Highlights of the Neonatal Assessment

Newborn Assessment Newborn historical data Gestational Age assessment Head to toe PE

“Ballard” Neonatal Gestational Maturity Assessment

Heel-to-ear maneuver. The position for assessing the heel-to-ear maneuver is demonstrated. The degree of extension seen is consistent with a 28- to 30-week infant.

General posture. The typical, marked flexor posture of the term infant.

Square window test. The position for assessing the square window is shown. The 45-degree angle seen between the palm and forearm is consistent with a gestational age of 30 to 32 weeks.

Scarf sign. The elbow cannot be drawn, with gentle traction on the upper extremity, across this term infant’s chest. This is in contrast to the marked flexibility of a preterm infant.

Female at 28 weeks’ gestation: prominent clitoris, small labia majora Female at 32 weeks’ gestation: increased fat deposit in labia majora Female at 36 weeks to term gestation: labia majora nearly covering labia minora

Male at 28 weeks’ gestation: tests high in scrotum Male at 32 weeks’ gestation: tests descending some scrotal rugae Male at 36 weeks to term gestation: testes well descended, increased scrotal pigmentation

28 weeks’ gestation: smooth sole 32 weeks’ gestation: creases in anterior one third 36 weeks to term gestation: creases over the majority of sole

28 weeks’ gestation: no breast tissue, areola barely visible 32 weeks’ gestation: visible areola, little breast tissue 36 weeks to term gestation: well-defined areola, breast nodules

28 weeks’ gestation: little cartilage, pliable 32 weeks’ gestation: increased cartilage, in-curvi outer pinna 36 weeks to term gestation: firm ear, well-formed margin

Lanugo. This fine body hair resembling “peach fuzz” is present on infants of 24 to 32 weeks’ gestation.

Premature skin. This premature infant demonstrates translucent paper-thin skin with a prominent venous pattern Postterm skin. Peeling and cracking of the skin are characteristics of the infant delivered after 42 week’s gestation

Babies come in different sizes!!! SGA LGA AGA

Neonatal Physical Exam

Mottling Skin abnormalities : color Acrocyanosis Bruising

Sebaceous Hyperlasia Erythema toxicum Neonatal pustular melanosis Skin abnormalities : Rashes

Neonatal pustular melanosis

Macular hemangioma (stork bites) Mongolian spot Skin abnormalities : Nevi

Caput succedaneum Molding Cephalohematoma Head : Shape

Head : Eyes :Red Reflex

Epstein’s pearls Natal teeth Cleft lip and palate Head: Mouth Cleft lip and palate Ebstein’s pearls

Genitalia (male) The penis: length > 2 cm, marked phymosis The meatus: hypospadias, epispadias Scrotum: –Palpate the testes, –Hydrocele (disappears in on year) –Blue color (testicular torsion )

Hypospadias Hydrocele Ambiguous genitalia

Polydactyly Syndactyly Tied accessory digits Extremities

Club foot Metatarsus varus Simian Crease Extremities

Hair in the sacral area Dimple Trunk and spine

Hips

Rooting Moro reflex ATNR Grasp reflex Nervous system :Tone and Neonatal reflexes Plantar Grasp Reflex