A normal newborn weighs 2.5-3.5 kg, is 45-55 cm long, and has a head circumference of 33-35 cm. Vital signs include a temperature of 96.8-99°F, heart rate of 120-160 beats/minute, and respiratory rate of 30-60 breaths/minute. A comprehensive physical exam assesses the newborn from head to toe and includes measurements, examination of features and organs, and assessment of reflexes. Key reflexes in newborns include rooting, sucking, swallowing, and Moro reflex. The physical exam establishes the health and normalcy of the newborn.

1. Submitted by-
Jayesh soni
HOD; Pediatrics

2. Normal Newborn
 Average duration of pregnancy is 37-40 weeks.
 A baby born after this period weighs 2.8 kg.
 Any newborn with a birth weight of < 2.5 kg. is
classified as a Low Birth Weight Baby (LBW)
characteristics of a normal newborn
 Weight 2.5 – 3.5 kg.
 Length 45-55 cm.
 Head circumference 33-35 cm.
 Chest circumference 30-33 cm.

3. Cont…
vitalsigns-
 Temperature- 96.8*-99*F (Axillary)
 Heart rate 120-160 beats per minute.
 Respiratory rates 30-60 breath per minute.
 B.P. Usually not require, 80-90/40-50 mmHg
 Extremities are bluish for short time period after birth, but
becomes pink within a few hours.
 Urine is passed during birth or immediately after birth, but
a vast majority passes urine within the 24 hours.
 First stool (meconium)
Black in colour and is paste like. Meconium is passes
within the first day and the stools change to golden brown
over the next 2 – 3 days.

4. Major steps in newborn assessment
 Assess with initiation of respiration
 Apgar score
 Vital sign
 Physical examination(head to toe)
 Anthropometric measurement
 Reflexes

5. Score of 0 Score of 1 Score of 2
Component
of acronym
Skin
Colour/Compl
exion
blue or pale
all over
blue at
extremities
body pink
(acrocyanosis)
no cyanosis
body and
extremities
pink
Appearance
Heart rate <60 <100 ≥100 Pulse
Reflex
irritability
no response
to stimulation
grimace/feebl
e cry when
stimulated
cry or pull
away when
stimulated
Grimace
Muscle tone none
some flexion
of extremities
flexed arms
and legs that
resist
extension
Activity
Breathing absent
weak,
irregular,
gasping
Good, strong,
crying
Respiration
Apgar score (1952, Dr.Verginia Apgar)

6. PHYSICALEXAMINATION
GENERAL MEASUREMENTS
Age
 Term = start of 38th wk. end of 42nd week.
 Preterm = before end of 37th wk.
 Post-term = after end of 42nd wk.
 Weight: - 2.5 kg. or above
 Length:- 45-55 cm
 Apgar Score:-7-10 is normal

7. HEAD MEASUREMENT
Shape- Round symmetrical , may have moulding ,
overriding sutures, Slight asymmetry.
 Microcephaly <32 cm
 Hydrocephaly >4 cm from chest
 Cephalohematoma
Size-33-35 cm (2 cm> CC)
Fontanells
 size,
 shape,
 consistency

8.  Anterior Fontanells -
 Sutures, palpable slight Soft
 3-4 cm long
 2-3 cm wide
 Diamond shape, Full bulging, large, depressed,
Closed on 12-18month.
 Posterior Fontanells
 1-2 cm
 Triangular shape
 Closed on 2-3 month.

9. EYES
Symmetrical & clear
Color :- Greyish/ blue or gray brown iris, Blue white
sclera,
Movement :- Random, jerky, uneven. Focus
momentarily.
Reaction to Light :- Pupils equal in size, round
and reactive to light. fixed
Eyelids :- Size and movement symmetric, Blink
reflex, Eyes on a parallel plane.
Cross hand for inspection and vision

10. EARS
 Reaction to noise Startle reflex to loud noise.
 Position :-
Symmetrical.
Line drawn through inner and outer canthus of
eye comes to top notch of ear as pinna (where it
connects with scalp.)
 Patency
Evidence of hearing. Reaction to noise.

11. NOSE
 Symmetrical
 Position
 Situated in Midline
 Mucus Clear,
 Patency:-
 Infants obligatory nose breathers.
 Sneezing is common.
 Flaring of nares

12. MOUTH
Symmetrical
Presence of sucking, gagging, rooting and
swallowing reflexes
Hard & soft palate intact,
Pink lip, no cracking, check mucus mem.
Presence of natal teeth or not,
Freely moving tongue
Oral infections (if any) -
(look for presence of “Thrush” candida albicans – white patchy are of
tongue & gums with pain )

13. NECK
 Mobility
 Short and thick
 Stiffness or rigidity
 Trachea and head held in midline
 Cyst or mass
 Excessive skin folds (trisomy 21)
 Webbing

14. CHEST
Size &Shape
Almost circular, Barrel shaped.
2-3 cm <head circ. (30-33cm)
Breast tissue
3-10 mm breast nodule,
Nipples prominent
Breast tissues are present, equal in size

15. RESPIRATIONS
 Rate: - 30-60/min
Tachypnea > 60/min
Bradypnea < 25/min
 Rhythm: - Shallow, Irregular when infant awake.
 Muscular activity involved-
 Simultaneous rise and fall of chest and abdomen.
 Subcostal and substernal retractions.

