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Newborn: complete physical exam within 24 hours of birth

Listen to heart and lung first when the infant is quiet

Warming the statescope before using

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VITAL SIGN

Temperature

Respirations: normal rate is 40-60 breaths/min

Blood Pressure

Pulse rate: normal rate is 100-180 beats/min

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HEAD CIRCUMFERENCE, LENGTH, WEIGHT, AND GESTATIONAL AGE

Head circumference and percentile: place the measuring tape around the front of the head (above the brow) and the occipital area, the tape should be above the ears, normally 32-37 cm at term.Length and percentileWeight and percentileAssessment of gestational age

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GENERAL APPEARANCE

Activity

Skin color

Obvious congenital abnormality

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SKIN

1. COLORPlethora (deep, rosy red color)- common in polycytemia- can be seen in overoxygenation and

overheated infant- Erythema neonatorum: normal

phenomenon in transition period and can occur when the infant has been stimulated

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JaundicePallor (washed-out, whitish appearance)Cyanosis - Central cyanosis: bluish skin

including the tongue and lips- Peripheral cyanosis: bluish skin with

pink lips and tongue- Acrocyanosis: bluish hands and feet only

SKIN

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Polycytemia and Pallor

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Cyanosis

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SKINExtensive bruising (ecchymoses): prolonged and difficult delivery‘Blue on pink’ or ‘pink on blue’: poor perfusion, inadequate oxygenation, inadequate ventilation, or polycytemia.Harlequin coloration (clear line of demarcation between an area of redness and an area of normal coloration)Mottling (lacy red pattern): maybe seen in healthy infants and in those with cold stress, hypovolemia, or sepsis. Persistent mottling (cutis marmorata) found in infants with Down syndrome, trisomy 13 or trisomy 18.

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Persistent mottling (cutis marmorata)

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Vernix caseosa: substance that covers the skin until 38th week of gestationCollodion infant: skin resembles parchment, restriction in growth of the nose and ears.Dry skin: postdate or postmature infant, congenital syphillis, and candidiasis

SKIN

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2. RASHESMilia: withish, pinhead-sized on chin, nose, forehead, and cheeks.Erythema toxicum: small areas of red skin with a yellow-white papule in the center.Candida albicans rash: erythematous plaques with sharply demarcated edges.Transient neonatal pustular melanosis: pustules, ruptured vesicupustules, and hiperpigmented macules.

SKIN

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Acne neonatorum: comedones and papules over the cheeks, chin, and forehead.

Herpes simplex: pustular vesicular rash, vesicles, bullae, or denuded skin.

SKIN

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SKIN

3. Nevi Macular hemangioma (‘stork bites’): dissappear spontaneously within 1st year of life.Port-wine stain (nevus flammeus): does not blanch with pressure and not disappear with time. Mongolian spot: dark blue or purple bruise-like makular spots, most common birthmark

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SKIN

Cavernous hemangioma: large, red, cyst-like, firm, ill-defined mass. If associated with thrombocytopenia (Kasabach-Merrit syndrome)Strawberry hemangioma (macular hemangioma): flat, bright red, sharply demarcated lesions.

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HEAD

Anterior and posterior fontanelles- anterior fontanelle usually closes at 9-12 mo and the posterior at 2-4 moMolding: temporary asymmetry of the skull resulting from the birth process.Caput succedaneumCephalhematomaSubgaleal hematoma

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Increased intracranial pressure:

- bulging anterior fontanelle

- separated sutures

- paralysis of upward gaze (setting-sun

sign)

- prominent veins of the skalp

- increasing macrocephaly

HEAD

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Bulging of fontanelle

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Craniosynostosis: premature closure of one or more sutures

Craniotabes: softening of the skull

Plagiocephaly: oblique shape of a head, asymmetric and flattened.

