Exam 4 - Newborn Physical Exam Flashcards
Normal head circumference for newborn
12-15 inches
Normal weight for newborn
5 lbs 8 oz - 8 lbs 13 oz
Normal length of newborn
18-22 inches
Normal temperature (axillary/rectal) of newborn
97.7-99.0 F
Normal HR for newborn
80-180 bpm (depending on infant state)
Normal RR for newborn
30-60 breaths per minute
Normal BP for newborn
Not routinely done in primary care unless there is an issue
- Can be measured on arm or leg
What scale should be used to measure pain in a newborn?
FLACC scale
Respiratory assessment of newborn (what to look out for)
- Chest excursion (symmetric and equal)
- Use of accessory muscles
- Retractions
- Abdominal breathing
What is periodic breathing?
Rapid periods of breathing followed by slower periods of breathing
- Normal, but begin to worry if there is constant fast breathing
What are the components of a newborn cardiac exam?
- Check HR at PMI
- Auscultate in all five areas: aortic, pulmonic, Erb’s point, tricuspid, mitral
- Palpate for heaves, thrills, and PMI
Are murmurs common in newborns?
S1 and S2 are normal (along with S3 or S4)
How would the provider screen for congenital heart defects in a newborn?
Obtain pre and postductal pulsoxiemetery screening after 24 hours of age AND before discharge
- Right hand - preductal
- Either foot - postductal
How would the provider screen for congenital heart defects if the newborn was born at home or discharged before 24 hours of life?
Perform screening at first newborn visit
What are normal results after a pre and postductal pulsoxiemetery to screen for congenital heart defects?
Both hand and food >95% and less than a 3% difference between hand and foot saturations
What should the provider do if there are discrepancies with pulsoxiemetery readings when screening for congenital heart defects?
Urgent referral to cardiology
What are the four most common murmurs (congenital heart diseases) in newborns? What do they sound like?
- PDA - machine-like sound
- ASD - heard best in pulmonic area
- VSD - harsh systolic murmur
- Coarctation of aorta - systolic murmur
What are normal skin findings for a newborn in terms of appearance, cap refill, skin turgor, and mucus membranes?
Appearance - pink, well perfused
Capillary refill - <2 seconds
Skin turgor - elastic
Mucus membranes - pink, moist
What is acrocyanosis? Is this normal?
Bluish discoloration of hands and feet
- Normal for first 24-48 hours of life d/t immature cardiac circulation
Can acrocyanosis be seen in older newborns?
Yes - d/t cold stress
Common skin finding: harlequin sign
Unilateral color change on one side of body d/t autonomic vasomotor instability
- More common in low birth weight infants
- Transcient, harmless, lasts for 10-20 minutes
Common skin finding: erythema toxicum
Yellow/white, 1-3 mm papules over erythematous base
- Anywhere on body except palmar surfaces
- Occurs abruptly; unknown cause
Common skin finding: milia
Exposed sebaceous glands that appear as whiteheads
- Disappears within first month of life
- No treatment needed
Common skin finding: mongolian spots
Bluish-grey pigmentation found on lower back, across shoulders, hips, legs
- More common in darker-skinned newborns
- Fades over time
- ALWAYS DOCUMENT so that these are not confused with non-accidental trauma
Common skin finding: strawberry hemangioma
Raised capillary nevi that can occur anywhere on body
- Can increase in size over first few months, but generally disapperas by age 10
When should the provider consider a referral with strawberry hemangiomas?
When there is an orbital hemangioma, very large hemangioma, or those with the potential to interfere with the airway
Common skin finding: stork bites
Pale pink or reddish discoloration of the skin
- Location: nape of neck, lower axilla, nasal bridge, eyelids
- More evident when newborn cries
- Generally disappears by 2 years old
- No treatment needed
Common skin finding: lanugo
Fine, soft hair that covers the newborn’s back, shoulders, cheeks, forehead, and scalp
- More common in premature infants
- Disappears within first month of life
Common skin finding: linea nigra
Line of increased pigmentation from umbilicus to genitalia
- More common in darker-skinned infants
Common skin finding: vervix caseosa
Cheesy, gray-white substance covering and protecting the skin during fetal life
- Diminishes near term
Common skin finding: neonatal acne
Caused by maternal hormone stimulation of sebaceous glands that appears at 3-4 weeks of life
- More common in males
- No treatment needed (topical lotions/creams make it worse)
- Can occur anywhere on body
Common skin finding: petechiae
Pinpoint-sized hemorrhage
- Normal on presenting parts –> prescence anywhere else could indicate infection
Common skin finding: jaundice
Yellowing of skin
- Most visible after blanching
- Progression is head to toe
- Can be physiologic or pathologic
Common skin finding: cyanosis
Bluish discoloration of the skin d/t fetal hgb with O2 sat <60% (hypoxemia), central cyanosis, or pathologic cyanosis
- Location: periorbital, circumoral, chest, abdomen
- Requires assessment for pathologic condition
Common skin finding: cafe-au-lait spots
Hyperpigmented lesions (usually macules) that are irregular in shape and light brown in color
- Usually benign but can be associated with pathologic conditions
- Any newborn with 6+ lesions >1cm requires workup for neurofibromitosis
Common skin finding: mottling
Marbling or spiderweb appearance of newborns skin d/t hypothermia or infection (concerning)
- Cutis marmorata: occurs in healthy newborn and appears the same, but improves as skin is warmed
Common skin finding: pallor
Paleness of skin that can occur with anemia or infection
- In children with darker skin, evaluate in soles of feet, palms of hands, or circumorally
How would the fontanels and sutures appear in newborns?