16. ARMSANDHANDS
 Length --Arms equal in length.
 Movements –Spontaneous, Full range of motion, Limited
movements.
 Muscle tone --Generally flexed. Fist often clenched with
thumb under finger.
Erb’s palsy -damage to bronchial plexus during delivery (5th/6th
cervical nerve)
 Fingers-Number should be Correct & check Absence of or
additional, or Short.
 Position -Fists often clenched with thumb under finger.
 Check palmer grasps reflex
 Redial and brachial pulses are palpable

17. ABDOMEN
 Contour
Rounded, protruding, distended or
Scaphoid (when the abdomen is sucked inwards)
 Musculature Not fully developed.
(Bowel sounds audible 1-2 hours after birth)

18. UMBILICAL CORD
 Assess Number of vessels at birth
(2 arteries & 1 vein )
 Appearance
 Clear,
 gelatine
 Odourless.
 Drainage or
 Redness
 Cord should be clamped for at least first 24 hrs after
birth , clamped can be removed when cord is dried
or occluded and no longer bleeding occurs

19. GENITo-URINARY
Female Ambiguous genitals
(infant's external genitals don't appear to be clearly either male or
female)
1. Labia --Usually edematous
a. Size -Covers labia minora & majora widely
separated
b. Appearance --May have pigment,
Symmetric in size, Minora prominent.
2. Vaginal discharge:- Absence of vaginal orifice.
Color :- Smegma under labia, May be blood
tinged, Fecal discharge.

20. Male
1. Testes in scrotum
 Palpable each side, Large.
 Cremasteric reflex. (inner part of the thigh stroked)
 Assess Abnormality/ Undescended
 Scrotum smooth.
2. Urethral meatus at end of penis ,
Correct position , Prepuce (foreskin) covers glands

21.  Voidings :
 Color --Clear, light yellow.
 Amount --Well saturated diapers
 Frequency --By 24 hrs after delivery. At least 3-4
times/day
 Specific gravity -1.008-1.010
RECTUM
Patency-Good sphincter tone of anus.

22. Spine
Straight, posture flexed, supportive,
easily moveable
Feel neck of sacrum (any dimple/ mass)
called Mangoliyan’s part (discoloured
area of blue/black part)
Back of leg and folds of skin matched
from another

23.  Pinkish red/brown/yellow,
 Assess Vernix caseosa (cheesy white substances on entire
body, more prominent between folds of skin or may be absent
after 24 hrs)
 Lanugo present (fine body hair especially on back)
 Milia (small white sebaceous gland appear on forehead, nose & chin)
 Assess cyanosis or Acrocyanosis
 Assess skin turgor over abdomen to detect hydration
status
 Assess Harlequin’s sign- (deep pink/red colour develops over
one side of newborn’s body while other side remains pale/normal)
 Harlequin’s sign present due to shunting of blood with
cardiac problems
 Assess birth marks (if any)

24.  Keep newborn warm
 Measure apical pulse for full 1 min
 Listen murmurs; Oxygen saturation via pulse
oximetry
 Palpate pulses in both hands
 Assess cyanosis

25.  Observe resp. distress or hypoxemia
Nasal flaring; grunting; cyanosis;
bradycardia or apnea
 Suction airway (if nacessary) with bulb
syringe for upper airway and “French
catheter” for deep suctioning
 Administor oxygen if nacessary
 Count respiration for 30 sec to full min.

26.  Observe tone, behaviour, movements and
posture.
 Assess newborn reflexes only if there is cause
for concern-
 Rooting Reflex
 Gagging Reflex
 Sneezing and coughing Reflex
 Blinking Reflex
 Palmer grasp Reflex
 Planter grasps Reflex

27. VITAL SIGNSAND GENERALMEASUREMENTS
Temperature(Range 36.5 to 37*C, axillary)
Common variations:
 Crying may elevate temperature
 Stabilizes in 8 to 10 hours after delivery
Heart rate (120 to 160 beats per minute)
Common variations:
 Heart rate range to 100 when sleeping to 180
when crying
 Color pink with acrocyanosis
 Heart rate may be irregular with crying

28. Cont...
Respiration (30 to 60 breaths per minute)
Common variations:
 Bilateral bronchial breath sounds
 Moist breath sounds may be present shortly after birth

29. ANTHROPOMETRICMEASUREMENT
 Head Circumference - 33 to 35 cm
Expected findings
(Head should be 2 to 3 cm larger than the chest)
 Chest circumference – 30 to 33 cm
Common variations:
 Moulding* of head may result in a lower head
circumference measurement
 Head and chest circumference may be equal for
the first 24 to 48 hours of life
 Weight range - 2500 - 4000 gms
 Length range - 48 to 53 cm (19 - 21 inches)

30. REFLEXES
Rooting Reflex
Sucking Reflex
Swallowing Reflex
Gagging Reflex
Sneezing and coughing Reflex

31. Cont...
Extrusion Reflex
Blinking Reflex
Doll’s eye Reflex
Palmer grasp Reflex
Planter grasps Reflex

32. Cont...
Dancing Reflex
Tonic neck Reflex (fencing position)
Babinski Reflex
Moro Reflex (Startle Reflex)