The document outlines the importance and process of newborn examination. Key points include examining the baby from head to toe to detect congenital anomalies and infections, identify normal variations to reassure parents, and influence policy by analyzing regional findings. The examination should be done systematically and involve observing the baby's appearance, activity and reflexes as well as examining specific areas like the head, chest, abdomen, limbs and skin. Important tests include the red reflex test to check for cataracts and femoral pulse examination to check for aorta issues.

1. What you have to look for…..
Lecture for medical undergraduates

2. 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.

3. 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. • 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

5. When would you do it ?
• As soon as possible after delivery
• Before discharge
• At 6/52

6. 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

7. 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

8. 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

9. Cephalhaematoma

10. 5. Caput succedaneum
echymotic, oedematous swelling of
soft tissues
crosses the midline
disappears after first few days
Head Contd..

11. Caput succedaneum

12. 6. Encephalocele
Head Contd..

13. 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

14. Down’s syndrome

15. Mid-line defects in trisomy 13

16. Prominent occiput & low-set ears in
trisomy 18

17. Bilateral cleft lip
&
complete cleft palate

18. pre-auricular
skin tags

19. Acute bacterial conjunctivitis

20. Cataract in Rubella syndrome

21. Unilateral microcornea &
microphthalmos

22. Unilateral iris coloboma in left eye

23. Micrognathia

24. Right facial nerve palsy
following birth injury

25. Neck
1. Goitre
correct technique
– slightly extended neck

26. 2. Sternomastoid tumour
after ~ 1/12 of age.
torticollis

27. 3. Cystic hygroma

28. 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

29. Abdomen
• Abdominal distension
• Scaphoid abdomen
• Liver – palpable
• Unusual masses

30. Abdomen contd.
• Umbilicus
umbilical sepsis
omphalocele

31. later – umbilical hernia

32. gastrochiasis

33. Abdomen Contd..
• Bladder exstrophy
• Cloacal exstrophy

34. Groin
• Femoral pulses
– to exclude coarctation
• Hip examination
– to exclude CDH

36. Ortolani manoeuvre
abducting the femur
– palpable clunk

37. Asymmetrical thigh creases
in
unilateral dislocation of hip

38. Genitalia
• Ambiguous genitalia
• Undescended testes
• Hypospadias
• Hydrocele
• Imperforated anus
• Inguinal hernia

39. Ambiguous genitalia

40. Hypospadias

41. Imperforated anus

42. Hydrocele

43. Inguinal hernia

44. High imperforated anus
communicates into vagina

45. Imperforate hymen

46. Limbs
• Observe for spontaneous or stimulated activity
• Polydactyly
• Syndactyly
• Nerve damage
• Talipes (Club foot): CTEV
• Other abnormalities
• Erb’s palsy
• Amniotic band defects

47. Turner syndrome
Low hairline
Abnormal ears
Neck webbing
Micrognathia
Shield chest with
widespread nipples

48. Lymphoedema in hands & feet
- Turner syndrome

49. Rocker-bottom feet (protruding calcanei) in
trisomy 18

50. Overlapping fingers in
trisomy 18

51. Polydactyly

52. Syndactyly

53. Lobster claw hand

54. Amniotic band defects

55. Talipes equino varus

56. Erb’s palsy

57. Spine
• Kyphoscoliosis
• Feel for defects
• Tuft of hair-Spina bifida occulta

58. Back / spine contd….
• Meningomyelocele

59. Skin
• Pustules

60. Skin Contd..
• Milia
- Sweat retention vesicles

61. • Thrush
- oral
- nappy rash – satellite lesions
Skin Contd..

62. Skin Contd..
• Mongolian blue
spots

63. Skin contd..
• Haemangioma

64. Skin Contd..
• Amoniacal dermatitis

65. • Erythema toxicum
Skin contd..

66. • Seborrhoeic dermatitis
Skin contd..

67. Skin contd..
• Sweat rash

68. Skin contd..
• Cutis marmorata

69. Skin contd..
• Stork bite

70. Anthropometric measurements
• Length
– infantometer

71. • Weight

72. • OFC

73. New born reflexes
• Rooting

74. • Sucking

75. • Grasp

76. • Moro
– gradually disappear by 4/12

77. • Asymmetrical tonic
neck reflex
- Appear at 2- 4/12
- Disappear by 6/12

78. 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.

79. 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