Professional Documents
Culture Documents
Dr Fawzi Ghanouni
Consultant Paediatrician
Newborn examination
objectives
Indication
& importance
Precautions prior to exam !
Systematic approach
Neonatal reflexes
Normal variants
Remember
Newborn
examination
Earliest
possible detection of
deviations.
Establishes
a baseline for
subsequent examinations
Parents
Newborn examination
indications
Immediately
Before
after birth
unit
Whenever
Examination
precautions
Hand washing,hand
washing ,hand washing ..
Thermal environment
Light & noise
Brief examination time
Common parental
concerns on
Syndactyly
/ Polydactyly
Feeding issues
Mild talipes gue tie
Skin tags
Sinuses
Birthmarks
Pseudomenstruation,Moulding
,Caput
Contd parental
concerns
Cephalohaematoma
Birth
trauma
Intergenerational eczema,
dermatitis & asthma
Intergenerated conditions &
syndromes
Congenital abnormalities in
first-degree relatives
Newborn first
exam
Apgar score
Heart rate
Respiratory effort
Color
Tone
Reflex irritability
General
Vigorous cry is assuring
inspection
Weak cry
sepsis, asphyxia, metabolic,
narcotic use
Hoarseness
Hypocalcemia, airway injury
High pitch cry
CNS causes, kernicterus
General(Growth
parameters)
Weight
(Naked)
Length(straight)
Head
circumference(3
measurements)
Vital
Signs(TPR)
-Heart Rate ( 120-160 )
-Temperature ( 36.5-37.5 C )
-Blood Pressure
General
Well,
Distressed or not?
Obvious Dymorphism or
malformations
Tone & Movements:
Flexion of upper & lower
extremities
-Asymmetric movement
Brachial plexus & fractured clavicle
General contd
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
Erythema toxicum
Erythematous
Erythema toxicum
Erythema
toxicum
Impetigo Neonatorum
Vesicular,
pustular, or bullous
lesions developing as early as
2-3days up to 2 weeks of life
Occur in moist or opposing
surfaces of skin
Unroofed lesions do not form
crusts
Treat with antibiotics
Impetigo
Neonatorum
Mongolian Spots
90%
Mongolian Spots
Benign Pustular
Melanosis
Pustular
Melanosis
Head
Forceps
Subperiosteal
Weeks to resolve
Dose not cross sutures
Caput Succadaneum
Scalp
edema secondary to
compression via the birth
canal overlies both the
occipital bones & portions of
the parietal bones bilaterally
Resolves spontaneously
within a few days
Differentiate from the rare
subgaleal bleed
Scalp Hematomata
Cephalohemato
ma
Head
Head
circumference
Shape :Molding,
Brachycephaly: flat occiput
Widening of suture
Fontanelles
Head auscultation: bruits
Infant skull
Craniosynostosis
Definition:
premature closure of
one or more cranial suture.
Growth of the skull occurs
parallel to the suture(s) involved
Early correction optimizes
cosmetic appearance
Can be part of
syndromes:Crouzon's , Apert's
syndrome
Craniosynostosis
Types:
Sagittal synostosis
results in scaphocephaly
coronal synostosis
results in brachycephaly
coronal, sagittal, and
lambdoid synostosis
results in acrocephaly
single suture on one
side of head can result
in plagiocephaly
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Chest &
Abdomen
Chest
Distress
signs(Grunting,Tachypnea,Nasal
flaring,asymetric chest rise,suprasternal, intercostal, sub costal
retraction).
Deformities(Pectus
carinatum)
excavatum,
Auscultate
chest
Suprmammary nipple
Breast
hypertrophy
Milk production
No redness
Supernumerary
Nipples
Found in males & females
Pink
Supernumerary
Nipples
Heart
HR
100-160 beats/min
Color, perfusion,Central
cyanosis
Murmur
Single S1
Splited S2
No split ;single ventricle,
pulmonary hypertension
Palpable femoral
Pulses
One side is sufficient
85
Abdomen
Inspection
Scaphoid
Distention
Abdominal wall defect (gastroschisis)
Palpation; baby sucking and use warm hands
Kidneys are normaly palpable
Liver 2-3 cm
Spleen palpable
Umbilical vessels
2 artery, one vein
Genitalia
Penile size
Hypospadias,
Testes
epispadias
2% cryptorchid
Hydrocele
Female:
Prominent clitoris & minora
Vaginal skin tag
Vaginal discharge /blood
Labial fusion
Anus
Hydrocoeles
Inguinal Hernias
palmar crease
Hip dislocation
Female, breach
Subluxation of the
Hip
Subluxation of the
Hip
deformities
& spine
abnormal curvature
Sinus tract, tuft of hair
CNS
Awakenes & alertness
moving extremities
Flexed body posture
Minimal Head lag
Ventral suspension
Vertical suspension
Neonatal
reflexes
Known as developmental,
Suck
Onset:
~24-28weeks GA
Well-established: 32-34 weeks
GA
Disappears: around 12 months
Elicited by the examiner
stroking the lips of the infant;
the infants mouth opens &
the examiner introduces their
gloved finger sucking starts.
Rooting
Onset:
28 weeks GA
Well-established: 3234 weeks GA
Disappears: 3-4
months
Elicited by the
examiner stroking the
cheek or corner of the
infants mouth. The
infants head turns
toward the stimulus
and opens its mouth.
Palmar grasp
Onset:
28 weeks GA
Well-established: 32
weeks GA
Disappears:
Elicited
2 months
by placing the
finger on the palmar
surface of the infants
hand & the infants hand
grasps the finger.
Attempts to remove the
finger result in the infant
tightening the grasp.
Well-established:
4 weeks
PCA
Disappearance: 7 months
Elicited by rotating the
infants head from midline to
one side. The infant should
respond by extending the
arm on the side to which the
head is turned and flexing
the opposite arm. The lower
extremities respond similarly.
Moro
Onset:
28-32 weeks GA
Well-established: 37 weeks GA
Disappearance: 6 months
The
Moro
Moro significance
An
absent or inadequate
Moro response on one side :
hemiplegia, brachial plexus
palsy, or a fractured clavicle
Persistence beyond 5 months
of age indicates significant
neurological defects.
Stepping
Onset:
35-36 weeks GA
Well-established: 37 weeks
GA
Disappearance: 3-4 months
PCA
Elicited by touching the
top of the infants foot to
the edge of a table while
the infant is held upright.
The infant makes
movements that resemble
stepping.
Galant (Trunk
incurvation)
Onset: 28 weeks GA
Well-established:
40 weeks
GA
Disappearance: 3-4 months
The infant is held in ventral
suspension with the chest
in the palm of the
examiners hand. Firm
pressure is applied to the
infants side parallel to the
spine in the thoracic area.
The response consists of
flexion of the pelvis toward
the side of the stimulus.
Babinski
Onset:
34-36 weeks GA
Well-established: 38
weeks
Disappearance: 12
months PCA
Elicited by stimulus
applied to the outer
edge of the sole of the
foot. The infant
responds by plantar
flexion and either
flexion or extension of
the toes.
Postnatal
assessment of
gestational age
Ballard Score
Accuracy within 1-2 weeks
2 parts
Neurologic characteristic
Physical characteristic
Part
of general examination
Physical
Maturity
Skin:
Neuromuscular
Maturity
Posture
Square
window
Arm recoil
Popliteal angle
Scarf sign
Heel to ear
Remember
Wash
He is watching you
! doctor
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THANKS
BABIES
ARE
FRAGILE, SO HANDLE
WITH CARE
NEWBORN EXAMINATION
Dr
Fawzi
Ghanouni
Consultant
Paediatrician