Examination of the Newborn Flashcards
History: Maternal background
- Age, parity, blood group, VDRL and HIV status.
- Outcome of previous pregnancies.
- Any problems with previous infants
History: Pregnancy
- Booked.
- Duration and fetal growth.
- Illness or complications e.g. diabetes, GPH.
- Drugs, smoking, alcohol.
- Feeding Choice.
History: Labour and Delivery
- Duration of labour.
- Rupture of Membranes, Amniotic Fluid Clear, Meconium.
- Drugs given to mother.
- Method of delivery.
- Time and Date of Delivery.
- Fetal condition.
- Complications.
History: Infant
- Condition at birth – Apgar score.
- Need for resuscitation, Time to spontaneous Respiration.
- Passage of urine and meconium.
- Feeding.
- Problems since delivery e.g. hypothermia, jaundice.
History: Placenta
- Weight.
- Gross abnormalities
When should a brief initial examination be conducted after delivery?
A brief initial examination should be done after delivery to detect major congenital abnormalities or gross disease requiring immediate attention.
When should a complete examination be performed in newborns?
A complete examination should be performed within 24 hours of birth and before discharge home.
What are some key reminders before conducting a newborn examination?
Wash your hands, undress the infant completely, and ensure the infant does not get cold.
Why is it important to examine the infant in the mother’s presence if possible?
Examining the infant in the mother’s presence reassures her and allows for an explanation of any observed issues or concerns.
How should infants be examined?
Infants must be examined gently with warm hands, and the examination should follow a fixed order to ensure nothing is forgotten.
What is the recommended order for conducting a physical examination of a newborn
The physical examination should begin with basic measurements, followed by a general inspection, examination by regions starting at the head and ending at the toes, and finally, assessment of the neurological status.
What are the normal measurements for birth weight in newborn infants?
Birth weight should be 2500g or above and between the 10th and 90th centile for gestational age.
What conditions are considered abnormal in birth weight measurement?
Low birth weight (below 2500g) or being underweight (below 10th centile) or overweight (above 90th centile) for gestational age are considered abnormal.
What are the normal measurements for head circumference in newborn infants?
Head circumference should be between the 10th and 90th centiles for gestational age.
What conditions are considered abnormal in head circumference measurement?
Having a small head (below 10th centile) or a large head (above 90th centile) for gestational age are considered abnormal.
What are the normal measurements for crown-heel length in newborn infants?
Crown-heel length should be between the 10th and 90th centile for gestational age, measured accurately with a measuring box.
What conditions are considered abnormal in crown-heel length measurement?
Being short (below 10th centile) or long (above 90th centile) for gestational age is considered abnormal.
What is the normal range for skin temperature in newborns?
The abdominal wall temperature should be between 36–36.5°C (or axilla 36.5–37°C).
What condition is indicated by a skin temperature below 35°C?
Hypothermia is indicated by a skin temperature below 35°C.
What physical and neurological features are characteristic of a term infant?
Term infants typically exhibit physical and neurological features appropriate for their gestational age, generally considered as being between 37 and 41.9 weeks.
How do premature infants (born before 37 weeks) typically differ in appearance from term infants?
Premature infants may exhibit immature features compared to term infants.
What physical features are characteristic of postterm infants (born at 42 weeks and above)?
Postterm infants may have long nails and are often wasted in appearance.
How would a well-term infant typically appear in terms of wellbeing?
A well-term infant is usually active and alert.
What are signs that an infant may be unwell or lethargic?
Lethargy and appearing ill are signs that an infant may be unwell.
What is considered normal in terms of wasting for a newborn?
Well-nourished soft tissue is considered normal for newborns.
What color is typically seen on the tongue of a healthy newborn?
A healthy newborn typically exhibits a pink tongue.
What are some abnormal colorations that may be observed in newborns?
Abnormal colorations may include cyanosis, pallor, jaundice, or plethora.
Abnormal colorations may include cyanosis, pallor, jaundice, or plethora.
