gds k-6 - newborn physical examination

7/24/2019 GDS K-6 - Newborn Physical Examination

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Division of PerinatologyDepartment of Child Health Medical

School


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Newborn: complete physical exam within 24

hours of birth

Listen to heart and lung first when the infantis quiet

Warming the statescope before using


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VITAL SIGN

Temperature

Respirations: normal rate is 4!"

breaths#min

$lood %ressure

%ulse rate: normal rate is &!&' beats#min


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HEAD CIRCUMFERENCE, LENGTH,

WEIGHT, AND GESTATIONAL AGE

(ead circumference and percentile: placethe measuring tape around the front of the

head )abo*e the brow+ and the occipital area,the tape should be abo*e the ears, normally-2!-. cm at term/

Length and percentileWeight and percentile

0ssessment of gestational age


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GENERAL APPEARANCE

0cti*ity

1in color

3b*ious congenital abnormality


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SKIN

&/ 3L3R

%lethora )deep, rosy red color+

! common in polycytemia

! can be seen in o*eroxygenation and

o*erheated infant

! 5rythema neonatorum: normal

phenomenon in transition period and can

occur when the infant has been stimulated


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6aundice

%allor )washed!out, whitish appearance+

yanosis! entral cyanosis: bluish sin

including the tongue and lips

! %eripheral cyanosis: bluish sin with pin lips and tongue

! 0crocyanosis: bluish hands and feet only

SKIN


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Polycytemia and Pallor


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Cyanosis


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SKIN

5xtensi*e bruising )ecchymoses+: prolonged anddifficult deli*ery

7$lue on pin8 or 7pin on blue8: poor perfusion,

inadequate oxygenation, inadequate *entilation, orpolycytemia/

(arlequin coloration )clear line of demarcationbetween an area of redness and an area of normalcoloration+

9ottling )lacy red pattern+: maybe seen in healthyinfants and in those with cold stress, hypo*olemia,or sepsis/ Persistent mottling (cutis marmorata)foundin infants with own syndrome, trisomy &- or

trisomy &'/


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Persistent mottling (cutismarmorata)


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;ernix caseosa: substance that co*ers thesin until -'thwee of gestation

ollodion infant: sin resembles parchment,restriction in growth of the nose and ears/

ry sin: postdate or postmature infant,

congenital syphillis, and candidiasis

SIN


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2/ R01(51

9ilia: withish, pinhead!si


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0cne neonatorum: comedones and papules

o*er the chees, chin, and forehead/

(erpes simplex: pustular *esicular rash,

*esicles, bullae, or denuded sin/

SIN


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SIN

-/ Ne*i

9acular hemangioma )7stor bites8+:

dissappear spontaneously within &styear oflife/

%ort!wine stain )ne*us flammeus+: does notblanch with pressure and not disappear with

time/9ongolian spot: dar blue or purple bruise!lie maular spots, most common birthmar


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SIN

a*ernous hemangioma: large, red, cyst!

lie, firm, ill!defined mass/ =f associated withthrombocytopenia (Kasabach-Merritsyndrome)

1trawberry hemangioma )macularhemangioma+: flat, bright red, sharplydemarcated lesions/


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HEAD

0nterior and posterior fontanelles

! anterior fontanelle usually closes at >!&2 mo

and the posterior at 2!4 mo9olding: temporary asymmetry of the sullresulting from the birth process/

aput succedaneumephalhematoma

1ubgaleal hematoma


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=ncreased intracranial pressure:

! bulging anterior fontanelle

! separated sutures

! paralysis of upward ga


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!"#$%&$ '( ('&)*&+##+


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raniosynostosis: premature closure of one

