Neonatal Physical Exam

Question 1

Position of infant

Answer 1

Infants should have tonically flexed limbs when laid on their back

Question 2

Erythema toxicum neonatorum

Answer 2

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

Question 3

Normal heart rate for a newborn

Answer 3

100-155, regular

Slightly lower than we expect for fetal

Question 4

Abdominal findings for a newborn

Answer 4

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.

Question 5

Examining the umbilical cord

Answer 5

You should be able to see two arteries and one vein, if the infant has not already been bathed.

Question 6

Genital exam for newborns

Answer 6

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.

Question 7

Assessing pulses in a newborn

Answer 7

Assess the brachial and femoral pulses, rather than the radial and achilles pulses.

Question 8

Barlow and Ortoloni test

Answer 8

Question 9

Reflex assessments in the newborn

Answer 9

• Palmar grasp
• Plantar grasp
• Rooting
• Babinski
• Moro
• Galant
• Fencer

Question 10

Caput succedaneum

Answer 10

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.

Question 11

Cephalhematoma

Answer 11

Question 12

Galant reflex

Answer 12

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.

Question 13

If the baby’s eyes are open at any time during your exam. . .

Answer 13

. . . examine them then

Babies don’t keep their eyes open for long.

Question 14

Assessing a neonate’s hydration status

Answer 14

The fontanelle bulge is an excellent way to do so

Shown is a sunken fontanelle, a sign of infantile dehydration

Question 15

Normal respiratory rate for a neonate

Answer 15

<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.

Question 16

Rales in an otherwise healthy newborn are. . .

Answer 16

. . . probably nothing

Remember, they just came out of a fluid filled environment. Asymptomatic rales should be basically expected.

Question 17

____ is an indicator that no significant heart disease is present, even in the presence of a murmur

Answer 17

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.

Question 18

Murmurs mean ___ on the first day of life than at any other time

Answer 18

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

Question 19

Most male infants are born with ___, which resolves spontaneously.

Answer 19

Most male infants are born with phimosis, which resolves spontaneously.

Question 20

Hypospadias

Answer 20

Question 21

Most female infants are born with ___, which resolves spontaneously.

Answer 21

Most female infants are born with an enlarged labia majora, which resolves spontaneously.

This is due to the maternal hormone surge during pergnancy

Question 22

Transient neonatal pustular melanosis

Answer 22

As the name implies. Transient and benign. Similar in natural history to erythema toxicum.

Question 23

Equinovarus valgus

Answer 23

aka clubfoot

Secondary to fetal oligohydramnios

Question 24

Galeazzi exam

Answer 24

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

Question 25

Risk factors for developmental hip dysplasia

Answer 25

• Female-bodied infant
• History of breech presentation

Question 26

Because of fetal positioning, many infants have ____ and mild degrees of these are normal.

Answer 26

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.

Question 27

Pilonidal cyst

Answer 27

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.

Question 28

Craniosynostosis

Answer 28

Immobility of the bones of the skull in a neonate

Question 29

Craniotabes

Answer 29

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.

Question 30

Sub-galeal hemorrhage

Answer 30

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.

Question 31

Benign lesions of the mouth

Answer 31

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

Question 32

The normal weight of a full term (38-42 week) infant is ___

Answer 32

The normal weight of a full term (38-42 week) infant is 2.5-4 kg

Question 33

Normal head circumference of a newborn infant is. . .

Answer 33

. . . 33-38 cm

Question 34

Only ___ are at risk for ABO hemolytic disease of the newborn

Answer 34

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.

Question 35

Normal urine output for a neonate

Answer 35

>1 mL/kg/hr

So, in a day for the average infant, >80 mL urine.

Question 36

Unlike adult kidneys, neonatal kidneys can only concentrate urine to ___ mOsm.

Answer 36

Unlike adult kidneys, neonatal kidneys can only concentrate urine to 600-700 mOsm.

Question 37

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.

Answer 37

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.