Neonatal neurological examination

Question 1

Normal neonatal movement

Answer 1

Active, symmetrical, yet uncoordinated movements. While lying on their back, they freely turn their head.

Question 2

Flexed posture

Answer 2

Arms and legs are bent. The flexed posture persists for 48 hours. Later flexion gradually weakens.

Question 3

Normal muscle tone

Answer 3

Passive muscle tone:
- Resistance is felt when extending and flexing the limbs.

Active muscle tone:
- When lifted, the neonate maintains the back and head in one line.
- Can hold the head in a straight position when held upright.
- While lying on the stomach, maintains the tone of flexed limbs and lifts the head.

Question 4

Clinical symptoms of central-type facial nerve damage

Answer 4

• Facial asymmetry during crying.
• The mouth is pulled toward the healthy side.
• Facial folds are deeper on the healthy side.
• Movements of the forehead and eyelids are unaffected.

Question 5

Clinical symptoms of peripheral-type facial nerve damage.

Answer 5

• Facial asymmetry during crying.
• Drooping corner of the mouth.
• Drooping eyelid.
• Smoothed forehead wrinkles.

Question 6

Treatment for brachial plexus injury

Answer 6

• Conservative: prevention of contractures - immobilization during the first week and then physical therapy.
• Surgical: in case of complete nerve fiber disruption.

Question 7

Radiological signs of phrenic nerve injury

Answer 7

Relaxed diaphragm on the affected side.

Question 8

Physiological neonatal reflexes

Answer 8

Rooting, sucking, Babkin, upper and lower grasp, Moro, Babinski, protective, crossed extension [https://youtu.be/rHYk1sYsge0]

Question 9

Describe rooting reflex

Answer 9

• Gently touch the newborn’s cheek or corner of the mouth with a finger – stimulate the corner of the lips very gently: if the newborn feels discomfort, they will turn their head to the opposite side – do not touch the lips.
• The newborn turns their head toward the stimulus, opens their mouth, and actively searches for the breast.

Question 10

Describe Babkin reflex

Answer 10

Gently press the newborn’s palm with your fingers. The newborn opens their mouth and extends their head forward. This is most prominent before feeding.

Question 11

Describe grasp reflex

Answer 11

1. Upper (palmar):
   - When the palm of a newborn lying on their back is touched, they automatically curl their fingers into a fist.
   - Sometimes, the examiner’s finger is gripped so tightly that the newborn can be lifted up.
2. Lower:
   - The grasp reflex is also triggered in the legs: pressing the thumb on the sole of the foot causes the toes to curl.

Question 12

Describe Moro reflex

Answer 12

The newborn is held horizontally, and then suddenly, either the whole body or just the head is slightly lowered downward.

Phase 1:
- The newborn throws their arms laterally to the sides of the torso.
- The fingers of the hands spread out, and the back straightens.

Phase 2:
- The fingers of the hands and feet curl.
- The newborn hugs themselves with their arms.

Question 13

Describe protective reflex

Answer 13

When the newborn is placed on their stomach, they immediately turn their head to the side.

Question 14

Describe stepping reflex

Answer 14

The newborn is held upright by the armpits and placed on a horizontal surface. When the newborn is leaned forward, they will try to step.

Question 15

Describe Babinski reflex

Answer 15

The newborn lies on their back, and a finger is stroked along the outer edge of the sole from the toes to the heel. The big toe moves dorsally, the other toes spread out, and then they curl.