or more sutures

raniotabes: softening of the sull

%lagiocephaly: oblique shape of a head,

asymmetric and flattened/

HEAD


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NEC

5liciting the rooting reflex

%alpate the sternocleidomastoid

1hort nec: Turners, Noonans, and Klippel-Feil

syndromes


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FACE

Note the general shape of the nose, mouth,and chin

Note the presence of hypertelorism )eyeswidely separated+

Note the presence of low!set ears

?acial ner*e in@ury: unilateral branches ofthe facial ner*e


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EARS

Loo for unusual shape or position

Low!set ears: congenital anomalies

%reauricular sin tags )papillomas+: benign

(airy ears: infants of a diabetic mothers

Aross hearing: when infant blins in

response to loud noises


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EES

hec the red reflex with anophthalmoscope

3pacification of the lens: cataract

1clera bluish tint: premature1clera deep blue: osteogenesis imperfecta

$rushfield8s spots )salt!and!pepper specling

of the iris+: own syndrome1ubcon@uncti*al hemorrhage: BC newborninfant/

on@uncti*itis


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NOSE

Nasal flaring: respiratory distress

1niffing and discharge: congenital syphilis

1nee


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MOUTH

Ranula: cystic swelling in the floor of themouth/

5pstein8s pearls: eratin!containing cysts9ucocele: small lesion on the oral mucosa

Natal teeth:

! Predeciduous teeth: supernumerary teeth! True deciduous teeth: true teeth that erupt

early/


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9acroglossia: enlargement of the tongue,

can be seen in Bec!iths syndrand Pompes

disease?rothy or copious sali*a: esophageal atresia

with tracheoesophageal fistula/

Thrush: sign of infection / albicans/

MOUTH


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Drooling

of saliva


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CHEST

3bser*ation

$reath sound

%ectus exca*atum$reast in a newborn:

! usually &cm in diameter in term

! abnormally -!4 cm: effects of maternal estrogens

! witch8s mil: white discharge


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HEART

9urmur: ;1, %0, oarctatio aorta, %1, %0,

T0, TA0, etc

%alpate the pulses )femoral, pedal, radial,and brachial+

hec for signs of (?: gallop, tachypnea,

hepatomegaly, whee


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A!DOMEN

3bser*ation: omphalochele, gastroschisis,

scaphoid abdomen/

0uscultation

%alpation: chec for distention, tenderness,

or masses/


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Scaphoid abdomen Abdomen distention

GastroschisisOmphalocele


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UM!ILICUS

Two arteries and one *ein

Normal cord: translucent

Areenish!yellow color: meconium staining


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GENITALIA

9ale

! chec dorsal hood, hypospadias,

epispadias, and chordee/! normal penile leghth at birth is D 2 cm

! etermine site of meatus, *erife the

testicles and the color of scrotum?emale

! examine the labia and clitoris


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LMPH NODES

%alpable lymph nodes usually in the inguinal

and cer*ical --C of normal neonates/


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ANUS AND RECTUM

hec for patency of the anus

hec the position of the anus

9econium should pass within 4' h


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Imperforate analmembrane

Atresia ani


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E-TREMITIES

1yndactyly : abnormal fusion of the digits

%olydactyly: supernumerary digits

1imian crease: a single trans*erse palmarcrease )own syndrome+

Talipes equino*arus )clubfoot+: foot is turn

downward and inward and the sole isdirected medially

9etatarsus *arus: adduction of the forefoot


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TRUN AND SPINE

hec for

! any gross defect of the spine

! abnormal pigmentation

! hairy patches o*er the lower bac

! sacral or pilonidal dimple: small

meningocele


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Fetal Phenytoin syndrome

Hirsutism


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HIPS

ongenital hip dislocation

3rtolani and $arlow maneu*ers:

! place in the frog position

! abduct the hips by using middle finger to apply gentle inward and upward pressure o*er the

greater trochanter )"rtolanis sign+

! adduct the hips by using the thumb to apply

outward and bacward pressure o*er the inner thigh (Barlo!s sign)

! a clic of reduction and a clic of dislocation: hip

dislocation/


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NERVOUS SSTEM

3bser*e for abnormal mo*ement or excessi*eirritability

9uscle tone: hypotonia, hypertoniaReflexes: rooting, glabellar, grasp, nec!righting, and moro

ranial ner*es

9o*ement%eri*eral ner*es: #rb-$uchenne paralysis,Klumpes paralysis


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Aeneral sign of neurologic disorder:

! 1ymptom of increased =%

! (ypotonia or hypertonia

! =rritability or hyperexcitability! %oor sucing and swallowing reflexes

! 1hallow, irregular respirations

! 0pnea

! 0pathy! 1taring

! 1ei


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gds k-6 - newborn physical examination

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