Definition of "Newborn examination"

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Newborn examination is an exam done of newborn babies in accordance with a checklist.

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Patient information

What is a newborn exam? I'm guessing it's an exam you do on all newborns?
Exactly! So it's like a bit of a screening test, and it's a combo test, that involves a little bit of everything. So there's a bit of heart and lung exam, a bit of tummy exam, a bit of musculoskeletal, and neurology too... which is basically all the physical exams we do on patients . But we do a bit of everything, rather than everything in detail.

Classification
  • Vitals:
    • BP
    • HR
    • RR
    • O2 sats
    • Temperature
  • Growth:
    • Weight
    • Length
    • Head circumference
  • General appearance:
    • ABC's
    • Distressed?
    • Well vs unwell looking
    • LOC
    • Activity
    • Quality of cry
    • Malformations/abnormalities/dysmorphisms
    • Posture/tone
    • Size/maturity
    • Color (pallor, plethora, jaundice, cyanosis/acrocyanosis)
  • Skin:
    • Color
    • Vernix
    • Milia
    • Mongolian spots
    • Hemangiomas
    • Salmon patch, are small flat patches of pink or red skin with poorly defined borders. They become more intense in color and noticeable when the child is crying. Most lesions will spontaneously dissapear within the 1st year of life. Stork bites are those found at the nape of the neck, and angel's kiss are those found on the forehead between the eyebrows or on the yeelids. Stork bites tend to be more persistent and may remain unchanged into adult life in 50% of cases. Salmon patches are very common and occur in 40% of all newborns
    • Cafe au lait spot/macule (French for "coffee with milk", aka giraffe spots), caused by a collection of pigmented-producing melanocytes in the epidermis of the skin. These spots are typically permanent, and may grow, or increase in number over time. It is often harmless, but may be associated with syndromes such as neurofibromatosis type 1
    • Petechiae or bruising

Patient information

So how do you examine a newborn bub?
So we always start by placing our hands behind our backs, and looking. Start with vitals. We can look at growth, like weight, length, head circumference. Check out general appearance, so whether they're distressed, looking well, conscious, active, crying, any malformations, tone, size, color. If you think about it, a lot of this is actually the APGAR test. We can look at skin, so color, whether there are any patches or spots, bruising.

Wait, what's the APGAR test again?
Appearance, pulse, grimace, activity, and respiration. Great way to memorize it too .

Head:

  • Head:
    • Head molding, which is an abnormal head shape that results from pressure on the baby's head during childbirth
    • Suture lines, where bony plates of the skull join together can be easily felt in the newborn infant
    • Fontanelles (anterior, posterior, aka soft spot), which is the anatomical feature comprising of the soft sutures between the cranial bones. Fontanelles allow for rapid stretching and deformation of the neurocranium as the brain expands faster than the surrounding bone. 
    • Bruising (caput seccedaneum, cephalohematomas, subgleal hematom)
  • Eyes:
    • Symmetry
    • Set/shape
    • Discharge
    • Erythema
    • Red [light] reflex, which is a reddish-orange reflection of light from the eye's retina observed when using an fundoscope from approximately 30cm. It is usually performed in a dimly lit or dark room. Leukocoria (aka white pupillary reflex) is abnormal white reflection from the retina, and can indicate cataract or retinoblastoma. Absence of a red reflex can indicate retinal detachment
  • Dysmorphic features
    • Flattened nasal bridge, which can indicate Down syndrome, fragile X syndrome, or FAS
    • Epicanthal folds (aka eye fold), which are the skin fold of the upper eyelid, covering the inner corner of the eye. It is often associated with the nasal bridge, with a lower-rooted nose bridge more likely to cause epicanthic folds, and a higher-rooted nose bridge less likely to do so
  • ENT
    • Ear set/shape
    • Nasal patency
    • Palate
  • Neck
    • Palpate sternocleidomastoid muscles
    • ROM of neck
    • Palpate clavicles
    • Webbing/redundant skin

Patient information

You then start from the top, at the head. What do you do?
So we look from pressure spots on bub's head, suture lines of bub's skull, the soft spot in their skull which lets them grow quick, bruising. With eyes, you look at shape, discharge, redness, light reflexes. Dysmorphic features, like a flat nose, or eye folds. The ENT, including the ear shape, patency of the nose, palate. Neck, so their muscles, movement of the neck, and checking for webbing.

Chest:

  • Inspect for:
    • Asymmetry
    • Breast hypertrophy
  • Palpate for:
    • Brachial pulses
    • Femoral pulses
  • Auscultate for:
    • Air entry
    • Crackles
    • Heart sounds
    • Murmurs

Patient information

Chest, I'm guessing you do a quick cardioresp... heart and lung exam?
Yep . So look for asymmetry. Palpate for pulses, which are done at the arm or the legs, the legs are probably the most easily felt. And listening for air entry, crackles, heart sounds, and murmurs. So it's just a quicky check of everything.