Newborns typically have smooth or mildly dry skin, with vernix and lanugo present.
stork bites
blue naevus
milia
erythema toxicum
salmon patches
What skin conditions or abnormalities may be observed in newborns?
Skin conditions may include meconium staining, petechiae, bruising, large or many pigmented naevi, capillary or cavernous haemangioma, skin infections, or oedema.
What are common features related to the shape of the newborn’s head?
Caput and moulding are common features related to the shape of the newborn’s head.
What abnormalities might be indicated by asymmetry in the shape of the newborn’s head?
Asymmetry in the shape of the newborn’s head might indicate conditions such as anencephaly, hydrocephaly, microcephaly, or encephalocoele.
cephalhaematoma, subaponeurotic bleed
What is the normal condition of the fontanelle in a newborn?
A normal fontanelle in a newborn is open and soft with palpable sutures.
What abnormalities might be indicated by the fontanelle being full or sunken?
A full or sunken anterior fontanelle might indicate abnormalities such as dehydration or a pathological condition affecting intracranial pressure. Large or closed fontanelles might indicate abnormal development.
What is the normal condition of the sutures in a newborn?
Palpable mobile sutures are considered normal in a newborn.
What abnormalities might be indicated by wide, fused, or markedly overlapping sutures?
Wide, fused, or markedly overlapping sutures might indicate abnormalities in skull development.
What is the expected variation in hair among newborns?
Newborns typically exhibit wide familial variation in hair.
What might a low posterior hairline suggest in a newborn?
A low posterior hairline might suggest certain genetic conditions or abnormalities.
What is the normal positioning of the eyes in a newborn?
In a newborn, there should be one eye space between the eyes.
What abnormalities might be indicated by hypertelorism or hypotelorism?
Hypertelorism or hypotelorism might indicate abnormalities in the spacing between the eyes.
What is the normal size expectation for the eyes in a newborn?
Normal eyes in a newborn should exhibit a typical size.
What abnormalities might be indicated by microphthalmia or macrocornea?
Microphthalmia or macrocornea might indicate abnormalities related to the size of the eyes, such as glaucoma.
What are common findings related to the eyelids in a newborn?
Mild oedema is common in newborn eyelids.
What abnormalities might be indicated by marked oedema, ptosis, or bruising of the eyelids?
Marked oedema, ptosis, or bruising of the eyelids might indicate trauma or underlying pathology.
What might narrow palpebral fissures suggest in a newborn?
Narrow palpebral fissures might suggest fetal alcohol syndrome (FAS) or other abnormalities.
Normal Conjuctivae
may have small subconjuctival haemorrhages
What are potential abnormalities related to the conjunctivae in a newborn?
Abnormalities might include pale or plethroic, conjunctivitis, or excessive tearing due to nasolacrimal duct obstruction.
What are normal expectations regarding the cornea, iris, and lens in a newborn?
The cornea should be clear, the pupil regular, and a red reflex should be present.
What condition might be indicated by choanal atresia?
Choanal atresia, a congenital condition where the back of the nasal passage (choana) is blocked, might be indicated by difficulty passing a feeding catheter or observing dry secretions blocking the nostrils.
What might a flattened nose suggest in a newborn?
A flattened nose in a newborn might suggest oligohydramnios, a condition characterized by low levels of amniotic fluid.
What is expected regarding the patency of the nostrils in a newborn?
Both nostrils should be patent, allowing for easy passage of a feeding catheter.
What abnormalities might be indicated by an opaque cornea, irregular pupil, cataracts, absence of red reflex, fixed squint, or abnormal eye movements?
These abnormalities might indicate issues such as corneal opacity, cataracts, or neurological problems affecting eye movement.
What is the typical shape of the nose in a newborn?
In a newborn, the nose is typically small with upturned nostrils.
What might be observed on the lips of a newborn?
Sucking blisters may be observed on the lips of a newborn.
Abnormal lips
Cleft lips
What might be observed on the palate of a newborn?
Epstein’s pearls
What characteristics might indicate fetal alcohol syndrome (FAS) in the lips?
In FAS, the lips may exhibit a long smooth upper lip, absence of a philtrum, and a thin pink border.
