Physical Examination of The Newborn

• General examination
• Gestational age assessment/anthropometry
• Specific systemic examination

• Guiding principles
• Above all, do no harm
• Patience, gentleness, flexibility

State: deep sleep, light sleep, awake with light movements, large movements, crying

Colour: perfusion, cyanosis, jaundice, pallor, plethora, hyper-pigmentation

Posture: reflects intrauterine position and body tone, influenced by GA

Spontaneous activity: stretching, eye opening, yawning, opening of hands & limb movements

Respiratory effort: an indicator of how distressed or comfortable a newborn is even when the cause is not pulmonary

Skin Lesions

• Milia; pinpoint white papules of keratin on nose, cheeks & forehead lasts few wks.
• Miliaria; obstructed sweat glands, pinpoint vesicles on forehead lasts 1 wk
• Transient neonatal pustular melanosis; small vesicupustules contains WBCs, present at birth
• Erythema toxicum; most common rash, irregular patches contains eosinophils
• Café au lait spots

Vital Signs

• Temp
• Resp rate (40 – 60)
• Heart rate (110 – 160)
• BP (60 – 90)/(40 – 60)

Methods:

1. Blanching or flush
2. Doppler monitoring

General Examination

• Distal airway; intercostal & sternal retractions, flaring, tachypnoea, grunting
• Upper airway; supra- sternal & sub-costal retractions
• Cardiac; tachypnoea without effort
• Neurodepression; apnoea, irregular resp
• Metabolic/septic; tachypnoea, apnea, minimal retractions

Gestational Age Assessment

Anthropometry

Head & Neck

• Head: shape, check for over-riding sutures, number of fontanelles and size, encephalocoeles, measure OFC
• Eyes: size, hyper/hypo-telorism, sub-conjunctival hemorrhage, cataracts, discharge
• Ears: asymmetry, low-set, irregular shape auricular & pre-auricular pits, lipomas, skin tags
• Nose: check for flaring, patency of internal nares (choanal atresia)
• Palate: check for cleft
• Mouth: shape, size
• Tongue: macroglossia
• Teeth: natal teeth
• Chin: micrognathia
• Neck: palpate clavicles for possible fractures, web neck, torticollis, cystic hygromas, lymph nodes

Chest & Lungs

• Respiratory Rate (RR)
• Respiratory Pattern
• Chest Movements for symmetry
• Listen for stridor, grunting
• Auscultate for breath sounds

Cardiovascular System (CVS)

• Check the baby's Heart Rate (HR), Blood Pressure (BP) in both upper & lower extremities, and Respiratory Rate (RR).
• Observe the baby's color for signs of pallor, cyanosis (blue discoloration), or any abnormalities.
• Palpate (feel) for capillary refill time, which is the time it takes for skin color to return to normal after gentle pressure.
• Feel for pulses in different areas like the radial and femoral (groin) pulses, and check for any delay in pulse between these sites.
• Listen to the baby's heart sounds and any murmurs (abnormal heart sounds) using a stethoscope.

Abdomen

• Examine the shape and contour of the baby's abdomen for any visible abnormalities or malformations.
• Look for common malformations like omphalocoele (protrusion of abdominal organs through the navel), gastroschisis (intestines outside the abdomen), or absence of abdominal muscles.
• Check the umbilical cord for any abnormalities in the number of blood vessels (normal is 2 arteries & 1 vein).
• Gently palpate the liver and spleen to assess their size and position. A normal liver may be felt up to 2cm below the costal margin.
• Listen for bowel sounds by using a stethoscope to ensure normal gastrointestinal activity.
• Look for any signs of hernias or abnormalities in the abdominal wall.
• Check for anal patency, ensuring that the baby can pass stool.

Urinary and Genital System (UGS)

• Assess the size and shape of the baby's kidneys through palpation.
• For male babies, measure the stretched length of the penis (at least 3cm) and inspect the urethral opening and testes.
• For female babies, inspect the labia, clitoris, and urethral opening.

Neurologic

• Observe the baby's state, whether they are in deep sleep, light sleep, awake with light movements, larger movements, or crying.
• Assess the baby's posture, which can reflect their intrauterine position and body tone, influenced by their gestational age.
• Check for muscle tone and head lag, which is the delay in head control when gently pulling the baby from a lying to a sitting position.

Primitive Reflexes

• Moro Reflex: Test this reflex by gently supporting the baby's head and neck with one hand and then suddenly lowering them. A normal response involves initial extension and abduction of arms followed by upper limb flexion and adduction with hand closure.
• Grasp Reflex: Observe the baby's grasp reflex when you place a finger in their palm.
• Rooting/Sucking Reflex: Stimulate the baby's cheek to see if they turn their head and mouth towards the stimulus, indicating the rooting reflex.
• Extensor Plantar Reflex: Observe the baby's foot response when the sole of the foot is stroked, which causes extension of the toes.