HEAD

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NECK

Eliciting the rooting reflex

Palpate the sternocleidomastoid

Short neck: Turner’s, Noonan’s, and Klippel-Feil syndromes

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FACE

Note the general shape of the nose, mouth, and chinNote the presence of hypertelorism (eyes widely separated)Note the presence of low-set earsFacial nerve injury: unilateral branches of the facial nerve

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EARS

Look for unusual shape or positionLow-set ears: congenital anomaliesPreauricular skin tags (papillomas): benignHairy ears: infants of a diabetic mothersGross hearing: when infant blinks in response to loud noises

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EYESCheck the red reflex with an ophthalmoscopeOpacification of the lens: cataractSclera bluish tint: prematureSclera deep blue: osteogenesis imperfectaBrushfield’s spots (salt-and-pepper specling of the iris): Down syndromeSubconjunctival hemorrhage: 5% newborn infant.Conjunctivitis

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NOSE

Nasal flaring: respiratory distress

Sniffing and discharge: congenital syphilis

Sneezing: response to bright or drug withdrawal.

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MOUTH

Ranula: cystic swelling in the floor of the mouth.Epstein’s pearls: keratin-containing cystsMucocele: small lesion on the oral mucosaNatal teeth:- Predeciduous teeth: supernumerary teeth- True deciduous teeth: true teeth that erupt

early.

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Macroglossia: enlargement of the tongue, can be seen in Beckwith’s syndr and Pompe’s disease

Frothy or copious saliva: esophageal atresia with tracheoesophageal fistula.

Thrush: sign of infection C. albicans.

MOUTH

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Drooling

of saliva

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CHEST

Observation Breath soundPectus excavatumBreast in a newborn: - usually 1cm in diameter in term- abnormally 3-4 cm: effects of maternal

estrogens- witch’s milk: white discharge

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HEART

Murmur: VSD, PDA, Coarctatio aorta, PS, PA, TA, TGA, etc

Palpate the pulses (femoral, pedal, radial, and brachial)

Check for signs of CHF: gallop, tachypnea, hepatomegaly, wheezes and rales, tachycardia, and abnormal pulses.

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ABDOMEN

Observation: omphalochele, gastroschisis, scaphoid abdomen.

Auscultation

Palpation: check for distention, tenderness, or masses.

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Scaphoid abdomen Abdomen distention

Gastroschisis Omphalocele

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UMBILICUS

Two arteries and one vein

Normal cord: translucent

Greenish-yellow color: meconium staining

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GENITALIA

Male- check dorsal hood, hypospadias,

epispadias, and chordee.- normal penile leghth at birth is > 2 cm- Determine site of meatus, verife the

testicles and the color of scrotumFemale- examine the labia and clitoris

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LYMPH NODES

Palpable lymph nodes usually in the inguinal and cervical 33% of normal neonates.

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ANUS AND RECTUM

Check for patency of the anus

Check the position of the anus

Meconium should pass within 48 h

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Imperforate anal membrane

Atresia ani

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EXTREMITIES

Syndactyly : abnormal fusion of the digitsPolydactyly: supernumerary digitsSimian crease: a single transverse palmar crease (Down syndrome)Talipes equinovarus (clubfoot): foot is turn downward and inward and the sole is directed mediallyMetatarsus varus: adduction of the forefoot

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TRUNK AND SPINE

Check for

- any gross defect of the spine

- abnormal pigmentation

- hairy patches over the lower back

- sacral or pilonidal dimple: small

meningocele

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Fetal Phenytoin syndrome Hirsutism

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HIPSCongenital hip dislocationOrtolani and Barlow maneuvers:- place in the frog position- abduct the hips by using middle finger to apply

gentle inward and upward pressure over the greater trochanter (Ortolani’s sign)

- adduct the hips by using the thumb to apply outward and backward pressure over the inner thigh (Barlow’s sign)

- a click of reduction and a click of dislocation: hip dislocation.

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NERVOUS SYSTEM

Observe for abnormal movement or excessive irritabilityMuscle tone: hypotonia, hypertoniaReflexes: rooting, glabellar, grasp, neck-righting, and moroCranial nervesMovementPeriveral nerves: Erb-Duchenne paralysis, Klumpke’s paralysis

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General sign of neurologic disorder:- Symptom of increased ICP- Hypotonia or hypertonia- Irritability or hyperexcitability- Poor sucking and swallowing reflexes- Shallow, irregular respirations- Apnea- Apathy- Staring- Seizure activity- Asymmteric reflexes

NERVOUS SYSTEM

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