Newborn examination

1. NEWBORN
EXAMINATION
By Dr.MOUNIKA

2.  Indication and importance
 Maternal and prenatal history
 Precautions prior to examination
 Vitals and anthropometry
 Assessment of gestational age
 General examination
 Systemic examination
 Neonatal reflexes

3.  To assess the baby’s transition from intrauterine life
to extrauterine existence
 Earliest possible detection of deviations
 Establishes a baseline for subsequent
examinations
 To assess the progress of the child
 Parents assurance and counseling

5.  Immediately after birth
 Detailed examination after 24hrs
 At discharge and 24hrs after discharge

6.  Hand washing
 Thermal environment
 Good source of light
 Background noise
 Brief examination time

7.  Check the correct name,sex
 Gestational age
• FULL TERM-between 37 to 42 weeks of gestation
• PRETERM-< 37 weeks
• POST TERM->42 weeks of gestation
• POST DATED-after EDD(>40 weeks of gestation)

9.  APGAR scoring done at 1min,5min and 10min after
birth
 Value > 7 indicate the baby’s condition is good to
excellent
 Value <4 necessitate continued resuscitation
 APGAR score is a good predictor of survival but
using it to predict long-term outcome is
inappropriate.

10.  Temperature
 Heart rate
 Respiratory rate
 Blood pressure
 SpO2

11.  Measure axillary temperature with tip of the
thermometer in the axilla.
 Normal axillary temp is 36.5 to 37.4
 Mild Hypothermia/cold stress – 36.0 to 36.4
 Moderate hypothermia – 32 to 35.9
 Severe hypothermia - <32
 Hyperthermia - >37.5

12. Heart rate
 Normal HR: 100-160/min(during crying -180min)
 Tachycardia: >180/min
 Bradycardia:<100/min
 Look for all the pulses(bounding pulses/feeble)
Respiratory rate
 In sleep or resting state: 30-60/min
 In preterms- cheyne stokes rhythm or periodic
respiration
 Diaphragmatic breathing

13. SILVERMAN ANDERSON SCORE

15.  Use appropriate sized cuff with cuff
width 50% of arm circumference
 Measured by oscillometry using NIBP
monitors
 Normal BP : 60/40mm Hg
 Invasive BP monitoring in sick new borns
 In right upper limb and one lower limb
 ZUBROS charts

16. Saturation
 By pulse oximeter
 Right upper limb and any lower limb
 SpO2 >95% on room air
Capillary filling time
 Measured on the sternum
 By pressing index finger for 5 seconds
 Normal CFT <3 sec

17. Birth weight
 Baby weighed in naked condition using weighing
machine with an accuracy of 5 grms.
 Normal >2.5kg
 Low birth weight: <2.5kg
 Very low birth weight: <1.5kg
 Extremely LBW : <1kg

18.  Classification By Weight Percentiles
AGA - 10th – 90th percentile for GA
SGA - <10th percentile for GA
LGA - >90th percentile for GA

19. Length:
 Measured by infantometer with infant supine
and knees stretched
 Crown to heel measurement
 Normal length: 47 -50cm
Head circumference:
 Occipitofrontal
 By using non stretchable tape
 Preferably after 24hrs
 Normal HC: 33-35cm

21. Chest circumference:
 Measured around chest at level of nipples
 Head circumference is usually 2-3cm more
than chest circumference
Ponderal index:
 To identify IUGR infants
weight(gms)
length(cms)³
× 100

23. POSTURE
SQUAREWINDOW
SCARFSIGN
ARMRECOIL
HEELTOEAR
POPLITEALANGLE
NEUROLOGICAL MATURITY

24. SKIN LANUGO SOLECREASES
BREAST
EARS
MALEGENITALIA
FEMALEGENITALIA
PHYSICAL MATURITY

25.  Posture and attitude-In Term infants normal
posture is hips abducted and partially flexed,
with knees flexed.
 Arms are abducted and flexed at the elbow.
 Fists are often clenched, with the fingers
covering the thumb
 Physical activity and behavior
 Active and passive muscle tone

26.  Colour-(normal is pink color in centre &
peripheries)
◦ Mottling/CUTIS MARMORATA– due to vasomotor instability
◦ Cyanosis(central or acrocyanosis)
◦ Pallor
◦ Icterus
◦ Edema

27. LANUGO VERNIX CASEOSA
MILARIA(superficial
obstruction of sweat ducts)
MILIA(epidermal
inclusion cysts)

28.  Hemangiomas
 Petechiae
 Extensive skin fragility
 Amniotic bands
 Sucking blisters or calluses
 Nails and Hair(texture,distribution)
SALMON
PATCH/nevus
simplex
PORT WINE STAIN

29. ERYTHEMA TOXICUM
 yellow or white papules or
pustules on erythematous
base.
 On face,trunk,extremities
except palms and soles
 contain eosinophils and are
sterile
 Benign and self limited
BENIGN PUSTULAR
MELANOSIS OF THE
NEWBORN
 Vesiculopapular eruption on
chin,neck,back,extremities
 Hyperpigmented macules
 Contain neutrophils
 Benign and lasts for 2-3
days

30.  Slate-gray to blue-black lesions
 Usually over
lumbosacral area and
buttocks
 Accumulation of melanocytes
within the dermis
 Generally fade by the age of 7
years
APLASIA CUTIS
CONGENITA
•Focal lesion with
congenital absence of
some or all layers of skin

31. HARLEQUIN COLOR
CHANGE
 Due to vasomotor
instability or immature
circulation
NEUROCUTANEOUS
MARKERS
 Café-au-lait spots
 Light brown macules or
patches
 No pathologic significance, if
5mm in length and < 6 in
number
 If >5mm or > 6 in number it may
indicate Cutaneous
Neurofibromatosis.

