Palpable Lymph Nodes in Healthy Newborns

and Infants

Mahrukh Bamji, MD, R. K. Stone, MD, A. Kaul, MD, G. Usmani, MD,

F. F. Schachter, PhD, and E. Wasserman, MD

From the Department of Pediatrics, New York Medical College, New York

ABSTRACT. We examined 548 healthy neonates and PATIENTS AND METHODS

infants to document the frequency, size, and location of
palpable lymph nodes. The subjects consisted of 214 A total of 548 children (214 neonates and 334
neonates from birth to 4 weeks of age and 334 infants infants) were selected from the normal newborn
from 4 weeks to 1 year of age. All of the infants were nursery and the well-child clinic of a large munici-
asymptomatic and had been free of major or minor sys-
temic or cutaneous infections in the past. Of the 214
pal hospital. Based upon age at the time of evalua-
neonates, 73 (34%) had palpable nodes at one or more tion, the infants were divided into five groups:
sites. Of the 334 infants, 190 (57%) had palpable lymph Group I, birth to 72 hours; group II, four to seven
nodes. Inguinal, cervical, and axillary lymph nodes can days; group III, 1 to 4 weeks; group IV, 1 to 6
be palpable in neonates and infants. Supraclavicular months; group V, 7 to 12 months of age. Infants in
nodes are not generally palpable. The commonest site of
groups I and II were examined in the newborn
palpable nodes is the inguinal area in neonates and the
cervical area in older infants. It would appear that the nursery, and those in groups III, IV, and V were
palpable nodes noted in the neonatal period do not dis- seen in the well-child clinic. The groups varied in
appear but persist. This knowledge is useful in deter- size from 58 to 172 children.
mining when adenopathy may be abnormal. Pediatrics Groups I, II, and III included consecutively born
1986;78:573-575; neonate, infant, lymph node.
full-term infants with a normal antenatal and per-
inatal history and a normal postnatal course. Only
those infants with a healthy and clinically unin-
fected cord base and uninfected prepuce following
The finding of palpable lymph nodes in normal circumcision were included. All of the neonates had
young children is a common event.”2 Several stud- normal findings on physical examination and a
ies have dealt with the etiology and management of normal hemogram and a negative cord VDRL re-
abnormally enlarged nodes in children.36 Standard sult. Infants in groups IV and V included those seen
texts have either vague criteria or none at all for consecutively during a 6-month period in the pri-
normal nodes in neonates and infants. A review of mary care clinic for health maintenance visits. They
the pediatric literature revealed only one recent were completely asymptomatic and had been free
study in normal infants and children.7 However, of major or minor systemic or cutaneous infections.
this report studied the prevalence of occipital, Each baby was examined independently by two
postauricular, and submandibular adenopathy only investigators (M. B. and G. U.). A note was made
and did not include neonates younger than 3 weeks of the type of delivery. All were examined for the
of age. Our study was undertaken to determine the presence of cervical, inguinal, axillary, and supra-
prevalence and characteristics of palpable lymph clavicular lymph nodes 3 mm or greater in diameter.
nodes at various sites in healthy neonates and All lymph nodes in the neck were grouped together
infants up to 1 year of age. as cervical nodes. After identifying the palpable
nodes, the nodes were encircled with a ball-point
pen and measured in vertical and horizontal diam-
Received for publication Dec 6, 1985; accepted Jan 15, 1986. eters by tape measure. After each reading by the
Reprint requests to (MB.) Department of Pediatrics, New York
first observer, the pen markings were removed with
Medical College-Metropolitan Hospital Center, 1901 First Aye,
New York, NY 10029.
alcohol, and infants were independently examined
PEDIATRICS (ISSN 0031 4005). Copyright © 1986 by the by the second observer. There was 94.6% agreement
American Academy of Pediatrics. regarding the presence of nodes between the two

