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What you have to look for…..
Lecture for medical undergraduates
Objectives
At the end of lecture, the student
• should understand the importance of new-
born examination.
• Should be aware of some normal conditions
that cause parental anxiety.
• Should be able to do a new born examination
systematically and detect congenital and
acquired abnormalities.
Why is it necessary ?
1. To detect congenital anomalies.
3- 5% of newborns
2. To detect some acquired abnormalities.
E.g: umbilical sepsis
3. Reassure parents when normal findings are
detected.
Eg: erythema toxicum
• 4. Identifies familial conditions
– DDH
• 5. Analysis of findings will identify the
problems specific to regions/ ethnic/
age groups
– This is particularly important in policy
making & preventive strategies
When would you do it ?
• As soon as possible after delivery
• Before discharge
• At 6/52
Important..
• Wash your hands first & dry them
• Examination of newborns
requires patience
gentleness
procedural flexibility
• If the baby is quiet auscultate the heart first
• Disturbing manipulations to be done last
New born examination is done from head to
toe.
Observe the baby
• General posture
• Colour
Pink
Acrocyanosis
Pallor
• Appearance of skin
Vernix
Lanugo hair
Nails
• Activity
Normal or diminished
Tremulous movements
Head
* Size and shape to be noted
1. Fontanelle
wide
bulging - tension
closed
2. Sutures
overriding
widely separated > 5 mm
3. Cephalhaematoma
bleeding under periosteum on the parietal bones
does not cross the midline
Cephalhaematoma
5. Caput succedaneum
echymotic, oedematous swelling of
soft tissues
crosses the midline
disappears after first few days
Head Contd..
Caput succedaneum
6. Encephalocele
Head Contd..
Face
1. Dysmorphic features
– Down’s :epicanthal folds, hypertelorism, low set ears
– Other syndromes
2. Oedema
– face presentation
– prolonged labour
3. Isolated abnormalities
– Mouth: precocious dentition/ cleft lip / palate/ Epstein pearls (self
resolving white inclusion cysts on palate/gums)
– Ear abnormalities (deformities, preauricular skin tags)
– Eye: cataract – red reflex, conjunctival / retinal haemorrhaege
– micrognathia
4. Facial nerve palsy
Down’s syndrome
Mid-line defects in trisomy 13
Prominent occiput & low-set ears in
trisomy 18
Bilateral cleft lip
&
complete cleft palate
pre-auricular
skin tags
Acute bacterial conjunctivitis
Cataract in Rubella syndrome
Unilateral microcornea &
microphthalmos
Unilateral iris coloboma in left eye
Micrognathia
Right facial nerve palsy
following birth injury
Neck
1. Goitre
correct technique
– slightly extended neck
2. Sternomastoid tumour
after ~ 1/12 of age.
torticollis
3. Cystic hygroma
Chest
• Breast
breast hypertrophy
mastitis neonatorum
super numerary nipples
• Chest deformities
• Observe breathing pattern
• Dyspnoea and grunting
• Heart : examine both sides
location
heart rate
peripheral pulses
Abdomen
• Abdominal distension
• Scaphoid abdomen
• Liver – palpable
• Unusual masses
Abdomen contd.
• Umbilicus
umbilical sepsis
omphalocele
later – umbilical hernia
gastrochiasis
Abdomen Contd..
• Bladder exstrophy
• Cloacal exstrophy
Groin
• Femoral pulses
– to exclude coarctation
• Hip examination
– to exclude CDH
Ortolani manoeuvre
abducting the femur
– palpable clunk
Asymmetrical thigh creases
in
unilateral dislocation of hip
Genitalia
• Ambiguous genitalia
• Undescended testes
• Hypospadias
• Hydrocele
• Imperforated anus
• Inguinal hernia
Ambiguous genitalia
Hypospadias
Imperforated anus
Hydrocele
Inguinal hernia
High imperforated anus
communicates into vagina
Imperforate hymen
Limbs
• Observe for spontaneous or stimulated activity
• Polydactyly
• Syndactyly
• Nerve damage
• Talipes (Club foot): CTEV
• Other abnormalities
• Erb’s palsy
• Amniotic band defects
Turner syndrome
Low hairline
Abnormal ears
Neck webbing
Micrognathia
Shield chest with
widespread nipples
Lymphoedema in hands & feet
- Turner syndrome
Rocker-bottom feet (protruding calcanei) in
trisomy 18
Overlapping fingers in
trisomy 18
Polydactyly
Syndactyly
Lobster claw hand
Amniotic band defects
Talipes equino varus
Erb’s palsy
Spine
• Kyphoscoliosis
• Feel for defects
• Tuft of hair-Spina bifida occulta
Back / spine contd….
• Meningomyelocele
Skin
• Pustules
Skin Contd..
• Milia
- Sweat retention vesicles
• Thrush
- oral
- nappy rash – satellite lesions
Skin Contd..
Skin Contd..
• Mongolian blue
spots
Skin contd..
• Haemangioma
Skin Contd..
• Amoniacal dermatitis
• Erythema toxicum
Skin contd..
• Seborrhoeic dermatitis
Skin contd..
Skin contd..
• Sweat rash
Skin contd..
• Cutis marmorata
Skin contd..
• Stork bite
Anthropometric measurements
• Length
– infantometer
• Weight
• OFC
New born reflexes
• Rooting
• Sucking
• Grasp
• Moro
– gradually disappear by 4/12
• Asymmetrical tonic
neck reflex
- Appear at 2- 4/12
- Disappear by 6/12
You CAN’T miss
1. Red reflex: Cataract
2. Femoral pulse: coarctation of aorta
3. DDH
• As missing any of the above in new borne examination does
much harm than missing anything else.
Summary
•New born examination is important in all babies to
exclude congenital abnormalities & acquired infections.
•All babies should be examined before discharge.
•Thorough examination should be done from head to toe.
•If abnormalities were detected, can take early actions to
correct them. Eg: DDH,CTEV
•Parents can be reassured if normal variations were
found. Eg: Erythema toxicum

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New born examination