Newborn Physical

Examination
A small group discussion
Presented by: Maria Isabel de Leon
Newborn PE
Done to check for major abnormalities and for difficulties while
transitioning to extrauterine life
Should be done within 24 hours
Should be performed while the baby is quiet
When the baby cries, check for his color, respiratory effort and facial
symmetry
The order of the exam should be adjusted as need
Physical Examination
Vital Signs Heart
Anthropometric Abdomen, Umbilicus
measurement Genitalia
General Appearance Extremities
Skin Nervous system
HEENM
Trunk, spine, hips
Chest
Vital Signs
Temperature - 36.5 to 37.5 C
Respirations- 40-60 breaths per minute
Pulse Rate
100-180 bpm or 120-160 when awake
70-80 bpm when asleep
Anthropometric Measurements and GA
With the use of a tape measure:
Head circumference
Length and percentile
Weight and percentile
Gestational Age
New Ballard Scoring System
General Appearance
Breathing pattern
Skin color and characteristics
Posture including body symmetry and spontaneous position
Muscle tone (flexion and spontaneous movement)
Level of consciousness
 Skin
Color: Pink to Pinkish brown
Plethora= Erythema neonatorum
Jaundice= bilirubin >5mg/dl
Pallor= anemia
Cyanosis= acrocyanosis
Turgor: Dry, Peeling skin
Lanugo and Vernix
Birth marks, lesions or rashes
Mongolian spots
Milia
Macular hemangioma
Head
Check for shape and symmetry (molding)
Cranial swelling
Fontanel bulging
Palpate Fontanels and Suture line and cranial bones
Facial features= should be in proportion, symmetrical and fully
formed
 Eyes
Observe eyes size and shape
Irises even colored
Coloboma- key-shaped defect
Corneas, bright and shiny
Pupillary light reflex
Red reflex
Leukocoria may be seen in cataract, retinoblastoma or retinal
detachment
Strabismus and Nystagmus may be seen
Ears Nose
Size, shape, alignment Midline symmetrical
Auricles should be flexible Check the breathing
Nasal Flaring
Skin tags Choanal atresia

Mouth Neck
Lips = cleft lip/palate Check for lymph nodes
Epstein pearls Palpate for the trachea, thyroid
Ranula Cystic hygroma
Oral thrush Torticollis
Rooting Reflex, Sucking Reflex
Chest
Thorax should be rounded and has a prominent xyphoid process
There should be no labored breathing or retractions (mild)
Breast tissue= polythelia, witchs milk
No adventitious breath sounds
Heart
Heart sounds may be relatively loud due to the thin chest wall
Grade 1 or 2 systolic murmur may be heard in the first 2-3 days after
birth
Ventricular septal defect- most common
Check for signs of congestive heart failure (hepatomegaly,
tachypneas, wheezes, rales, tachycardia
Check the pulses
Abdomen, umbilicus
Assess bowel sounds
Should be round, symmetrical, protruding and moves with respiration
Check the umbilical cord stump
- should fall off after 10-14 days
- Urachus, omphalitis
Flex the knees and hips to relax the abdominal muscles
Palpate for the livers edge, the spleen and the kidneys
Check for bulges in thee groin area (hernia)
Genitalia
Male
Inspect penis-2-3 cm; meatus at the tip
Hypospadia, epispadia, phimosis
Scrotum has deep rugae
Should feel for testicles
Female
Labia majora is swollen and cover the labia minora and clitoris
Mucosal tag
discharge
Extremities
Check the range of motion and muscle tone
Check the nails and look for extra fingers (polydactyly) or webbing
(syndactyly)
Palmar grasp reflex
Check for head lag
Ortolanis maneuver for hip displacement
Check the alignment of feet (Matatarsus varus or valgus or Talipes
Equinovarus)
Babinski reflex
Nervous system
Reflexes
Dolls eye reflex
Stepping Reflex
Moro Reflex
Spine and Anus
length of spine is straight
No openings, masses or tufts of hair
Check for patency of anal opening

End
References
Neonatology
https://www.youtube.com/watch?v=hW3n9seV4SY&list=PLCC5664B
A7D769F0B&index=6