Abnormal palate of a newborn
high arched or cleft palate may be observed in a newborn.
What is considered normal regarding the appearance of the tongue in a newborn?
A normal tongue in a newborn is pink in color.
What abnormalities might be indicated by a cyanosed, pale, or large tongue (macroglossia)?
These abnormalities might indicate issues such as poor oxygenation, anemia, or conditions like macroglossia.
In what condition might the tongue be posteriorly placed?
In Pierre-Robin anomaly, the tongue may be posteriorly placed, leading to potential airway obstruction.
What is the normal dental condition at birth?
Newborns typically have no teeth at birth.
What might adventitious or primary teeth suggest in a newborn?
These teeth might suggest abnormalities or conditions affecting dental development.
What normalities might be observed on the gums of a newborn?
small cysts
What abnormalities might be observed on the gums of a newborn?
epulis may be observed on the gums of a newborn.
normal mucous membranes
pink and shiny
What conditions might affect the mucous membranes in a newborn?
Thrush or ulcers may affect the mucous membranes in a newborn.
When might excessive saliva production be observed in a newborn?
Excessive saliva production may be observed in newborns with poor swallowing or esophageal atresia.
How does the size of the jaw in a newborn compare to that of an older child?
The jaw in a newborn is typically smaller than that of an older child.
when do newborns typically have micrognathia
Pierre Robin anomaly
What is the typical position of the pinnae (outer ears) in a newborn?
In a newborn, the pinnae are typically vertical at term.
What might be indicated by ears that are rotated backward with poorly formed upper pinnae (low set)?
Ears that are rotated backward with poorly formed upper pinnae might suggest abnormalities in ear development or placement.
What is considered normal regarding the appearance of the ears in a newborn?
Familial characteristics are considered normal in the appearance of the ears in a newborn.
What might be indicated by the presence of a pre-auricular skin tag or sinus?
A pre-auricular skin tag or sinus might indicate a minor congenital anomaly, which is often benign.
What abnormalities might be observed in the ears of a newborn?
Malformed ears or hairy ears in infants of diabetic mothers (IDM) might be observed.
What does “IDM” stand for?
“IDM” stands for infants of diabetic mothers.
What is the typical shape of the neck in a newborn?
The neck in a newborn is usually short.
What might be indicated by webbing or torticollis in the neck?
Webbing or torticollis in the neck might indicate abnormalities in muscle development or positioning.
What is considered normal regarding the presence of masses in the neck of a newborn?
In a normal newborn, there are typically no palpable lymph nodes or thyroid masses.
What might be indicated by the presence of a cystic hygroma in the neck?
A cystic hygroma in the neck might indicate a congenital abnormality of the lymphatic system.
What condition might be indicated by a goitre in the neck?
A goitre in the neck might indicate an abnormal enlargement of the thyroid gland.
What is a sternomastoid tumor?
A sternomastoid tumor, also known as congenital muscular torticollis, is a condition characterized by tightness or swelling of the sternocleidomastoid muscle in the neck.
What might be indicated by swelling or crepitus in the clavicle of a newborn?
Swelling or crepitus in the clavicle might indicate a fractured clavicle, which is a relatively common birth injury.
What might be observed regarding breast development in a newborn?
Palpable breast nodules, typically measuring 0.5 to 1 cm, may be present at term.
What conditions might be indicated by the presence of accessory or wide-spaced nipples?
Accessory or wide-spaced nipples might indicate variations in normal breast development or congenital anomalies.
What might be indicated by the presence of mastitis in a newborn?
Mastitis in a newborn might indicate inflammation or infection of the breast tissue.
What might be indicated by enlarged, lactating breasts in a newborn?
Enlarged, lactating breasts in a newborn might indicate exposure to maternal hormones in utero or other hormonal imbalances.
What is the typical heart rate range in a newborn?
The typical heart rate range in a newborn is 120–160 beats per minute.
How might abnormal pulses be characterized in a newborn?
Abnormal pulses in a newborn might be weak, collapsing, absent, fast, or slow.
What is considered normal regarding capillary filling time in a newborn?
