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
Respirations: normal rate is 40-60 breaths/min
Pulse rate: normal rate is 100-180 beats/min
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 percentile
Weight and percentile
Assessment of gestational age
Obvious congenital abnormality
Plethora (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
Pallor (washed-out, whitish appearance)
Central cyanosis: bluish skin, including the tongue and lips
Peripheral cyanosis: bluish skin with pink lips and tongue
Acrocyanosis: bluish hands and feet only
Extensive 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.
Vernix caseosa: substance that covers the skin until 38th week of gestation
Collodion infant: skin resembles parchment, restriction in growth of the nose and ears.
Dry skin: postdate or postmature infant, congenital syphillis, and candidiasis
Milia: 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.
Acne neonatorum: comedones and papules over the cheeks, chin, and forehead.
Herpes simplex: pustular vesicular rash, vesicles, bullae, or denuded skin.
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
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.
Anterior and posterior fontanelles :anterior fontanelle usually closes at 9-12 mo and the posterior at 2-4 mo
Molding: temporary asymmetry of the skull resulting from the birth process.
Increased intracranial pressure: bulging anterior fontanelle, separated sutures, paralysis of upward gaze (setting-sunsign, prominent veins of the scalp, increasing macrocephaly
Craniosynostosis: premature closure of one or more sutures
Craniotabes: softening of the skull
Plagiocephaly: oblique shape of a head, asymmetric and flattened.
Eliciting the rooting reflex
Palpate the sternocleidomastoid
Short neck: Turner’s, Noonan’s, and Klippel-Feil syndromes
Note the general shape of the nose, mouth, and chin
Note the presence of hypertelorism (eyes widely separated)
Note the presence of low-set ears
Facial nerve injury: unilateral branches of the facial nerve
Look for unusual shape or position
Low-set ears: congenital anomalies
Preauricular skin tags (papillomas): benign
Hairy ears: infants of a diabetic mothers
Gross hearing: when infant blinks in response to loud noises
Check the red reflex with an ophthalmoscope
Opacification of the lens: cataract
Sclera bluish tint: premature
Sclera deep blue: osteogenesis imperfecta
Brushfield’s spots (salt-and-pepper specling of the iris): Down syndrome
Subconjunctival hemorrhage: 5% newborn infant.
Nasal flaring: respiratory distress
Sniffing and discharge: congenital syphilis
Sneezing: response to bright or drug withdrawal.
Ranula: cystic swelling in the floor of the mouth.
Epstein’s pearls: keratin-containing cysts
Mucocele: small lesion on the oral mucosa
Predeciduous teeth: supernumerary teeth
True deciduous teeth: true teeth that erupt early.
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.
Breast in a newborn: usually 1cm in diameter in term
abnormally 3-4 cm: effects of maternal estrogens
witch’s milk: white discharge
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.
Observation: omphalochele, gastroschisis, scaphoid abdomen.
Palpation: check for distention, tenderness, or masses.
Two arteries and one vein
Normal cord: translucent
Greenish-yellow color: meconium staining
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 scrotum
examine the labia and clitoris
Palpable lymph nodes usually in the inguinal and cervical 33% of normal neonates.
ANUS AND RECTUM
Check for patency of the anus
Check the position of the anus
Meconium should pass within 48 h
Syndactyly : abnormal fusion of the digits
Polydactyly: supernumerary digits
Simian crease: a single transverse palmar crease (Down syndrome)
Talipes equinovarus (clubfoot): foot is turn downward and inward and the sole is directed medially
Metatarsus varus: adduction of the forefoot
TRUNK AND SPINE
any gross defect of the spine
hairy patches over the lower back
sacral or pilonidal dimple: small
Fetal Phenytoin syndrome: Hirsutism
Congenital hip dislocation
Ortolani 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.
Observe for abnormal movement or excessive irritability
Muscle tone: hypotonia, hypertonia
Reflexes: rooting, glabellar, grasp, neck-righting, and moro
Periveral nerves: Erb-Duchenne paralysis, Klumpke’s paralysis
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