Newborn examination

AIMS :
1)
Assess the baby's transition from intrauterine to extrauterine life.
2) Quickly identify danger.
3)
Earliest possible detection of deviations both from usual and normal
4) Establishes a baseline for subsequent examinations.
5) To give parents a true account of the baby's physical state.
Newborn examination objectives
Indication and importance
Precautions prior to exam !
Systematic approach
Neonatal reflexes
Normal variants
Newborn examination indication
Immediately after birth
Before discharge from maternity unit
Whenever there is any concern about the infant's progress
Newborn first exam
Apgar score

Heart rate

Respiratory effort

Color

Tone

Reflex irritability
Examination precaution
Hand washing,hand washing ,hand washing
Thermal environment
Light and noise
Brief examination time
General (growth) parameters
Weight (Naked)
Length(straight)
Head circumference(3 measurements)
Vital signs
Respiratory Rate
RR 40-60/min
Heart rate
120-140/min
Capillary filling time
2-3 sec
Tone
Colour
General
Well, Distress or not?
skin

Pink is normal

Acro cyanosis is normal

Cyanosis

Bruised part look blue

Jaundice

Common variants skin rash

Erythema toxicum, mongolian spot, Benign Pustular Melanosis

General (growth parameters)
Weight (Naked)
Length(straight)
Head circumference(3 measurements)

Order of examination
AF

Face color / peculiarities.

HR , RR . Lungs can be auscultated

Palpate the abdomen.

Eyes, ears, nose and mouth.

Neck, clavicles
Arms, hands, legs & feet.

Femoral pulses.

Umblical cord, genitalia and anus.

Prone position examination

Hips.
Erythema Toxicum
Erythematous macules and firm 1-3 mm yellow or white papules or pustules
Etiology obscure
Pustules contain eosinophils and are sterile
Appear in the first 3-4 days of life

Range: Birth to 14 days

Benign and self limited
DD: Impetigo Neonatorum
Vesicular, pustular, or bullous lesions developing as early as day of life 2-3 up to 2 weeks of life
Lesions occur in moist or opposing surfaces of skin
Unroofed lesions do not form crusts
Treat with antibiotics
Mongolian spots
90% of African infants, 81% of Asian, and 9.6% of Caucasian infants
Slate-gray to blue-black lesions
Usually over lumbosacral area and buttocks
Accumulation of melanocytes within the dermis
Generally fade by age 7 years
Skin- rashes
Milia
- inclusion cysts - keratinized stratum corneum
- resolve without treatment.
- inside the mouth (Epsteins pearls
Transient neonatal pustular melanosis :
- lesions are present from birth.
contain neutrophils
very fragile - easily wiped - leave a scaly area.
Resolves into hyperpigmented brown maculesMiliaria rubra( prickly heat)- hot humid climates. -head and upper trunk

General
Obvious Dysmorphism or malformations E:g(Down syndrome, ear tag, neural tube defect )
Tone & Movements:
Flexion of upper and lower extremities
-Asymmetric movement

Brachial plexus and fractured clavicle

-Ventral, vertical suspension and head control for tone assessment
General inspection
Vigorous cry is assuring
Weak cry

sepsis, asphyxia, metabolic, narcotic use

Hoarseness

Hypocalcemia, airway injury

High pitch cry

CNS causes, kernicterus

Head and face

Shape of the head
Fontanels?
Sutures?
Eyes?
Nose?
Mouth,lips,palate?
Ears?
Neck?

Head

Forceps and vacuum marks

Caput succedaneum

Boggy edema in presenting part of head

Cross suture lines

Disappear in few days

Cephalhematoma

Subperiosteal

Weeks to resolve

Dose not cross sutures

APGAR SCORING
APGAR scale (evaluate @ 1 and 5 min postpartum)

Sign

Activity (Muscle tone)

Active

Arms and legsflexed

Absent

Pulse(HR)

>100/min

<100/min

Absent

Grimace (reflex
irritability)

Sneezes, cough, pulls

away

Grimaces

No response

Appearance (Skin color)

Pink all over the body

Normal all over except

extremities

Cyanotic
or pale all
over

Respiration

Good, crying

Slow, irregular

Absent