In a newborn, capillary filling time should be less than 3 seconds over the chest and peripheries.
What might prolonged capillary filling time indicate in a newborn?
Prolonged capillary filling time in a newborn might indicate cold or shock.
How is the precordium typically described in a newborn?
The precordium in a newborn is typically described as having mild pulsation felt over the heart and epigastrium.
abnormal precordium
hyperactive precordium
Where is the apex beat typically heard in a newborn?
The apex beat is typically heard maximally to the left of the sternum in a newborn.
abnormal apex beat
heard best in right chest in dextocardia
How might abnormal heart sounds be characterized in a newborn?
Abnormal heart sounds in a newborn might include a gallop or widely split-second sound.
normal heart sounds
loud, single 2nd heart sound on day 1
What is considered normal regarding heart murmurs in a newborn?
Soft, short systolic murmurs are common on day 1 in a newborn.
abnormal murmurs
systolic or diastolic murmurs
What might be indicative of heart failure in a newborn?
Heart failure in a newborn might be indicated by hepatomegaly, tachypnea, excessive weight gain, or occasionally, edema.
What is the typical respiration rate in a newborn?
The typical respiration rate in a newborn is 40–60 breaths per minute.
What might irregular respiration patterns in a newborn suggest?
Irregular respiration patterns in a newborn, such as periodic breathing with no change in heart rate or color, might suggest normal REM sleep.
How is tachypnea characterized in a newborn?
Tachypnea in a newborn is characterized by a respiration rate above 60 breaths per minute, gasping, or apnea with accompanying signs such as a drop in heart rate, pallor, or cyanosis.
What might be indicated by asymmetrical chest movement in a newborn?
Asymmetrical chest movement in a newborn might indicate conditions such as pneumothorax or diaphragmatic hernia.
normal recession in newborns
mild recession in prems
How is abnormal recession characterized in the chest of a newborn?
Costal recession in respiratory distress
What might an expiratory grunt indicate in a newborn?
An expiratory grunt in a newborn might indicate respiratory distress.
What does inspiratory stridor suggest in a newborn?
Inspiratory stridor in a newborn is a sign of upper airway obstruction.
What are some abnormal findings in percussion of the chest of a newborn?
Abnormal findings in percussion of the chest might include dullness with effusion or hemothorax, or hyperresonance with pneumothorax.
How is air entry typically assessed in a newborn?
Air entry in a newborn is typically assessed by ensuring equal air entry over both lungs, with bronchovesicular sounds auscultated.
What type of lung sounds are typically heard during auscultation in a newborn?
During auscultation, bronchovesicular sounds are typically heard over both lungs in a newborn.
What might be indicated by unequal or decreased air entry in a newborn?
Unequal or decreased air entry in a newborn might indicate conditions such as lung consolidation or atelectasis.
What are some examples of abnormal adventitious sounds that may be heard during auscultation in a newborn?
Adventitious sounds that may be heard during auscultation in a newborn include crackles, wheezes, or rhonchi, which may suggest underlying respiratory pathology.
What are some examples of adventitious sounds that may be heard during auscultation in a newborn?
transmitted sounds
What is the typical configuration of the umbilicus in a newborn?
In a newborn, the typical configuration of the umbilicus includes 2 arteries and 1 vein.
What might be indicated by the presence of 1 artery and 1 vein in the umbilicus of a newborn?
The presence of 1 artery and 1 vein in the umbilicus of a newborn might indicate an abnormality, such as a single umbilical artery.
What abnormal findings might be observed in the umbilicus of a newborn?
Abnormal findings in the umbilicus of a newborn might include infection, bleeding or discharge, hernia, or exomphalos.
abnormal findings on the abdominal skin
periumbilical erythema or oedema
How is the liver typically assessed in a newborn?
The liver in a newborn is typically assessed by palpating 1 cm below the costal margin, where it should feel soft.
What might be indicated by an enlarged, firm, and tender liver in a newborn?
An enlarged, firm, and tender liver in a newborn might indicate liver pathology or infection.
How is the spleen typically assessed in a newborn?
