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Physical Examination of the Newborn. PGI Michelle Matematico. The newborn should be examined 3 times. In the nursery/rooming-in. Immediately at birth. Upon discharge, in the presence of the mother. HOW???. Inspect Auscultate Palpate

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Physical examination of the newborn

Physical Examination of the Newborn

PGI Michelle Matematico


The newborn should be examined 3 times
The newborn should be examined 3 times

In the nursery/rooming-in

Immediately at birth

Upon discharge, in the presence of the mother


HOW???

  • Inspect

  • Auscultate

  • Palpate

  • NB: the newborn should be naked when doing the physical examination


The general appearance
THE GENERAL APPEARANCE

  • Posture

  • Skin color

  • Activity

  • Muscle tone

  • Congenital anomalies


Vital signs
VITAL SIGNS

  • Temperature (36.5 C-37.5 C)

  • Respiratory rate (and type)(NV-40-60cpm)

  • Cardiac rate (120-60bpm)

    • Higher in preterm

    • May be <100bpm in post-term

  • Do these q30 x 2 hours or until stable


Vital signs1
VITAL SIGNS

  • BP is not routine in the new born but used for infants requiring special care especially if evaluating coarcttion of the aorta or congenital heart diseases

  • BP higher in the UE than the LE may indicate coarctation of the aorta



Anthropometrics
ANTHROPOMETRICS

  • Head circumference– from the glabella –occipital area (lubchenco’s)

  • Weight and percentile- use the lubchenco’s chart

    • SGA (symmetric or asymmetric)-below the 10thpercntile

    • AGA-10th-90th percentile

    • LGA- >90th percentile


Anthropometrics1
ANTHROPOMETRICS

  • Length and percentile(lubchengco’s chart)

    • Crown of the head to heel


Assesment of gestational age
ASSESMENT OF GESTATIONAL AGE

  • The new ballard score

  • Done after initial stabilization or by 12 hours after birth

  • Neuromuscular maturity and Physical maturity

  • Avoid eliciting primitive reflexes

  • Perform the maneuvers with the head in the midline and avoid grasping the palms and toes




SKIN

  • Color

  • Rashes

  • Texture

  • Turgor

  • Edema

  • Induration

  • Thickness of underlying fat


SKIN

Vernixcaseosa

Mongolian spot

Milia

Neonatal pustularmelanosis


SKIN

Hemangioma

Mottling

Nevus flammeus

Cutis mamorata


SKIN

Erythematoxicum

Miliariacrystalina


HEAD

  • Macrocephaly->2SD from the mean

  • Microcphaly- < 3 SD below the mean

  • Anterior Fontanel-closes at 9-18 mos; diamond-shaped

  • Posterior fontanel-closed at birth or closes at 2-4 mos


HEAD

  • Caput succedanum -accumulation of blood/serum above the periosteum and crosses the suture lines & w/ skin discoloration. Resolves within days.

  • Cephalhematoma- traverses the periosteum, does not cross the suture lines, w/o skin discoloration. Resolves w/in 2 wks-3 months

  • Molding-temporary asymmetry of the skull w/c resolves w/in a week


Cephalhematoma vs caput succedanum
Cephalhematomavs Caput succedanum

Cephalhematoma

Caput succedanum


Eyes

  • ROR present-Normal

  • White pupillary reflex-cataract

  • Subconjunctival hemorrhages-benign and usu. Resolves w/in 2 weeks


Ears

  • Low-set ears

  • Skin tags

  • Hairy ears-common in diabetic mothers


Nose and m outh
Nose and Mouth

Nose

Mouth

Clefts

Deciduous teeth

Epstein pearls (Normal)-hard and soft palate

  • Check for patency by inserting an NGT


Chest
CHEST

Lungs

Heart

Heart rate

murmurs

  • symmetry

  • Retractions

  • Fractures

  • Presence and equality of breath sounds


A bdomen
Abdomen

omphalocoele

Gastroschisis


A bdomen1
Abdomen

  • N-globular, soft

  • Inactive bowel sounds on the first days of life

  • Palpate for distention, tenderness or masses starting from the umbilicus towards the diaphragm

  • Umbilicus-2A:1V;blleding, signs of infection, should be transluscent, if greenish-yellow: meconium staining


Hips

Positive:

click of reduction

and dislocation


Genitalia female
Genitalia-Female

  • Size and location of labia, clitoris, meatus, vaginal opening, relation of posterior fourchette to the anus

  • All female newborns should have a redundant hymenal tissue w/c will disappear in a few weeks

  • discharges


Genitalia male
Genitalia-Male

  • Check for:

  • Testis: descended, retracted, ecopic, cryptorchid

  • Dorsal hood

  • Hypospadia

  • Epispadia

  • Chordee

  • Normal penile length: >2cm

  • Phimosis and hydrocoele are common in newborn. Hydrocoele will disappear by 1 y/o


Extremities
Extremities

  • Pulses

  • Syndactyly

  • Polydactyly

  • Simian crease

  • Talipesequinovarus

  • Metatarsus varus


Extremities1
EXTREMITIES

Polydactyly

Syndactyly

Simian crease

Metatarsus varus

Talipesequinovarus


Trunk and spine
Trunk and spine

  • Tufts of hair

  • Dimpling


Anus and rectum
Anus and rectum

  • Check for patency

  • Meconium should pass w/in 48 hours of birth


T H A N K Y O U.


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