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Physical Examination of the Newborn

Physical Examination of the Newborn. PGI Michelle Matematico. The newborn should be examined 3 times. In the nursery/rooming-in. Immediately at birth. Upon discharge, in the presence of the mother. HOW???. Inspect Auscultate Palpate

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Physical Examination of the Newborn

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  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 10thpercntile • 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 Vernixcaseosa Mongolian spot Milia Neonatal pustularmelanosis

  15. SKIN Hemangioma Mottling Nevus flammeus Cutis mamorata

  16. SKIN Erythematoxicum Miliariacrystalina

  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. Cephalhematomavs Caput succedanum Cephalhematoma 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 Clefts Deciduous teeth Epstein pearls (Normal)-hard and soft palate • Check for patency by inserting an NGT

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

  24. Abdomen omphalocoele Gastroschisis

  25. 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

  26. Hips Positive: click of reduction and dislocation

  27. 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

  28. 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

  29. Extremities • Pulses • Syndactyly • Polydactyly • Simian crease • Talipesequinovarus • Metatarsus varus

  30. EXTREMITIES Polydactyly Syndactyly Simian crease Metatarsus varus Talipesequinovarus

  31. Trunk and spine • Tufts of hair • Dimpling

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

  33. T H A N K Y O U.

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