COMPLETE ASSESSMENT OF THE NEWBORN Flashcards
HEAD
Specifics: __________________
Usual Findings:
Shape;
- symmetrical
- molded
- round
- Palpable anterior and posterior fontanels and sutures
- Anterior fontanel flush with neighboring parts
- suture are normelly felt as ridges
Head
Variations:
- asymmetry due to molding
- scalp lesions or abrasion
- cephalhematoma
- caput succedaneum
- Posterior fontanel may be difficult to palpate if sutures are overriding
HEAD
Abnormalities:
- overriding of the sutures
- severe molding
- Tension of the anterior fontanel
- Remarkable pulsation of fontanels
- Depressed fontanel
- Full bulging fontanel (intracranial
pressure) - Depressed skull fracture
- Unusually large or small head
in relation to body size - Unusual hair pattern or texture
- Subgaleal hemorrhage
- Craniosynostosis
- Widened sutures or fontanels
- Craniotabes
immature
fusion of the newborn’s cranial
bones
Craniosynostosis
EYES
* Specifics:
Symmetry, Appearance,
Discharge, Sclera
EYES
Usual Findings:
o Correct placement on face in relation to one another
o Absence of tears and ability to follow midline with rudimentary fixation on objects
o Edemao Blue or gray irises; permanent color: 3-12 months
o Blink reflex present
o Cornea is round
o Strabismus due until 4-6 months
o Gets Subconjunctival hemorrhage – red spot on the sclera (absorbed in 2- 3 weeks)
o Has red reflex
o No Discharges
o Bluish-white
Eyes:
Abnormalities:
o Centered or deviated to right or left
o Marked edema or inflammation
o Drooping
o Setting-sun sign
o Purulent discharge
o Pink Iris
o Upward slant in non-oriental
o Hypertelorism
o Hypotelorism
o Congenital cataracts
o Retinal hemorrhage
o Constricted or dilated fixed pupil
o Absence of red reflex, pupillary
or corneal reflex
o Inability to follow object or bright
light to midline
o Blue or yellow sclera
EARS
* Specifics:
Shape
EARS
* Usual Findings:
o Well-formed
o Cartilage present
o Upper part of ear should be on same
plane or above angle of eye
EarS:
Variations
o Preauricular papillomas (ear tags)
may be present
o Amt. of cartilage varies (less
with prematurity)
o May be folded or creased
Ears
Abnormalities
o Malformations
o Low placement or low set of ears
indicate:
- Chromosomal defect
- Kidney disease
- Craniofacial lesions
Low placement or low set of ears
indicate:
- Chromosomal defect
- Kidney disease
- Craniofacial lesions
NOSE
* Specifics:
Symmetry, Shape, Patency
NOSE
Usual Findings:
Midline of face
o Appears flattened
o Should breathe easily
through nose when mouth
is closed
NOSE
Variations:
Some mucous present in nares
may interfere with breathing
NOSE
* Abnormalities:
o Deviated to the right or left
o Malformation or unusual flattening
o Flaring of nares
o Stenosis of naris (choanal atresia)
MOUTH
* Usual Findings:
➢ Pink lips, gums, tongue and palate
➢ Normal size tongue
➢ Observe frenulum
➢ Uvula in midline
➢ There is rooting, gag, extrusion
and sucking reflex
➢ Having minimal salivation
MOUTH
Variations:
➢ There is presence of EPSTEIN
PEARL (small white epithelial
cysts along midline of hard
palate)
➢ Circumoral cyanosis
➢ Rear gums whitish
➢ Teeth can be present or
inclusion cysts (whitish toothlike cysts)
MOUTH
Abnormalities
➢ Cleft lip or palate
➢ Persistent cyanosis
➢ Tongue thrush
➢ Protrusion of tongue
➢ Frenulum linguae (tongue tie)
(may interfere with sucking)
➢ Large and thick (prominent tongue)
➢ Moniliasis/Candidiasis – white
cheesy patches in mucous
membrane and tongue
o Usually blowing bubbles,
mucus, drooling indicates
tracheoesophageal fistula and
esophageal atresia
FACE /NECK
➢ Specifics:
Appearance and Motion
FACE /NECK
Usual Findings:
➢ Neck is short and straight with
creased skin
➢ Skin fold and unrestricted
range of motion
➢ Face is symmetrical
➢ Tonic neck reflex present
FACE /NECK
➢ Abnormality:
➢ Torticollis or wry neck – head
can’t be turned from side to side;
damaged sternocleidomastoid
muscles
➢ Opisthotonus
➢ Nuchal rigidy
➢ Masses
➢ Distended veins or edema
➢ Webbing
head
can’t be turned from side to side;
damaged sternocleidomastoid
muscles
Torticollis or wry neck
CHEST
➢ Specifics:
Shape, clavicle,
