PHYSICAL EXAMINATION

OF THE NEWBORN

ESGUERRA-CASTILLO-ROBLES

PHYSICAL EXAMINATIONShould include:

Evaluation of growthObservation of behavior

Average weight term NB = 3.4 kg (7.5 lbs) B > GAverage length (term) = 50 cm (20 in)Head circumference (term) = 35 cm (14 in)

Nelson Textbook of Pediatrics 20th edition page 63

Newborn PE (The 1st 24 HOL)I. VITAL SIGNS• Temperature• Respirations• Blood Pressure• Pulse Rate

Newborn PE (The 1st 24 HOL)II.Head Circumference, length, weight and gestational age

HC = measured at the maximum point of occipital protuberance & at a point 1 ince above the glabella anteriorlyCC = measured at the level of the substernal notch in midinspiration (33 cm [30-36 cm])Average length (term) = 50 cm (20 in)Average weight (term) = 3.4 kg (7.2 lbs)Assessment of gestational age

SGA - <10th percentile, BW of 2,500 or lessAGA - >2500 grams to <4000 gramsLGA - >90th percentile, BW of 4000 grams or more

Newborn PE (The 1st 24 HOL)III. General Appearance• Activity, skin color, and obvious congenital

abnormalitiesIV. Skin• Color, rashes, nevi

Newborn PE (The 1st 24 HOL)V. Head• Note the general shape of the head• Inspect for any cuts and bruises secondary to

forceps or fetal monitor leads• Check for microcephaly or macrocephaly• Anterior and posterior fontanelles, Molding, Caput

succedaneum, cephalhematoma, hemorrhage

Newborn PE (The 1st 24 HOL)VI. Neck

• Eliciting the rooting reflex causes the infant to turn the head & allows easier examination of the neck

• Palpate the SCM for a hematoma & the thyroid for enlargement & check for thyroglossal duct cysts

• Short neck – Turner’s Noonan’s, Klippel-Feil syndromes

• Webbed neck – Turner’s

• Bull-neck - Diphtheria

Newborn PE (The 1st 24 HOL)VII. Face• Look for obvious abnormalities• Note the general shape of the nose, mouth &

chin, hypertelorism (eyes widely separated) or low set ears

• Facial nerve injury

Newborn PE (The 1st 24 HOL)VIII. Ears• Look for unusual shape or an abnormal positionIX. Eyes• Check the RORX. Nose• Verify patency of the nostrils

Newborn PE (The 1st 24 HOL)XI. Mouth• Examine the hard & soft palates for evidence of a

cleft palateXII. Chest• Note whether the chest is symmetric, for

respiratory distress• Listen for the presence & equality of breath sounds

Newborn PE (The 1st 24 HOL)XIII. Heart• Observe for heart rate, rhythm, quality of heart sounds,

active precordium and presence of murmur• Position of the heart may be determined by auscultation• Palpate the pulses (femoral, pedal, radial & brachial)• Check for signs of CHF (hepatomegaly, gallop, tachypnea,

wheezes & rales, tachycardia & abnormal pulses)

Newborn PE (The 1st 24 HOL)XIV. Abdomen• Observe for omphalocele, scaphoid abdomen• Listen for bowel sounds• Check the abdomen for distention, tenderness,

masses or organomegalyXV. Umbilicus• AVA (2 arteries 1 vein)

Newborn PE (The 1st 24 HOL)VI. Genitalia• Any infant with ambiguous genitalia should not undergo gender

assignment until a formal endocrinology evaluation has been performed

• Male with any question of a penile abnormality should not be circumcised until he is evaluated by a urologist or a pediatric surgeon

• MALE – check for dorsal hood, hypo/epispadia & chordee, penile length, size of meatus, observe color of scrotum

• FEMALE – examine labia and clitoris, and any discharges

Newborn PE (The 1st 24 HOL)XVII. Lymph nodes• Palpable lymph nodes, usually in the inguinal & cervical

areasXVIII. Anus and Rectum• Check for patency of the anus to rule out imperforate anus• Check the position of the anus• Meconium should pass within 48h of birth for teen infants

Newborn PE (The 1st 24 HOL)XIX. Extremities• Examine the arms & legs, paying close attention to the

digits & palmar creasesXX. Trunk & Spine• Check for any gross defects of the spine• Any abnormal pigmentation of hairy patches over the

lower back should increase the suspicion that an underlying vertebral abnormality exists

Newborn PE (The 1st 24 HOL)XXI. Hips• Evaluate for congenital hip dislocation using Ortolani &

Barlow maneuversXXII. Nervous System• Observe the infant for any abnormal movement (e.g.

seizure activity) or excessive irritability• Muscle tone• Reflexes

Newborn PE (The 1st 24 HOL)• Cranial nerves• Note the presence of gross nystagmus, the

reaction of the pupils & the ability of the infant to follow moving objects with his or her eyes

• Movement• Check for spontaneous movement of the limbs,

trunk, face & neck

THANK YOU!!

ESGUERRA-CASTILLO-ROBLES