Physical Examination of the Newborn

PGI Michelle Matematico

The newborn should be examined 3 times

Immediately at birth In the nursery/rooming-in

Upon discharge, in the presence of the mother

HOW???

InspectAuscultatePalpate

NB: the newborn should be naked when doing the physical examination

THE GENERAL APPEARANCE

• Posture• Skin color• Activity• Muscle tone• Congenital anomalies

VITAL SIGNS• Temperature (36.5 C-37.5 C)• Respiratory rate (and type)(NV-40-60cpm)• Cardiac rate (120-60bpm)– Higher in preterm– May be <100bpm in post-term

• Do these q30 x 2 hours or until stable

VITAL SIGNS

• BP is not routine in the new born but used for infants requiring special care especially if evaluating coarcttion of the aorta or congenital heart diseases

• BP higher in the UE than the LE may indicate coarctation of the aorta

ANTHROPOMETRIC MEASUREMENT

ANTHROPOMETRICS

• Head circumference– from the glabella –occipital area (lubchenco’s)

• Weight and percentile- use the lubchenco’s chart– SGA (symmetric or asymmetric)-below the 10th

percntile– AGA-10th-90th percentile– LGA- >90th percentile

ANTHROPOMETRICS• Length and percentile(lubchengco’s chart)– Crown of the head to heel

ASSESMENT OF GESTATIONAL AGE

• The new ballard score• Done after initial stabilization or by 12 hours

after birth• Neuromuscular maturity and Physical maturity• Avoid eliciting primitive reflexes• Perform the maneuvers with the head in the

midline and avoid grasping the palms and toes

NEUROMUSCULAR MATURITY

PHYSICAL MATURITY

SKIN

• Color• Rashes• Texture• Turgor• Edema• Induration• Thickness of underlying fat

SKIN

Vernix caseosa

Neonatal pustular melanosis

MiliaMongolian spot

SKIN

MottlingHemangioma

Cutis mamorataNevus flammeus

SKIN

Erythema toxicumMiliaria crystalina

HEAD

• Macrocephaly->2SD from the mean• Microcphaly- < 3 SD below the mean• Anterior Fontanel-closes at 9-18 mos;

diamond-shaped• Posterior fontanel-closed at birth or closes at

2-4 mos

HEAD

• Caput succedanum -accumulation of blood/serum above the periosteum and crosses the suture lines & w/ skin discoloration. Resolves within days.

• Cephalhematoma- traverses the periosteum, does not cross the suture lines, w/o skin discoloration. Resolves w/in 2 wks-3 months

• Molding-temporary asymmetry of the skull w/c resolves w/in a week

Cephalhematoma vs Caput succedanum

Cephalhematoma Caput succedanum

Eyes

• ROR present-Normal• White pupillary reflex-

cataract• Subconjunctival

hemorrhages-benign and usu. Resolves w/in 2 weeks

Ears

• Low-set ears• Skin tags• Hairy ears-common in

diabetic mothers

Nose and Mouth

Nose • Check for patency by

inserting an NGT

Mouth• Clefts• Deciduous teeth• Epstein pearls (Normal)-

hard and soft palate

CHEST

Lungs • symmetry• Retractions• Fractures• Presence and equality of

breath sounds

Heart • Heart rate• murmurs

Abdomen

omphalocoele Gastroschisis

Abdomen

• N-globular, soft• Inactive bowel sounds on the first days of life• Palpate for distention, tenderness or masses

starting from the umbilicus towards the diaphragm

• Umbilicus-2A:1V;blleding, signs of infection, should be transluscent, if greenish-yellow: meconium staining

Hips

Positive: click of reduction and dislocation

Genitalia-Female

• Size and location of labia, clitoris, meatus, vaginal opening, relation of posterior fourchette to the anus

• All female newborns should have a redundant hymenal tissue w/c will disappear in a few weeks

• discharges

Genitalia-Male

• Check for:• Testis: descended, retracted, ecopic, cryptorchid• Dorsal hood• Hypospadia• Epispadia• Chordee• Normal penile length: >2cm• Phimosis and hydrocoele are common in newborn.

Hydrocoele will disappear by 1 y/o

Extremities

• Pulses• Syndactyly• Polydactyly• Simian crease• Talipes equinovarus• Metatarsus varus

EXTREMITIES

Metatarsus varus

Syndactyly

Talipes equinovarus

Simian creasePolydactyly

Trunk and spine

• Tufts of hair• Dimpling

Anus and rectum

• Check for patency• Meconium should pass w/in 48 hours of birth

T H A N K Y O U.