32. IMPETIGO NEONATORUM
 Vesicular, pustular, or bullous
lesions developing as early as
day of life 2-3 up to 2 weeks of
life.
 Lesions occur in moist
areas of skin
 Unroofed lesions do not form
crusts
 Treat with antibiotics
HSV
CONGENITAL SYPHILIS
CONGENITAL CANDIDIASIS

33.  Orifice count
 Skull
Moulding of the head
Size of the head-
MACROCEPHALY/MICRO
CEPHALY
Shape of the head
CRANIOTABES

34.  Wide areas of fibrous tissue at junction of two
or more sutures
 6 fontanelle at birth
 1 anterior
 1 posterior
 2 anterolateral
 2 posterolateral
FONTANELLE

35. CAPUT SUCCEDANEUM
– Boggy edema in
presenting part of
head
– Cross suture lines
– Disappear in few days
CEPHALHEMATOMA
– Subperiosteal
– Dose not cross
sutures
– Weeks to resolve

36. .uscneurol
premature closure of one or more cranial suture.
TYPE OF SKULL SYNOSTOSIS APPEARANCE LENGTH-WIDTH
INDEX
MESOCEPHALY normal Normal cranium 76-80
DOLICOCEPHALY/
SCAPHOCEPHALY
sagittal Long/canoe
shaped cranium
70-75
BRACHYCEPHALY coronal Short cranium 80-85
PLAGIOCEPHALY U/L coronal or
lambdoid
Oblique deformity
TRIGONOCEPHALY metopic High peaked >85

37.  Look for Dysmorphic features – mongoloid facies,
potter, elfin facies
 Facial asymmetry
 Hypoplasia of depressor anguli oris
 Milia

38. • Microophthalmia, buphthalmos
• Epicanthal folds
• Sub Conjuctival and retinal hemorrhages
• Pupils:equality, reactivity to light.
• Squint
• Cornea-microcornea
• Congenital cataracts
• Conjunctiva
• Iris-coloboma,heterochromia,
Brushfield spots

39. SQUINT CONGENITAL GLAUCOMA
RED REFLEX
LEUKOCORIA

40. Hypotelorism
Canthal index<33
Normal
Canthal index:33-38
Hypertelorism
Canthal index: >38

41.  Pre auricular tags
 Partial or complete absence of pinna
 Deformed pinna and microtia
 Low set ears

42.  Nares for symmetry and patency
 Flat/depressed nasal bridge
 Choanal atresia

43.  Microstomia/Macrostomia
 Micrognathia/retrognathia
 Fish like mouth appearance
 Natal teeth
 Complete or incomplete Cleft lip
 Soft and hard palate – high arched palate,
cleft palate(submucosal left)
 EPSTEIN PEARLS – small, greyish white
swellings on either side of raphe
 TONGUE – size and position,
ankyloglossia, protruding tongue

44.  Look for swellings – goitre, cystic hygroma,
branchial arch cysts, teratoma, hemangioma,
sternocleidomastoid tumour.
 Shortening or webbing of neck
 Congenital torticollis
 Palpate clavicles for fractures

45.  Chest asymmetry and deformities
 Supernummery nipples
 Inverted nipples
 Widely spaced nipples – Turner syndrome
 Breast hypertrophy
Milk production
No redness
Look for asymmetry, erythema, induration or
tenderness
Unilateral absence or hypoplasia of pectoralis
major-POLAND SYNDROME

46. Umbilical cord
Abdominal wall defect-
gastroschisis,omphalocele,
bladder extrophy
Visible intestinal loops
UMBILICAL CORD
CYST
DIASTASIS RECTI

48.  Hip dislocation – Barlows and Ortolani’s test

49.  Erb’s palsy: extended arm
and internal rotation with
limited movement
 Humerous fracture
 Digital abnormality
Syndactyly,
brachydactyly,
polydactyly,clinodactyly
EDEMA of hands and feet-
Turners

50.  Dermatoglyphics-Single palmar crease/SIMIAN
CREASE
 Rocker bottom foot, club foot, pes planus/ pes
cavus

51.  Male :
 Penile size(<2cm-micropenis)
 Phimosis,Hypospadias, epispadias
 Testes-2% cryptorchid,Hydrocele
 Female:
 Prominent clitoris and minora
 Vaginal skin tag
 Vaginal discharge /blood
 Labial fusion
 Ambiguous genitalia

