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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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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

slide3
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
slide13
SKIN
  • Color
  • Rashes
  • Texture
  • Turgor
  • Edema
  • Induration
  • Thickness of underlying fat
slide14
SKIN

Vernixcaseosa

Mongolian spot

Milia

Neonatal pustularmelanosis

slide15
SKIN

Hemangioma

Mottling

Nevus flammeus

Cutis mamorata

slide16
SKIN

Erythematoxicum

Miliariacrystalina

slide17
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
slide18
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

slide20
Eyes
  • ROR present-Normal
  • White pupillary reflex-cataract
  • Subconjunctival hemorrhages-benign and usu. Resolves w/in 2 weeks
slide21
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
slide27
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
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