Abdomen:

  • Inspect for:
    • Defects
    • 3 vessel umbilical cord, with most babies have 1 vein and 2 arteries
    • Diastasis recti
    • Umbilical hernia
    • Scaphoid abdomen
    • Abdominal distension
  • Palpate for:
    • Liver
    • Spleen tip?
    • Kidneys

Patient information

So moving further down to the tummy?
Yep, so we look for defects, herniation in the tummy, distension of the tummy. We look for the umbilical cord, which should usually have 3 vessels, 1 vein and 2 arteries. Like the lungs, it's the other way around, so the veins supply bub with oxygenated blood, and the arteries take away deoxygenated blood back to the placenta which connects them to mom's womb wall. We also want to feel for their liver on the upper RHS, spleen on the upper LHS, and kidneys at the flanks on both sides.

Genito-urinary:

  • Inspect for:
    • Ambiguous genetalia?
  • Male:
    • Testes present
    • Scrotal swelling - hernia? hydrocele?
    • Penis length
    • Petechia or bruising
  • Female:
    • Labia majora
    • Clitoromegaly?
  • Anus:
    • Patent
    • Sacral dimple?

Patient information

Further down is the urinary system?
So checking for genetalia. So in boys, checking testes are present, and there's no swelling, or bruising. Checking that the anus is patent.

MSK:

  • Inspection for spontaneous symmetric movements?
  • Hands:
    • Polydactyly
    • Syndactyly
    • Abnormal dermatoglyphic patterns
  • Feet:
    • Polydactyly
    • Syndactyly
    • Talipes equinovarus
    • Gap between toes
  • Hip:
    • Barlow maneuver, used to screen for development dysplasia of the hip. It is performed by adducting the hip (i.e. bringing the thigh towards the midline). If the hip is dislocatable, that is, if the hip can be popped out of the socket, this test is considered positive. The ortolani maneuver is then used to confirm the positive finding (i.e. the hip is actually dislocated)
    • Ortolani maneuver, which relocates the dislocation of the hip joint that has just been elicited by the Barlow maneuver. The examiner flexes the hips/knees to 90 degrees, then with the examiner's index fingers placing anterior pressure on the greater trochanters, gently and smoothly abduct the infant's legs using the examiner's thumbs. A positive sign is a distinctive "clunk" which can be heard and felt as the femoral head relocates anteriorly into the acetabulum. Specifically, this tests for posterior dislocation of the hip. This test usually becomes negative after 2 months of age
  • Spine:
    • Scoliosis
    • Spinal disraphisms, including:
      • Tufts of hair, in the lower spine, indicating spina bifida
      • Lipomas
      • Hemangiomas
      • Large dimple, in the lower spine, indicating spina bifida

Patient information

Now that we've worked down to the bottom, we work in, into the bones?
Yep, so we make sure bub is moving both sides. Making sure their hands and feet are fine. There's special tests we do for the hip. And we check the spine as well, ensuring their spine is straight.

Wait, what are the tests you do on the hips?
So there's Barlow maneuver, where you bring the thighs towards the midline, and see if the hip can be dislocated. If it can be, we use Ortolani maneuver to ensure the hip IS actually dislocated, by relocating the dislocation, by flexing it to 90 degrees, which should make a distinctive "clunk" sound.

Neuro:

  • Inspect for:
    • Posture
    • Alertness (with and without stimulation)
  • Tone for suspension
  • Reflexes:
    • Plantar reflex, which is elicitated when the sole of the foot is stimulated with a blunt instrument. Whereas in adults, it should cause a downward response - in children, there should be an upward response known as the Babinski sign (aka Koch sign) - which although suggests a UMN lesion in adults, is normal a primitive reflex in infants which is only inhibited by 1-2yo
    • Rooting reflex, is where an infant will turn its head towards anything that strokes its cheek or mouth, searching for the object by moving its head in steadily decreasing arcs until the object is found. After becoming used to responding this way, the infant will move directly to the object without searching. This reflex assists in the act of breastfeeding. It dissapears around 4mo, as it gradually comes under voluntary control
    • Moro reflex (aka startle response, embrance reflex), which occurs when the infant's head suddenly shifts position, temperature changes abruptly, or they are startled by a sudden noise. The legs and head extend while the arms jerk up and out with the palms up and thumbs flexed. Afterwards, the arms are brought together, and the hands clench into fists, and the infant cries loudly. It normally dissapears by 3-4mo, but may last up to 6mo. Bilateral absent can mean damage to the CNS, whilst unilateral absence could mean injury due to birth trauma (e.g. fractured clavicle, injury to the brachial plexus). It has evolutionarily helped infants cling to their mothers whilst being carried around. If the infant lost its balance, the reflex caused the infant to embrace its mother and regain hold of the mother's bdy
    • Palmar grasp reflex, where an object is placed in the infant's hand and strokes their palm, their fingers will close and they will grasp it with a palmar grasp. The grip is strong but unpredictable, they may release the grip suddenly and without warning. It persists until 5-6mo

Patient information

So the neurological exam's the last one?
Yep. So we check for posture, alertness. And then the many, many reflexes.

What sorts of reflexes are there?
So there's the plantar reflex, which in kids, goes upwards, unlike adults. Rooting reflex, where bub turns it's head towards anything that strokes its cheek or mouth. Moro reflex, where bub's head suddenly shifts when startled by a sudden noise. And palmar grasp reflex, where bub will curl and grasp anything that strokes their palm.

Source: 2011/01/Newborn-Exam-Checklist.pdf">Learn pediatrics


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Definition of Newborn examination | Autoprac


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