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PEDIATRICS Vol. 78 No. 4 October 1986 573
observers and minimal interobserver variability in In neonates younger than 4 weeks of age (groups
the measurements of the palpable nodes (±2 mm). I, II, and III), the inguinal area was the commonest
For each baby, the two observers’ measurements site of palpable nodes, followed by cervical and then
were averaged. axillary. However, in infants older than 4 weeks of
age (groups IV and V), cervical nodes were present
RESULTS more frequently, followed by inguinal and then
axillary. No palpable supraclavicular nodes were
Palpable nodes were found in 73 (34%) neonates
detected.
and 190 (57%) infants; 46 (37%) of 123 male neo-
nates and 27 (30%) of 91 female neonates had
DISCUSSION
palpable nodes. Thirty-two of the boys were circum-
cised. The prevalence of palpable nodes in circum- Until recently, the only survey of lymph node
cised v noncircumcised neonates is given in Table prevalence in normal children reported in the lit-
1. The uncircumcised neonates were more likely to erature was done in 1,886 in children younger than
have palpable nodes at one or more sites, although 12 years of age grouped together.8 The presence of
the difference was not statistically significant. palpable lymph nodes in normal neonates younger
Twenty-four newborns were delivered by Cesarean than 3 weeks of age has not been previously docu-
section and 190 by vaginal delivery. Five (21%) of mented. Barness9 noted that nodes less than 3 mm
the former and 66 (35%) of the latter had palpable are normal and that cervical and inguinal nodes up
nodes. There were no significant differences in to 1 cm in diameter are normal in children up to 12
prevalence of palpable nodes based on type of deliv- years of age. Zeulzer and Kaplan’#{176} noted that, al-
ery or the sex of the neonates. though lymph nodes are not usually palpable in
The nodes were firm, discrete, nontender, and neonates, the amount of lymphoid tissue is consid-
freely mobile with normal overlying skin. The size erable at birth, steadily increases to puberty, and
of the palpable nodes ranged from 3 mm to 12 mm then undergoes a relative reduction. In the present
(horizontal) x 3 mm to 12 mm (vertical) in groups study, 34% of neonates and 58% of infants up to 1
I, II, and III, whereas the size ranged from 3 mm to year of age were found to have palpable nodes at
16 mm (horizontal) x 3 mm to 16 mm (vertical) in single or multiple sites. The presence of nodes was
groups IV and V. The number of nodes at any one not related to the type of delivery. The number of
site ranged from one to three, and when present at nodes at one site varied from one node to three
any one site, the nodes were more likely to be single nodes, but the nodes were more likely to be single
rather than multiple. Nodes were more likely to be as opposed to multiple. The inguinal area was the
present at multiple sites than at single sites. The commonest site at which the nodes were palpable
youngest age at which nodes were palpable was two in the newborns, whereas the cervical area was the
hours after birth. The relationship between age and commonest site in infants. The nodes did not ex-
the presence of palpable nodes at different sites is ceed 12 mm in diameter in newborns and 16 mm in
shown in Tables 2 and 3. There was an increasing diameter in infants. These node sizes are probably
prevalence of palpable nodes with increasing age.

TABLE 3. Prevalence of Palpa ble Lymph N odes From

TABLE 1.
Prevalence of Palpable Lymph Nodes in Cir- 4 Weeks to 12 Months of Age
cumcised and Uncircumcised Male Neonates (0 to 4 1-6 Mo 6-12 Mo Total
Weeks of Age)
No. of infants 176 158 334
Circumcised Uncircumcised Total
No. of infants with 74 (42%) 116 (73%) 190 (57%)
No. of neonates 98 25 123 palpable nodes
No. ofpalpable 32 (33%)* 14 (56%)* 46 (37%) Inguinal 40 (22.7%) 58 (36.7%) 98 (29%)
nodes Cervical 48 (27.2%) 88 (55%) 136 (41%)
* No significant difference noted. Axillary 12 (6.8%) 22 (14%) 34 (10%)

TABLE 2. Prevalence of P alpable Lymp h Nodes at Van ous Sites from Birth to 4 Weeks
of Age
0-72 H 72 H-i Wk 1-4 Wk Total
No. of neonates 58 74 82 214
No. of neonates with pal- 14 (24%) 26 (35%) 33 (40%) 73 (34%)
pable nodes
Inguinal 11 (18%) 20 (26%) 21 (25%) 52 (24%)
Cervical 7 (12%) 14 (19%) 18 (22%) 39 (17%)
Axillary 1 (1%) 5 (6%) 8 (10%) 14 (6.5%)

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574 PALPABLE LYMPH NODES
normal for newborns and infants and agree with healthy neonates and about one half of healthy
other reports!’7 infants. The presence of small palpable lymph
The prevalence of palpable lymph nodes in our nodes during the neonatal period does not seem to
study was similar to that reported by Herzog,7 a!- be an abnormal physical finding and, hence, does
though Herzog’s study did not include infants not warrant clinical investigations to determine its
younger than 3 weeks of age and only the head and etiology. The prevalence of palpable nodes in-
neck region were examined. The size, consistency, creases with age. It is possible that the palpable
and mobility of palpable nodes were also compara- nodes noted during the neonatal period do not
ble in both reports. Herzog reported the youngest disappear but persist at least during the first year
age at which lymph nodes were palpable as 6 weeks. of life as normal lymphoid tissue.
The number of infants between 3 and 6 weeks of
age in the study is not mentioned. Moreover, the
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ARTICLES 575
 Palpable Lymph Nodes in Healthy Newborns and Infants
Mahrukh Bamji, R. K. Stone, A. Kaul, G. Usmani, F. F. Schachter and E. Wasserman
Pediatrics 1986;78;573

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 Palpable Lymph Nodes in Healthy Newborns and Infants
Mahrukh Bamji, R. K. Stone, A. Kaul, G. Usmani, F. F. Schachter and E. Wasserman
Pediatrics 1986;78;573

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