The spleen in a newborn is typically assessed by palpation, although it is not easily palpated in normal conditions.
What might be indicated by an enlarged and firm spleen in a newborn?
An enlarged and firm spleen in a newborn might indicate splenomegaly or underlying pathology.
normal kidneys
often palpable but normal size
abnormal kidneys
enlarged and firm
How are bowel sounds typically assessed in a newborn?
Bowel sounds in a newborn are typically heard immediately on auscultation.
What might be indicated by depressed or absent bowel sounds in a newborn?
Depressed or absent bowel sounds in a newborn might indicate bowel obstruction or ileus.
normal anus
patents and skin tags
abnormal anus
absent or covered. displaced anteriorly
What is the typical timing for the passage of meconium in a newborn?
Meconium is typically passed within 48 hours of birth in a newborn.
When are yellow stools typically expected in a newborn?
Yellow stools are typically expected by day 5 in a newborn.
How might the appearance of breastfed stool differ from other stools in a newborn?
Breastfed stool in a newborn may be green and mucoid in appearance.
What are potential abnormal findings associated with stool in a newborn?
Potential abnormal findings associated with stool in a newborn include blood in or on the stool, white stools in obstructive jaundice, or offensive watery stools, which may indicate underlying health issues.
What are some normal findings when examining the spine of a newborn?
What are some normal findings when examining the spine of a newborn?
Normal findings when examining the spine of a newborn may include a coccygeal dimple or sinus, a straight spine,
abnormal spine
sacral dimple or sinus. scoliosis, meningomyelocoele
What is a coccygeal dimple or sinus?
A coccygeal dimple or sinus is a small indentation or pit in the skin overlying the coccyx (tailbone) at the lower end of the spine.
How might scoliosis present in a newborn?
Scoliosis in a newborn might present as an abnormal lateral curvature of the spine.
What is meningomyelocele?
Meningomyelocele is a type of neural tube defect characterized by the protrusion of the spinal cord and its meninges through a defect in the vertebral column, resulting in a sac-like structure on the back.
What is a normal finding concerning the urethral opening in a newborn male?
A normal finding is the urethral opening being located at the center of the glans penis.
What conditions might be indicated by abnormalities in the position of the urethral opening in a male newborn?
Hypospadias or epispadias might be indicated by abnormalities in the position of the urethral opening in a male newborn.
What is micropenis?
Micropenis refers to an abnormally small penis.
By what age are the testes typically descended in a male newborn?
The testes are typically descended by 37 weeks of gestation in a male newborn.
What is a concerning finding regarding the testes in a male newborn?
Undescended testes are a concerning finding in a male newborn.
normal scrotum
well formed at term
What are some abnormalities that might be observed in the scrotum of a male newborn?
Abnormalities in the scrotum of a male newborn might include inguinal hernia or fluid hernia.
What are some normal findings concerning the vulva in a female newborn?
Normal findings concerning the vulva in a female newborn might include skin tags or mucoid or bloody discharge.
What condition might be indicated by fusion of the labia in a female newborn?
Fusion of the labia might indicate an abnormality.
normal clitoris
uncovered in preterm or wasted infants
What is adrenal hyperplasia, and how might it affect the clitoris in a female newborn?
Adrenal hyperplasia is a condition characterized by excessive growth of the adrenal glands. It might result in an enlarged clitoris in a female newborn.
normal passage of urine
passed in first 12 hours
What might a poor stream of urine in the first 12 hours suggest in a newborn?
A poor stream of urine in the first 12 hours might suggest posterior urethral valve obstruction.
What is a normal finding concerning the position of the hands in a term infant?
A normal finding is a flexed position in a term infant.
What is Erb’s palsy?
Erb’s palsy is a condition resulting from injury to the brachial plexus, leading to weakness or paralysis of the arm.
abnormalities in the arms of newborns
clavicle or humerus fracture
What conditions might be indicated by abnormalities in the hands of a newborn?
Abnormalities in the hands of a newborn might include extra, fused, or missing digits, skin tags, single palmar crease, or hypoplastic nails.
