Physical Examination of the Newborn PGI Michelle Matematico
Mar 23, 2016
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.