expansion, respiration, breast
tissue, nipples
Usual Findings:
CHEST
➢ Shape is almost circular,
anteroposterior and lateral
diameters are equal with
prominent xiphoid process
➢ Clavicles are straight and smooth
➢ Symmetry of movement
with respirations
➢ Respiratory Rate is 30-60 bpm
➢ Periodic respiration with
episodic apnea is normal
➢ Breast tissue is present in both
sexes
➢ Symmetrical placement of nipples
CHEST VARIATIONS
➢ Excessive amount of breast tissue
➢ Engorged breast due to influence of
maternal hormone - witch milk
➢ Presence of supernumerary nipples
CHEST
Abnormalities:
➢ Fractures on clavicle (tenderness,
palpable mass)
➢ Wide-spaced nipples
➢ Depressed sternum
➢ Marked retractions of chest and
intercostal spaces during
respiration
➢ Asymmetric chest expansion
diaphragmatic hernia,
pneumothorax)
➢Retraction (drawing in of the chest
wall with inspiration)
➢ Grunting on expiration, stridor,
wheezing
➢ Tachypnea
➢ Asymmetrical placement of
nipples
CIRCULATION
Specifics:
Heart Rate, Capillary Refill,
Murmur, Pulses
Heart Rate
100-160 bpm
CIRCULATION
Usual Findings:
Rate increased following
physical or emotional stimulus
➢ Capillary refill - < 3 seconds
➢ Absent murmur
➢ Pulses are equal bilaterally
CIRCULATION
Variations:
➢ Murmurs are intermittent
during first few days of life
CIRCULATION
Abnormalities:
➢ Heart sounds heard on right
side (dextrocardia)
➢ Tachycardia
➢ Capillary refill > 3-4 seconds
(poor perfusion)
➢ Murmurs are persistent
➢ Muffled heart sounds
➢ Extra heart sound
➢ Absent or weak pulse
➢ Bounding (PDA)
➢ Upper pulses > lower pulses
ABDOMEN
➢ Specifics:
Shape, umbilical stump, sounds
ABDOMEN
Usual Findings:
➢ Contour cylindrical and
relatively prominent; Soft
➢ Umbilical stump appears bluish
white with 3 vessels
➢ Umbilical stump appears dry
within
several hours after birth
➢ Bowel sounds occur 1 hour after
birth and are transient in first 24
hrs.
➢ Liver is usually palpable 1 to 2 cm
below the right costal margin.
➢ Edge of the spleen may be
palpable 1 to 2 cm below the
left costal margin
➢ Peristaltic waves must not be
visible
Abdomen Variations:
Umbilical hernia may be present and
is usually insignificant
➢ Intermittent sounds
Abdomen Abnormalities
➢ Asymmetry
➢ Bladder extropy
➢ Localized bulging (e.g. hernia)
➢ Umbilical stump with
abnormal redness, bleeding or
oozing, odor
Omphalocele
o Sounds: hypermobility
o Palpable olive shape mass or
sausage shaped mass
➢ Abdominal distension
➢ Sunken appearance may
indicate missing abdominal
contents or a diaphragmatic
hernia (bowel positioned in the
chest instead of the abdomen).
➢ Enlarged liver and spleen
➢ Ascites
➢ Visible peristaltic waves
➢ Gastroschisis or
Omphalocele- protrusion or
sac formation of abdominal
content
ANUS
➢ Specifics:
Patency
Usual Findings: ANUS
➢ Normal position
➢ Dimpled or puckered appearance
Abnormalities: ANUS
➢ Imperforated anus
GENITALIA
➢ Specifics:
Appearance
GENITALIA➢ Usual Findings:
➢ Female:
➢ Labia minora is quite prominent and
protrude over labia majora
➢ Male:
➢ Prepuce usually adherent to the
glands
➢ Testicles usually in scrotum
➢ Scrotum small and firm or fairly
loose, relaxed and pendulous with
rugae
➢ Meatal opening should appear as a
slit
Genetalia Variations:
➢ Smegma
➢ Vaginal discharge - mucoid or
blood tinged (pseudo menstruation)
GENITALIA Abnormalities:
Excessive vaginal bleeding
➢ Enlarged clitoris with
urethral meatus at tip
➢ Fused labia
o Absence of vaginal opening
➢ Meconium from vaginal opening
➢ No urination within 24 hours
➢ Location of urinary meatus of
penis
➢ dorsal (above– epispadias)
or ventral (hypospadias)
➢ Cryptorchidism: absence of one
or two testicles in the scrotum
(undescended testes);
➢ Malformations (phimosis),
Hydrocele
o Ambiguous (both male/female)
o Chordee: ventral curvature of
penis
EXTREMITIES
➢ Specifics:
Appearance, Movement
➢ EXTREMITIES: Usual Findings
o Maintains a posture of flexion
with good muscle tone, and
extremities
return quickly to an attitude of
flexion after extension
➢ Extremities are short in relation to
the body, without deformities
➢ Full range of motion and
movements are present in all
joints.