What is a common finding concerning the legs of a newborn?
Mild bowing of the lower legs is a common finding in newborns.
What might dislocatable knees in a newborn indicate?
Dislocatable knees in a newborn might indicate breech presentation.
normal feet
positional deformation
What might clubbed feet indicate in a newborn?
Clubbed feet might indicate a congenital deformity where the foot is twisted out of shape or position.
What conditions might be indicated by abnormalities in the feet of a newborn?
Abnormalities in the feet of a newborn might include clubbed feet, or abnormal toes.
What is a normal behavioral response in a newborn concerning neurological status?
A normal behavioral response in a newborn is being alert and responsive, and cries but is consolable.
What might drowsiness and irritability indicate concerning neurological status in a newborn?
Drowsiness and irritability might indicate neurological abnormalities or distress in a newborn.
also jittery and inconsolable
What is a normal level of movement in a newborn concerning neurological status?
A normal level of movement includes being active and moving all limbs equally when awake, as well as stretching, yawning, and twisting the trunk.
What might absent or decreased movement indicate in a newborn concerning neurological status?
Absent or decreased movement might indicate neurological dysfunction or developmental issues in a newborn.
abnormal movement
jittery or convulsions
What is a normal tone in a newborn concerning neurological status?
A normal tone might include some hypotonia in preterm infants.
abnormal tone
hypotonia or hypertonia,. asymmetrical tone
normal pull to sit
Some initial head control
abnormal pull to sit
Totally floppy.
normal supported sitting
Holds head erect briefly, moves
head forward
abnormal supported sitting
Head flops back or forward. No
attempt to elevate head.
normal ventral suspension
Holds head in line with body
momentarily
abnormal ventral suspension
Totally floppy or very
hyperextended.
normal hands in neuro
Intermittently clenched. Opens
hands and moves individual
fingers when relaxed.
abnormal hands in neuro
Permanently clenched
normal cry
Good cry when awake
abnormal cry
Weak, high pitch or hoarse cry.
normal vision
Follows a face, bright light or
red object for 90°. Alternating or
intermittent squint
abnormal vision
Absent or poor following. Fixed
squint.
normal hearing
Responds to loud noise
abnormal hearing
No response.
normal sucking
Good suck and rooting reflexes
after 36 weeks gestation
abnormal sucking
Weak suck at term. Biting
normal rooting
Good symmetrical reflexes after
36 weeks.
abnormal rooting
absent rooting
normal moro reflex
Full extension then flexion of
arms and hands. Symmetrical
abnormal moro reflex
Absent, incomplete or
asymmetrical response
Why is it important to examine the hips of newborn infants?
It is important to examine the hips of newborn infants to exclude congenital dislocation or an unstable hip.
position of examining the hips
The infant is examined lying on his/her back with the hips flexed to a right angle and
knees flexed.
What is Barlow’s test used for in the examination of newborn hips?
Barlow’s test is used to demonstrate an unstable or dislocatable hip by applying pressure to the femoral head to assess its stability within the acetabulum.
Describe how Barlow’s test is performed.
Barlow’s test is performed by immobilizing the pelvis with one hand while moving the opposite thigh into mid-abduction with the other hand. If the hip is unstable, backward pressure on the lesser trochanter causes the femoral head to slip out of the acetabulum.
What is Ortolani’s test used for in the examination of newborn hips?
Ortolani’s test is used to detect congenital hip dislocation by feeling and hearing a “clunk” as the femoral head slips forward into its normal position in the acetabulum.
Explain how Ortolani’s test is performed.
Ortolani’s test is performed by abducting both thighs while the examiner’s fingers are over the greater trochanters and thumbs rest on the inner aspects of each thigh. If a hip is dislocated, a “clunk” can be felt and heard as the femoral head slips into the acetabulum.
What are the management options for hip abnormalities in newborns?
Management of hip abnormalities includes informing the parents, referral to Orthopaedic services, and potentially using the Pavlik Harness or surgical intervention if necessary
how to diagnosis congenital hip dislocation
Ultrasound is commonly used for diagnosis.