52.  Anus : Patency and location
 Meconium within12-24hrs after birth

53. Abnormal Curvature
Sinus Tract, Tuft Of Hair
Meningomyelocele
Hemagiomas
Lipomas

55.  Inspection for any Distress
signs(Grunting, Tachypnea, Nasal
flaring, stridor, asymmetric chest
rise,supra-sternal, intercostal, sub costal
retraction).
 Auscultate
Air entry, symmetry
Added sounds

56.  HR 100-160 beats/min
 Color, perfusion, Central cyanosis
 Apex: 4T
Hto 5thICS, lateral to left sternal border
 Precordial pulsations
 Dextrocardia- heart on right side and Displacement of apex
 S2 slightly sharper and higher pitch than S1
 Murmurs
 Innocent murmurs in neonates
Systolic murmurs along upper or lower left sternal borders
Intensity 1 to 2/6
Ex: transient TR, closing PDA, pulmonary flow murmur

57.  Inspection
 Palpation; baby sucking and use warmhands
– Kidneys are normaly palpable
– Liver 2-3 cm
– Spleen tip palpable
– Umbilical vessels
• 2 artery, one vein
– Hernias ; umbilical and inguinal
– Look for cystic/solid masses

58.  HIGHER
MENTAL
FUNCTIONS:
 Awakenes
and alertness
 Irritabilty
 Consolibilty
 Cuddlabilty

59. 1-smell of mother’s milk(not routinely done)
2-fixing at soft light, pupillary reflex, blinking reflex
3,4,6-ptosis,eye movements(spontaneous and doll’s eye
response)
5-rooting reflex, corneal reflex
7-observe child cry for facial palsy
8-response to sound(startle reflex)
9,10-suck and swallow, position of uvula during cry,
choking during feeding
11-lift head off the bed and look for SCM
12-symmetry of the tongue

60.  Motor assessment-
 Tone(active and passive)
 Posture
 Head control(pull to sit)
 Spontaneous movements
 Trunk(ventral suspension,vertical suspension)
 Response to handling
 DTRs,
 Babinski reflex(normal)

62.  Also known as developmental, primary, or
primitive reflexes.
 They consist of autonomic behaviors that
do not require higher level brain
functioning. They can provide information
about lower motor neurons and muscle
tone.
 They are often protective and disappear as
higher level motor functions emerge.

63.  Onset: ~28weeks GA
 Well-established: 32-34 weeks GA
 Disappears: around 12 months
 Elicited by the examiner stroking the lips of the
infant; the infant’s mouth opens and the
examiner introduces their gloved finger and
sucking starts.

64. Onset: 28 weeks GA
Well-established: 32-34
weeks GA
Disappears: 3-4 months
Elicited by the examiner
stroking the cheek or corner of
the infant’s mouth. The infant’s
head turns toward the
stimulus and opens its mouth.

65. Onset: 28 weeks GA
Well-established: 32 weeks
GA Disappears: 2 months
Elicited by the examiner
placing his finger on the palmar
surface of the infant’s hand and
the infant’s hand grasps the
finger. Attempts to remove the
finger result in the infant
tightening the grasp.

66. Onset: 35 weeks GA
Well-established: 4 weeks PCA
Disappearance: 7 months
Elicited by rotating the infants head
from midline to one side. The infant
should respond by extending the arm
on the side to which the head is
turned and flexing the opposite arm.
The lower extremities respond
similarly.

67.  The examiner holds the infant so that one hand
supports the head and the other supports the
buttocks. The reflex is elicited by the sudden
dropping of the head in hand.
 The response is
Opening of hands(by 28weeks gestation)
extension and abduction of the upper extremities(by
32weeks).
anterior flexion of the upper extremities(by 37 wks)
 audible cry.
 Onset: 28-32 weeks GA
 Well-established: 37 weeks GA
 Disappearance: 6 months

68. •BILATERAL absence:
 CNS depression by narcotics or anesthesia
 Brain anoxia and kernicterus
 Very Premature baby
 ASYMMETRIC response:
 Erbs palsy , fracture clavicle or humerus
 PERSISTENCE beyond 6th month
 CNS damage

69. Onset: 28 weeks GA
Well-established: 40 weeks GA
Disappearance: 3-4 months
The infant is held in ventral suspension with the chest in
the palm of the examiner’s hand. Firm pressure is applied
to the infant’s side parallel to the spine in the thoracic
area. The response consists of flexion of the pelvis toward
the side of the stimulus.

70. Onset: 35-36 weeks GA
Well-established: 37 weeks GA
Disappearance: 3-4 months PCA
Elicited by touching the top of the infant’s
foot to the edge of a table while the infant is
held upright. The infant makes movements
that resemble stepping.

71.  When dorsum of the baby
foot touches the under surface
of the table
→ flexion then extension to
place or put his foot on the
table

72.  Wash your hand prior to examination
 Inspect,Inspect,Inspect,then Touch.
 Neonatal reflexes
 Normal variations in newborn