o Palms of the hands should have
creases
➢ Hold the arms down by the
sides and note their length. The
fingertips should reach the
proximal thigh. Unusually short
arms may signify
achondroplastic dwarfism
o Equal and strong femoral and
brachial pulses upon palpation
➢ Legs- bowed; feet- flat due to a
fatty pad in the arch of the foot.
➢ Creases should cover at least two
thirds of the bottom of the feet.
➢ * (-) Ortolani’s sign and (-) Barlow’s
sign
➢ EXTREMITIES: Abnormalities
➢ Simian crease (a single palmar
crease) – associated with Down
syndrome
➢ * Digits Assessment:
Syndactyly, polydactyly,
adactyly
➢ * Plantar flexed feet- indicates
clubfoot
➢ * Hip dislocation or dysplasia:
➢ Signs:
➢ ** (+) Ortolani’s Sign, (+) Barlow’s
Sign
➢ ** uneven gluteal folds, one knee
that is lower than the other
➢ *** when the newborn is supine
with both knees flexed.
SKIN
➢ Normal:
- red pink skin, smooth at birth
➢ : 2nd and 3rd day- pink, flaky, dry
➢ : presence of lanugo and vernix
caseosa
o Pallor: Anemia
o Yellow: Jaundice
➢ - Pathologic: progressive within 24
hours
➢ - Physiologic: Icterus
Neonatorum- within 3-5 days after
delivery
➢ Milia
o Vernix Caseosa
➢ * Erythema Toxicum
➢ * Harlequin sign
➢ * Cutis Marmorata
o * Lanugo
➢ * Birthmarks
o A. Hemangiomas- Nevus Flammeus,
Strawberry Hemangioma, Cavernous
Hemangioma
o B. Mongolian Spots
BACK/SPINE: Usual Findings
➢ Normally flat and straight in the lumbar and
sacral areas
➢ Curve of back usually develops at 5-6
months
➢ Inspect the base of a newborn’s spine
carefully to be sure there is no pinpoint
opening, dimpling, or sinus tract in the skin
➢Abnormalities:
BACK SPINE
A mass, tuft of hair or dimple
incomplete closure of vertebrae
indicates spina bifida – an
opening in the spinal column
with or without herniation of the
meninges)
Babies experience growth spurts during the
first year at about
3 months, 6 months, and 9
months;
FEEDING
* every
2 to 4 hours
Feeding patterns become
fairly regular in
approximately 2 weeks.
Regurgitation
(“spitting up”)
SLEEPING
* approximately
16 to 20 hours per day.
difficult for infants to fall
asleep by themselves
first 3 to 4 months
The Comprehensive Newborn Screening
(NBS) Program was integrated as part of
the country’s public health delivery system
with the enactment of the
Republic Act no.
9288 otherwise known as Newborn
Screening Act of 2004.
Inclusions: screening of six disorders:
- Congenital Hypothyroidism (CH)
- Congenital adrenal hyperplasia (CAH)
- Phenylketonuria (PKU)
- Glucose-6- phosphate dehydrogenase
(G6PD) Deficiency - Galactosemia (GAL)
- Maple syrup urine disease (MSUD).
The Expanded Newborn Screening will include 22
more disorders such as hemoglobinopathies and
additional metabolic disorders, namely, organic
acid, fatty acid oxidation, and amino acid disorders.
The latter are included in the standard care across
the globe.
Cystic Fibrosis
* Biotinidase Deficiency
* Organic Acid Disorders
* Fatty Acid Oxidation Disorders
* Amino Acid Disorders
* Urea Cycle Disorders
* Hemoglobin Disorders