Fontanels: anterior (diamond shaped), posterior (triangle shaped)
Sutures: five total (open or overlapped)
Cephalohematoma vs caput succedaneum: which one crosses suture lines?
Cephalohematoma - does NOT cross suture lines
Caput succedaneum - does cross suture lines
What is a cephalohematoma?
Collection of blood under the periosteum caused by pressure during labor or operative measures
- Resolves w/o intervention by 6-8 weeks
What is a caput succedaneum?
Localized swelling of the soft tissues of the scalp caused by pressure during labor and birth
- Resolves spontaneously within 24-48 hours after birth
What should the provider assess for during an eye exam of a newborn?
- Can the newborn fix and focus on an object 8-10 inches from the face?
- Assess size, shape, and placement
- Permanent eye color by 3-6 months
Abnormal findings during newborn eye assessment
- Placement - hypertelorism/hypotelorism
Placement problem - “third eye” should fit easily between the two eyes; if not, could indicate chromosomal anomaly or syndrome
- Hypertelorism - eyes too widely spaced
- Hypotelorism - eyes too closely spaced
Abnormal findings during newborn eye assessment
- Corneal abnormalities
Haziness could indicate glaucoma
Abnormal findings during newborn eye assessment
- Red reflex
Absence can indicate infection or cataracts
Grey or white pupil could indicate retinoblastoma
Abnormal findings during newborn eye assessment
- Palpebral fissure
Eye openings too small –> could indicate chromosomal anomaly or syndrome
Abnormal findings during newborn eye assessment
- Epicanthal folds
Slanting of eyes –> could indicate chromosomal anomaly or syndrome
Normal presentation during ear assessment
- Full term infant should have firm, flexible cartilage; recoil should be brisk
- Line from inner canthus to outer canthus of eye should lead to occiput (top of pinna should touch line)
- Angle of placement of ear should be vertical or no more than 10 degrees from vertical
Abnormal ear findings during newborn assessment
- Malformed/malpositioned ears - congenital or chromosomal anomaly
- Preauricular sinus/tag - outer ear and renal tissues formed at the same time
- Consider renal abnormalities
- Requires repeat hearing screen at 6 months
True/false: Newborns are obligate nose breathers
True
- Become upset or have difficulty feeding when nasal passagways are obstructed
Abnormal throat/mouth findings during newborn assessment
- Macroglossia - congenital/chromosomal anomaly
- Ankyloglossia - difficuty feeding/latching
- Palpate cleft palates, submucous cleft, high arched palate
When do the anterior and posterior fontanels close?
Anterior - 18 months
Posterior - 4 months
What should the provider look for during a newborn chest/thorax assessment?
- Cylindrical
- 1:1 AP ratio
- Chest circumference is 33cm or 2cm less than head circumference
- Breast engorgement and “witches milk” are normal
- Inspect clavicles for crepitus
What should the provider look for during a newborn abdominal assessment?
- Rounded and domed
- Umbilical cord should have two arteries, one vein
- Cord falls off between 7-10 days
What should the provider look for during a male newborn genital assessment?
- Placement of urethral opening should be at the tip
- Both testes should be descended and palpable
What should the provider do when a hydrocele is present during a male genitalia exam?
Check to see if it transluminates
- Will spontaneously resolve
What should the provider look for during a female genitalia assessment?
- Assess size of labia majora/minora and clitoris
- Milky vaginal discharge is normal
- Blood tinged mucus/vaginal discharge is normal
What should the provider assess for during a spine examination of a newborn?
- Should be straight and flexible
- Observe for pilonidal dimple (be sure base is visible)
What should the provider assess for during an upper extremity examination?
- Full ROM
- Symmetry
- Brachial pulses
What should the provider assess for during a lower extremity examination?
- Femoral pulses
- Barlow and Ortolani’s maneuvers
- Symmetry of skin folds (gluteal and femoral areas)
- Size, shape, symmetry of newborns feet
Eight newborn reflexes
- Rooting
- Sucking
- Tonic neck reflex (fencing)
- Palmar grasp
- Galant
- Moro (startle)
- Plantar grasp
- Babinski
How would the provider assess cranial nerve I (olfactory)?
Alcohol wipe under nose to ellicit grimmace
How would the provider assess cranial nerve II (optic), III (oculomotor), IV (trochlear), VI (abducens)?
- Light in eyes should cause rapid eye closure
- Baby’s head should follow your face when 8-10 inches away
How would the provider assess cranial nerves V (trigeminal), IX (glossopharyngeal), and XII (hypoglossal)?
- Rooting and sucking reflexes
- Swallowing assessed by observing latch
How would the provider assess cranial nerve VII (facial)?
Glabella tap assessed for blinking
How would the provider assess for cranial nerve VIII (auditory)?
Assess infant in a quiet room to observe their reaction to sound
