Newborn Physical Examination

• Newborn physical examination by CSD Mentors: Alondra Cartagena Toledo & Kiara Melissa Gómez Vázquez.

Immediate Assessment

• Goal is to provide warmth if the newborn is at term gestation, has good tone, & is crying.
• A healthy-looking newborn should have pink skin, rest symmetrically with arms and legs in flexion, cry vigorously when stimulated, and move all extremities equally.
• Normal ranges for newborn vital signs:
  • Heart rate: 120 to 160 beats per minute
  • Respiratory rate: 40 to 60 breaths per minute
  • Systolic blood pressure: 60 to 90 mm Hg
  • Temperature: 97.7°F to 99.5°F (36.5°C to 37.5°C)
• Weight ranges:
  • Females: 2.8 to 4.0 kg (6 lb-8 lb), average 3.5 kg (7 lb)
  • Males: 2.9 to 4.2 kg (6 lb - 9 lb), average 3.6 kg (8 lb)
• Newborn length range is 19 to 21 in (48 to 53 cm), with an average of 20 in (51 cm).
• Concerning measurements would include anything >90th percentile or <10th percentile.
• The APGAR score is assessed at 1 and 5 minutes of life:

  • Appearance:

    • 2 points: Pink
    • 1 point: Extremities blue
    • 0 points: Pale or blue

  • Pulse:

    • 2 points: > 100 bpm
    • 1 point: < 100 bpm
    • 0 points: No pulse

  • Grimace:

    • 2 points: Cries and pulls away
    • 1 point: Grimaces or weak cry
    • 0 points: No response to stimulation

  • Activity:

    • 2 points: Active movement
    • 1 point: Arms, legs flexed
    • 0 points: No movement

  • Respiration:

    • 2 points: Strong cry
    • 1 point: Slow, irregular
    • 0 points: No breathing

  • APGAR scores of 0-3 indicate the need for immediate resuscitation.

  • APGAR scores of 4-7 indicate possible need for resuscitation and observation.

  • APGAR scores of 8-10 indicate good cardiopulmonary adaptation.

Skin Inspection

• Includes assessment for:
  • Acrocyanosis
  • Erythema toxicum
  • Hemangiomas
  • Mongolian Spots
  • Jaundice
  • Milla
  • Wine Port Stain
  • Salmon Patch
  • Pustular Melanosis
  • Café au lait spots
  • Cutis marmorata
  • Vernix caseosa: Should not be removed to regulate temperature

Head

• Head circumference range is 13 to 15 in (33 to 37 cm), with an average of 14 in (35 cm).
• Fontanelles and sutures examination
• Should be palpated with the newborn in the upright position.
• Cranial synostosis is premature fusion of sutures.
• Caput succedaneum is a circular boggy area of edema with indistinct borders.
• Cephalohematoma is a fluid-filled mass that does not cross suture lines

Eyes

• A complete assessment will confirm the presence of the eyeball and red reflex.
• Leukokoria is an abnormal white reflection from the retina, the causes of which include:
  • Cataract: Opacity or clouding of the lens, often due to a genetic or systemic disorder.
  • Chorioretinitis: Inflammation of the retina and choroid, potentially due to cytomegalovirus or toxoplasmosis.
  • Coats Disease: Congenital disorder caused by abnormal blood vessels behind the retina, which leads to progressive deterioration of vision.
  • Coloboma: Full-thickness defect of the eye.
  • Persistent fetal vasculature: Failure of the hyaloid vascular system and the embryonic vitreous to completely involute.
  • Retinoblastoma: Most common intraocular tumor in children.
  • Retinopathy of prematurity: Abnormal blood vessel development most often in premature infants
  • Vitreous Hemorrhage: Blood clot in the vitreous body, due to trauma or hemorrhagic disease.

Ears

• Check for patency of the ear canal and preauricular skin tags or sinuses.
• Low-set ears may indicate Down, Turner, or trisomy 18 syndrome.

Nose and Mouth

• Inspect for choanal atresia.
• One or both sides of the nasal airway are narrowed or blocked.
• If bilateral, the newborn may present with cyanosis relieved by crying.
• A low bridge nose could be related to Down Syndrome.
• Inspect for Ankyloglossia: short frenulum attaches the tongue to the floor of the mouth, and could interfere with breastfeeding.

Neck

• Assess full range of motion and signs of fracture.
• Congenital torticollis
• Palpate clavicle to assess for fracture
• Goiter
• Thyroglossal duct or cyst

Heart and Lungs

• Newborns with heart disease often exhibit tachypnea without retractions and cyanosis in severe cases.
• Benign murmurs can be common in the first hours of life.
• Respiratory distress signs include tachypnea, nasal flaring, grunting, retractions, and cyanosis.
• Respiratory Distress Syndrome arises from a lack of surfactant, leading to alveolar collapse.
• The Silverman Andersen Score is used to assess respiratory distress:
  • Upper chest movement is graded with synchronized, lag on inspiration, or see-saw.
  • Lower chest retractions are graded with none, just visible, or easily seen.
  • Xiphoid retractions are graded with none, just visible, or easily seen.
  • Nares dilation is graded with none, just visible, or easily seen.
  • Expiratory grunt is graded with none, heard with a stethoscope, or heard by ear.

Chest Inspection & Palpation

• Assessment includes pneumothorax, cystic malformation of the lung, diaphragmatic hernia, pectus excavatum or carinatum, prominent xiphoid, breast hypertrophy, supernumerary nipples, widely spaced nipples , and prominent precordium
• Chest should also be observed for symmetric movement, and abnormalities.
• Chest auscultation, verify RR.
• Pathological findings may include hyaline membrane.
• Physiological findings include transient taquipnea, S3, benign murmurs and vesicular murmur.

Abdomen Inspection & Palpation

• Use one hand to hold the legs (with the hips & knees flexed) and the other hand to palpate the abdomen.
• Inspect for Scaphoid Abdomen, Distended Abdomen, Diastasis recti abdominis and Linea nigra.
• Verify Umbilical cord contains 2 arteries and 1 vein, inspect signs of infection and bleeding.
• Auscultate for Bowel sounds.
• Palpate for Omphalocele, Gastroschisis and Masses.
• Palpate for Organomegaly & Kidney
• Apply gentle but firm palpation with both hands (bimanual).

GU Inspection & Palpation

• Males: Verify bilateral undescended testes, micropenis & bifid scrotum, Hypospadia, Epispadia, Hydrocele and Chordee
• Females: Inspect Prominent, Evaluate hymen & inguinal hernia, Check for Clitoromegaly
• Assess VACTERL, Imperforate anus and 1st meconium pass in 48 hrs.
• Normal placement & patency

Extremities

• Inspect hands and feet for Lenght symmetry, Muscle tone, Congenital amniotic bands, Syndactyly, polydactyly and Single palmar crease
• Palpate pulses intensity.
• Palsies: Brachial plexus injury, shoulder dystocia, Erb palsy & Klumpke palsy
• Hip Dysplasia

Neurologic

• Evaluate tone and confirm the presence of normal primitive reflexes including: Suck, Grasp, Root, Primitive stepping, Moro, Babisnki

Overview of newborn physical examination, including immediate assessment and APGAR scoring. Normal vital signs, weight ranges, and length are discussed. Measurements outside the 10th to 90th percentile are concerning.