Physical examination of the newborn
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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

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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


Physical examination of the newborn

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


Anthropometric measurement

Anthropometric measurement


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


Neuromuscular maturity

NEUROMUSCULAR MATURITY


Physical maturity

PHYSICAL MATURITY


Physical examination of the newborn

SKIN

  • Color

  • Rashes

  • Texture

  • Turgor

  • Edema

  • Induration

  • Thickness of underlying fat


Physical examination of the newborn

SKIN

Vernixcaseosa

Mongolian spot

Milia

Neonatal pustularmelanosis


Physical examination of the newborn

SKIN

Hemangioma

Mottling

Nevus flammeus

Cutis mamorata


Physical examination of the newborn

SKIN

Erythematoxicum

Miliariacrystalina


Physical examination of the newborn

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


Physical examination of the newborn

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


Physical examination of the newborn

Eyes

  • ROR present-Normal

  • White pupillary reflex-cataract

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


Physical examination of the newborn

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


Physical examination of the newborn

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


Physical examination of the newborn

T H A N K Y O U.


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