1. Physical Examination of the Newborn
PGI Michelle Matematico

2. The newborn should be examined 3 times
In the nursery/rooming-in
Immediately at birth
Upon discharge, in the presence of the mother

3. HOW??? Inspect Auscultate Palpate
NB: the newborn should be naked when doing the physical examination

4. THE GENERAL APPEARANCE
Posture
Skin color
Activity
Muscle tone
Congenital anomalies

5. VITAL SIGNS Temperature (36.5 C-37.5 C)
Respiratory rate (and type)(NV-40-60cpm)
Cardiac rate (120-60bpm)
Higher in preterm
May be <100bpm in post-term
Do these q30 x 2 hours or until stable

6. VITAL SIGNS
BP is not routine in the new born but used for infants requiring special care especially if evaluating coarcttion of the aorta or congenital heart diseases
BP higher in the UE than the LE may indicate coarctation of the aorta

7. Anthropometric measurement

8. ANTHROPOMETRICS
Head circumference– from the glabella –occipital area (lubchenco’s)
Weight and percentile- use the lubchenco’s chart
SGA (symmetric or asymmetric)-below the 10th percntile
AGA-10th-90th percentile
LGA- >90th percentile

9. ANTHROPOMETRICS Length and percentile(lubchengco’s chart)
Crown of the head to heel

10. ASSESMENT OF GESTATIONAL AGE
The new ballard score
Done after initial stabilization or by 12 hours after birth
Neuromuscular maturity and Physical maturity
Avoid eliciting primitive reflexes
Perform the maneuvers with the head in the midline and avoid grasping the palms and toes

11. NEUROMUSCULAR MATURITY

12. PHYSICAL MATURITY

13. SKIN Color Rashes Texture Turgor Edema Induration
Thickness of underlying fat

14. SKIN Vernix caseosa Mongolian spot Milia Neonatal pustular melanosis
Vernix-until 38th week aog-warmth
Plethora-deep red color. Polycythemia. Overoxygenated/overheated infant
Cyanosis-acrocyanosis-normal;central cyanosis lo O2 sat
Juaundice-yellowish-incirect hyperbil, greenish-direct hyperbil; bil.5mg/dl
Pallor-asphyxia, anemia, shock, PDA
Milia-whitish, pinhead-sized cyst usu. Nose, chin, forehead and cheeks
Neonatal pustular melanosis-benign, self limiting. 3 stages: pustules, ruptured vesicopustules w/scaling/typical halo appearance, hyperpigmented macules
Mongolian spot-bluish discoloration usu in the sacrum;most common birthmark
Neonatal pustular melanosis

15. SKIN Hemangioma Mottling Nevus flammeus Cutis mamorata
Mottling-cold stress, hypovolemia, sepsis. Cutis marmorata if persistent (trisomy 21,13,18)
Hemangioma-”stork botes-glabella, eyelids, occipital area
Nevus flammeus/portwine stain-doesn’t blanch w/ pressure and does not disappear with time
Nevus flammeus
Cutis mamorata

16. SKIN
Erythema toxicum
Miliaria crystalina

17. HEAD Macrocephaly->2SD from the mean
Microcphaly- < 3 SD below the mean
Anterior Fontanel-closes at 9-18 mos; diamond-shaped
Posterior fontanel-closed at birth or closes at 2-4 mos

18. HEAD
Caput succedanum -accumulation of blood/serum above the periosteum and crosses the suture lines & w/ skin discoloration. Resolves within days.
Cephalhematoma- traverses the periosteum, does not cross the suture lines, w/o skin discoloration. Resolves w/in 2 wks-3 months
Molding-temporary asymmetry of the skull w/c resolves w/in a week

19. Cephalhematoma vs Caput succedanum

20. Eyes ROR present-Normal White pupillary reflex-cataract
Subconjunctival hemorrhages-benign and usu. Resolves w/in 2 weeks

21. Ears
Low-set ears
Skin tags
Hairy ears-common in diabetic mothers

22. Nose and Mouth Nose Mouth Check for patency by inserting an NGT Clefts
Deciduous teeth
Epstein pearls (Normal)-hard and soft palate

24. CHEST Lungs Heart symmetry Retractions Fractures
Presence and equality of breath sounds
Heart rate
murmurs

25. Abdomen
omphalocoele
Gastroschisis

26. Abdomen N-globular, soft
Inactive bowel sounds on the first days of life
Palpate for distention, tenderness or masses starting from the umbilicus towards the diaphragm
Umbilicus-2A:1V;blleding, signs of infection, should be transluscent, if greenish-yellow: meconium staining

27. Hips
Positive:
click of reduction
and dislocation

28. Genitalia-Female
Size and location of labia, clitoris, meatus, vaginal opening, relation of posterior fourchette to the anus
All female newborns should have a redundant hymenal tissue w/c will disappear in a few weeks
discharges

29. Genitalia-Male Check for:
Testis: descended, retracted, ecopic, cryptorchid
Dorsal hood
Hypospadia
Epispadia
Chordee
Normal penile length: >2cm
Phimosis and hydrocoele are common in newborn. Hydrocoele will disappear by 1 y/o

30. Extremities Pulses Syndactyly Polydactyly Simian crease
Talipes equinovarus
Metatarsus varus

31. EXTREMITIES Polydactyly Syndactyly Simian crease Metatarsus varus
Talipes equinovarus

32. Trunk and spine
Tufts of hair
Dimpling

33. Anus and rectum Check for patency
Meconium should pass w/in 48 hours of birth

34. T H A N K Y O U.