"), ("LEFTPADDING", (0,0), (-1,-1), 5), ("RIGHTPADDING", (0,0), (-1,-1), 5), ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4), ])) story.append(tips_table) story.append(sp(12)) # ── Footer / Source ────────────────────────────────────────────────────────── story.append(hr()) story.append(Paragraph( "Source: Textbook of Family Medicine, 9th Edition (Rakel). " "Compiled for Pediatrics Clinical Examination reference. For educational use only.", source_style )) # ── Build ───────────────────────────────────────────────────────────────────── doc.build(story) print("PDF generated successfully.") PYEOF python /tmp/workspace/newborn-exam/generate_pdf.py

ls -lh /tmp/workspace/newborn-exam/Newborn_Head_to_Toe_Examination.pdf