Neonatal Physical Exam Flashcards
Position of infant
Infants should have tonically flexed limbs when laid on their back
Erythema toxicum neonatorum
Common benign rash seen in full-term newborns. It usually appears in the first few days after birth and fades within a week.
Up to half of all newborns will have ETN
Normal heart rate for a newborn
100-155, regular
Slightly lower than we expect for fetal
Abdominal findings for a newborn
The spleen should not be palpable in a newborn
However, the liver may be palpable 1-2 cm beneath the costal margin in a healthy newborn.
Kidneys may also be palpable in the flanks of a newborn.
Examining the umbilical cord
You should be able to see two arteries and one vein, if the infant has not already been bathed.
Genital exam for newborns
In females: Assess the size of the labia majora, labia minora, and clitoris for signs of virilization that may indicate congenital adrenal hyperplasia.
In males: Palpate the testicles. Assess the length of the penis. Assess for hypospadias, phimosis, paraphimosis. and patency of the urethra meatus.
In both: Check for placement and patency of the anal canal. Assess for a sacral dimple.
Assessing pulses in a newborn
Assess the brachial and femoral pulses, rather than the radial and achilles pulses.
Barlow and Ortoloni test
Reflex assessments in the newborn
- Palmar grasp
- Plantar grasp
- Rooting
- Babinski
- Moro
- Galant
- Fencer
Caput succedaneum
Swelling, or edema, of an infant’s scalp that appears as a lump or bump on their head shortly after delivery. This condition is harmless and is due to pressure put on the infant’s head during delivery.
Cephalhematoma
Galant reflex
Elicited by holding the newborn in ventral suspension (face down) and stroking along the one side of the spine.
The normal reaction is for the newborn to laterally flex toward the stimulated side.
If the baby’s eyes are open at any time during your exam. . .
. . . examine them then
Babies don’t keep their eyes open for long.
Assessing a neonate’s hydration status
The fontanelle bulge is an excellent way to do so
Shown is a sunken fontanelle, a sign of infantile dehydration
Normal respiratory rate for a neonate
<60 breaths per minute
But note: Many infants are periodic breathers – breathing regularly for a minute or two but then with a short period of no breathing at all ensuing for 5-10 seconds. This is normal and should not be confused with apnea.
Rales in an otherwise healthy newborn are. . .
. . . probably nothing
Remember, they just came out of a fluid filled environment. Asymptomatic rales should be basically expected.
____ is an indicator that no significant heart disease is present, even in the presence of a murmur
Physiologic slowing rate phenomenon is an indicator that no significant heart disease is present, even in the presence of a murmur
such as slowing of heart rate when the infant is relaxed, calm, and quiet.
Murmurs mean ___ on the first day of life than at any other time
Murmurs mean less on the first day of life than at any other time
many of them gone by day 2-3 of life
a closing ductus arteriosus may cause a worrisome sounding, but only transient, murmur
Most male infants are born with ___, which resolves spontaneously.
Most male infants are born with phimosis, which resolves spontaneously.
Hypospadias
Most female infants are born with ___, which resolves spontaneously.
Most female infants are born with an enlarged labia majora, which resolves spontaneously.
This is due to the maternal hormone surge during pergnancy
Transient neonatal pustular melanosis
As the name implies. Transient and benign. Similar in natural history to erythema toxicum.
Equinovarus valgus
aka clubfoot
Secondary to fetal oligohydramnios
Galeazzi exam
Test for unilateral hip dislocation
The knees are in the midline position and flexed so the heels meet the buttocks. The knees should have symmetric height. This test doesn’t work for bilateral dislocation
Risk factors for developmental hip dysplasia
- Female-bodied infant
- History of breech presentation
Because of fetal positioning, many infants have ____ and mild degrees of these are normal.
Because of fetal positioning, many infants have forefoot adduction, tibial bowing or tibial torsion, or femoral ante-version and mild degrees of these are normal.
Pilonidal cyst
A pilonidal cyst is an abnormal pocket in the skin that usually contains hair and skin debris. A pilonidal cyst is almost always located near the tailbone at the top of the cleft of the buttocks.
Craniosynostosis
Immobility of the bones of the skull in a neonate
Craniotabes
Softness of the outer table of the medial part of the parietal bones
Pressure here causes a startling pingpong ball feel to this outer table. This “worrisome” finding spontaneously regresses.
Sub-galeal hemorrhage
Superficial to the periosteum of the skull. Crosses suture lines superficially.
Bleeding here can be massive, and is important to dinstinguish from the benign cephalhematoma.
Benign lesions of the mouth
Bohn’s nodules: Benign growths in the gums of a newborn
Epstein’s pearls: Benign pearl-like cysts often found at the junction of the hard and soft palate
The normal weight of a full term (38-42 week) infant is ___
The normal weight of a full term (38-42 week) infant is 2.5-4 kg
Normal head circumference of a newborn infant is. . .
. . . 33-38 cm
Only ___ are at risk for ABO hemolytic disease of the newborn
Only infants of blood type O mothers are at risk for ABO hemolytic disease of the newborn
This is because, for whatever reason, only these individuals produce IgG1 anti-A and anti-B (not AA/AO or BB/BO). It is usually much more mild than Rh mismatch though.
Normal urine output for a neonate
>1 mL/kg/hr
So, in a day for the average infant, >80 mL urine.
Unlike adult kidneys, neonatal kidneys can only concentrate urine to ___ mOsm.
Unlike adult kidneys, neonatal kidneys can only concentrate urine to 600-700 mOsm.
Parents should expect to see a wet diaper at least every ___ hours. If they don’t see one in ___ hours, they should supplement breastfeeding with formula.
Parents should expect to see a wet diaper at least every 12 hours. If they don’t see one in 24 hours, they should supplement breastfeeding with formula.
