Newborn exam Flashcards
What do you ask the grownup to do before examining the newborn?
Undress to diaper
What should you ask grownup before examining newborn?
Basic pregnancy and birth history: gestational age, issues during pregnancy/labour/delivery
Any congenital conditions in family
Feeding, passing pee and meconium (black poo)
Any concerns
How soon should a newborn pee and poop after birth?
Pee w/in 24h
Pass meconium w/in 48h
What features should you note on general observation of a newborn?
Skin: jaundice, cyanosis, bruising
Tone
Sleepiness/rousability
Nature of cry
What should you examine physically on general assessment of a newborn?
Weight
Length
Temperature
What should you do first in a newborn exam (beyond general observation)?
Auscultate heart and lungs: baby may start crying
What should you note on examination of the head (not face)?
Size, shape (?moulding from delivery) Head circumference (measure twice!) Palpate fontanelles
What should you note on examination of the face?
General appearance, symmetry (?dysmorphic)
Eyes: position, symmetry, size, shape (Down’s); red reflex
Ears: position, symmetry, size, shape; patency of external auditory meatus
Mouth: (clean glove and) palpate palate (cleft? high?), assess for tongue tie, assess suck
What are abnormal findings on assessment for red reflex, and what do they mean?
White: retinoblastoma
Absent: congenital cataracts
What should you note on examination of the upper limbs?
Shape, size, symmetry, deformity, movement
Count fingers
Note palmar creases (?Downs)
What should you do to assess the cardiovascular system in a newborn?
Auscultate heart (first / whenever not crying)
Palpate femoral, brachial, & radial pulses (rate, rhythm, volume)
Asses for radio-radial and radio-femoral delay
Palpate precordium for heart position (?dextrocardia)
Check cap refill time on sternum
What is the normal heart rate of a newborn?
110-160 bpm
What condition may be signified by radio-femoral delay?
Coarctation of the aorta
What condition may be signified by bounding pulses?
Patent ductus arteriosus
What should you do to assess the respiratory system in a newborn?
Auscultate
Note general pattern and depth
Listen for stridor, grunting
Look for nasal flaring, intercostal indrawing
Resp rate
What is the normal resp rate for a newborn?
30-60 bpm
What should you note on examination of the abdomen?
Inspect for distention
Check umbilicus for hernia, infection
Palpate for organomegaly, masses (Note: common to feel liver and/or spleen in healthy neonates)
What should you note on examination of the genitalia & anus?
Inspect carefully (clear M/F vs ambiguous; exclude hypospadias)
Palpate testes in boy
Check anus is patent
What should you note on examination of the back?
Inspect for defects, tufts of hair (spina bifida) Palpate spine (spina bifida occulta) Note spinal symmetry & curvatures
What are the forms of spina bifida?
Occult spinal dysraphism: ≥ 1 vertebrae do not form normally, and the spinal cord and meninges may also be affected.
In spina bifida cystica, the protruding sac can contain meninges (meningocele), spinal cord (myelocele), or both (myelomeningocele).
What should you note on examination of the lower limbs?
Inspect shape, size, symmetry, deformity, movement
Exclude club foot
Count toes
Assess for DDH (Barlow’s, Ortolani’s)
Which of Barlow and Ortolani assess for dislocation vs relocation?
Assessing for posterior dislocation:
- Barlow (Back): dislocates
- Ortolani (Open): relocates
What primitive reflexes should you assess in the neonatal exam?
Moro (warn parents first!)
Palmar grasp
Suckling (?strong suck – not rooting reflex)
All of above should be present from birth.
How is the Moro reflex assessed, and what do you expect to see?
Explain to parents, hold baby in front of you above mat
One hand under bottom, other hand supporting back, head, neck. Suddenly drop upper body back and down.
Arms should ABduct and extend, then ADduct and flex; baby may then cry
