- A newborn should receive a thorough examination within 24 hours of birth to assess gestational age, measurements, vital signs, and physical features. The exam includes evaluating the skin, head, eyes, ears, chest, heart, abdomen, hips, extremities and neurological reflexes. - Key measurements taken are head circumference, chest circumference, body length, abdominal circumference, and weight. Gestational age classification and weight classifications like SGA, AGA, LGA are also determined. - During the physical exam, the examiner evaluates various areas and systems for abnormalities, assessments vital signs and checks for "red flags" like those seen in Potter's Syndrome. Neurological reflexes like the moro,

1. EXAMINATION OF NEWBORNS
Reference:
PERINATAL and PEDIATRIC RESPIRATORY CARE
3rd Edition Brian K. Walsh

2. NEWBORN ASSESSMENT

3. • A newborn should be thoroughly evaluated within 24hours of
birth.
• HISTORY
 Review of present pregnancy, labour and delivery
including screening tests and risk factors for sepsis
 Review of past pregnancy including a history of congenital
anomalies, still births.

4. GESTATIONAL AGE (GA)
• It is measured in weeks, from the first day of the woman's
last menstrual cycle to the current date. A normal
pregnancy can range from 38 to 42 weeks.
• Classification based on GA
 Preterm ˂ 37 Weeks
 Term 37-42 Weeks
 Post term ˃ 42 Weeks

5. Newborn first exam

6. PHYSICAL EXAMINATION
• Measurements
• Vital Signs
• Skin, Head, Face
• Eyes, Ears, nose, Mouth
• Neck
• Chest Wall
• Auscultation, Heart Murmur
• Genetalia
• Neurological Examination
• Abdomen, Extremities, hips
HEAD
TOE

7. Examination precaution
• Thermoneutral environment
• Light and noise
HAND WASHING,HAND
WASHING ,HAND WASHING

8. Anthropometric Measurements
MEASURING THE NEWBORNS
A. Head Circumference
Range: 32–37 cm (12.5–14.5 in)
B.Chest Circumference
Average: 32 cm (12.5 in)
Range: 30–35 cm (12–14 in)
C.Body Length – Height
Average: 50 cm (20 in)
Range: 48–52 cm (18–22 in)
D.Abdominal Circumference
Average: 32 cm (12.5 in)
Range: 31 to 33 cms

9. Weight
– Average: 3400 g
– Range: 2500–4000 g
Low birth weight (LBW)˂2500 gm
Very low birth weight (VLBW)˂ 1500 gm
Extreme low birth weight (ELBW) < 1000gm.

10. Classification of Size based on Gestational Age
• SGA - Small for
gestational age-weight
below 10th percentile
• AGA - Weight between 10
and 90th percentiles
• LGA - Weight above
90th percentile

11. SKIN
Neurocutaneous
lesions
Milia
Mangolian spots
HEAD
Microcephaly,
SUTURE
(sagittal, coronal,
lambdoid, and
metopic)
Molding
EYE
Symmetry, eye
movements, pupils
(red reflex)
Cataract
Ptosis
FACE
Symmetry,Sensory
EARS
Position size and
appearance
NOSE
Choana patency
MOUTH
Cleft palate
NECK
Masses: Cystic
Hygroma
Hematoma
CHEST WALL
Paradoxical
respiration
HEART MURMER
Position
PDA murmer
ABDOMEN
Liver palpation 1-3cm
of coastal rib margin
HIP
Dislocation
EXTREMITIES
Spontaneous
movement
Symmetry
GENETALIA
Gender- Ambigous
genetalia

12. Chest and Abdomen

13. Chest - Distress signs
• Grunting
• Tachypnea
• Nasal Flaring
• Asymetric Chest Rise
• Supra-sternal
• Intercostal
• Sub Costal Retraction

14. Deformities
 Pectus Excavatum-funnel Shaped
 Pectus Carinatum- Protruding
Auscultate
 Air entry, symmetry
 Early crepitation sound is transmitted upper sound
 Late inspiratory crepitation

15. Respiratory function
• Periodic breathing: Irregular breathing pattern of
intermittent respiratory pauses longer than 5 sec.
• Apnea: cessation of breathing for more than 20 sec.
associated with cyanosis, bradycardia
• Abnormal breath sounds: Rhonchi,Wheeze, Stridor
,Crackles

16. VITAL SIGNS
Adequate MBP = GA(weeks) + 5

17. Abdomen
INSPECTION
 Scaphoid
 Distention
 Abdominal wall defect
PALPATION
 Kidneys are normally
palpable
 Liver 2-3 cm
 Spleen palpable
 Umbilical vessels
• 2 artery, one vein

18. Hip and Extremities
 Humerous fracture
 Digital abnormality
• Syndactaly, polydactaly
 Hip dislocation

19. Neurological Reflexes

20. Moro Reflex is present
It is elicited by the sudden dropping
of the infant's head in relation to the
trunk
Which results in abduction and
extension of the infant's arms and
opening of the hands, followed by
flexion.
Moro Reflex

21. The Plantar Reflex is well
established by 32 weeks
conceptional age and disappears
by three months of age.
During the normal plantar grasp,
the toes plantar flex around the
examiner's finger when it is
brought across the ball of the
foot.

22. Grasp Reflex
Stroking the palm of a baby's hand
causes the baby to close his/her fingers
in a grasp.
The grasp reflex lasts only a couple of
months and is stronger in premature
babies.
Step Reflex
This reflex is also called the walking or
dance reflex because a baby appears
to take steps or dance when held
upright with his/her feet touching a solid
surface.

23. Sucking Reflex
Rooting helps the baby become to
suck. When the roof of babies
mouth is touched
The baby will turn his/her head and
open his/her mouth to follow and
"root" in the direction of the
stroking.
suck reflex.mp4

24. “RED FLAGS” IN NEONATAL patients

27. POTTER’S SYNDROME
Flat nose, low set ears,
receding chin, arthrogryposis
and, often, a bell-shaped chest.

28. THANK YOU