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Newborn: complete physical exam within 24 hours of birth
Listen to heart and lung first when the infant is quiet
Warming the statescope before using
3
VITAL SIGN
Temperature
Respirations: normal rate is 40-60 breaths/min
Blood Pressure
Pulse rate: normal rate is 100-180 beats/min
4
HEAD CIRCUMFERENCE, LENGTH, WEIGHT, AND GESTATIONAL AGE
Head circumference and percentile: place the measuring tape around the front of the head (above the brow) and the occipital area, the tape should be above the ears, normally 32-37 cm at term.Length and percentileWeight and percentileAssessment of gestational age
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SKIN
1. COLORPlethora (deep, rosy red color)- common in polycytemia- can be seen in overoxygenation and
overheated infant- Erythema neonatorum: normal
phenomenon in transition period and can occur when the infant has been stimulated
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JaundicePallor (washed-out, whitish appearance)Cyanosis - Central cyanosis: bluish skin
including the tongue and lips- Peripheral cyanosis: bluish skin with
pink lips and tongue- Acrocyanosis: bluish hands and feet only
SKIN
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SKINExtensive bruising (ecchymoses): prolonged and difficult delivery‘Blue on pink’ or ‘pink on blue’: poor perfusion, inadequate oxygenation, inadequate ventilation, or polycytemia.Harlequin coloration (clear line of demarcation between an area of redness and an area of normal coloration)Mottling (lacy red pattern): maybe seen in healthy infants and in those with cold stress, hypovolemia, or sepsis. Persistent mottling (cutis marmorata) found in infants with Down syndrome, trisomy 13 or trisomy 18.
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Vernix caseosa: substance that covers the skin until 38th week of gestationCollodion infant: skin resembles parchment, restriction in growth of the nose and ears.Dry skin: postdate or postmature infant, congenital syphillis, and candidiasis
SKIN
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2. RASHESMilia: withish, pinhead-sized on chin, nose, forehead, and cheeks.Erythema toxicum: small areas of red skin with a yellow-white papule in the center.Candida albicans rash: erythematous plaques with sharply demarcated edges.Transient neonatal pustular melanosis: pustules, ruptured vesicupustules, and hiperpigmented macules.
SKIN
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Acne neonatorum: comedones and papules over the cheeks, chin, and forehead.
Herpes simplex: pustular vesicular rash, vesicles, bullae, or denuded skin.
SKIN
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SKIN
3. Nevi Macular hemangioma (‘stork bites’): dissappear spontaneously within 1st year of life.Port-wine stain (nevus flammeus): does not blanch with pressure and not disappear with time. Mongolian spot: dark blue or purple bruise-like makular spots, most common birthmark
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SKIN
Cavernous hemangioma: large, red, cyst-like, firm, ill-defined mass. If associated with thrombocytopenia (Kasabach-Merrit syndrome)Strawberry hemangioma (macular hemangioma): flat, bright red, sharply demarcated lesions.
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HEAD
Anterior and posterior fontanelles- anterior fontanelle usually closes at 9-12 mo and the posterior at 2-4 moMolding: temporary asymmetry of the skull resulting from the birth process.Caput succedaneumCephalhematomaSubgaleal hematoma
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Increased intracranial pressure:
- bulging anterior fontanelle
- separated sutures
- paralysis of upward gaze (setting-sun
sign)
- prominent veins of the skalp
- increasing macrocephaly
HEAD
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Craniosynostosis: premature closure of one or more sutures
Craniotabes: softening of the skull
Plagiocephaly: oblique shape of a head, asymmetric and flattened.
HEAD
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NECK
Eliciting the rooting reflex
Palpate the sternocleidomastoid
Short neck: Turner’s, Noonan’s, and Klippel-Feil syndromes
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FACE
Note the general shape of the nose, mouth, and chinNote the presence of hypertelorism (eyes widely separated)Note the presence of low-set earsFacial nerve injury: unilateral branches of the facial nerve
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EARS
Look for unusual shape or positionLow-set ears: congenital anomaliesPreauricular skin tags (papillomas): benignHairy ears: infants of a diabetic mothersGross hearing: when infant blinks in response to loud noises
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EYESCheck the red reflex with an ophthalmoscopeOpacification of the lens: cataractSclera bluish tint: prematureSclera deep blue: osteogenesis imperfectaBrushfield’s spots (salt-and-pepper specling of the iris): Down syndromeSubconjunctival hemorrhage: 5% newborn infant.Conjunctivitis
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NOSE
Nasal flaring: respiratory distress
Sniffing and discharge: congenital syphilis
Sneezing: response to bright or drug withdrawal.
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MOUTH
Ranula: cystic swelling in the floor of the mouth.Epstein’s pearls: keratin-containing cystsMucocele: small lesion on the oral mucosaNatal teeth:- Predeciduous teeth: supernumerary teeth- True deciduous teeth: true teeth that erupt
early.
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Macroglossia: enlargement of the tongue, can be seen in Beckwith’s syndr and Pompe’s disease
Frothy or copious saliva: esophageal atresia with tracheoesophageal fistula.
Thrush: sign of infection C. albicans.
MOUTH
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CHEST
Observation Breath soundPectus excavatumBreast in a newborn: - usually 1cm in diameter in term- abnormally 3-4 cm: effects of maternal
estrogens- witch’s milk: white discharge
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HEART
Murmur: VSD, PDA, Coarctatio aorta, PS, PA, TA, TGA, etc
Palpate the pulses (femoral, pedal, radial, and brachial)
Check for signs of CHF: gallop, tachypnea, hepatomegaly, wheezes and rales, tachycardia, and abnormal pulses.
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ABDOMEN
Observation: omphalochele, gastroschisis, scaphoid abdomen.
Auscultation
Palpation: check for distention, tenderness, or masses.
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UMBILICUS
Two arteries and one vein
Normal cord: translucent
Greenish-yellow color: meconium staining
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GENITALIA
Male- check dorsal hood, hypospadias,
epispadias, and chordee.- normal penile leghth at birth is > 2 cm- Determine site of meatus, verife the
testicles and the color of scrotumFemale- examine the labia and clitoris
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ANUS AND RECTUM
Check for patency of the anus
Check the position of the anus
Meconium should pass within 48 h
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EXTREMITIES
Syndactyly : abnormal fusion of the digitsPolydactyly: supernumerary digitsSimian crease: a single transverse palmar crease (Down syndrome)Talipes equinovarus (clubfoot): foot is turn downward and inward and the sole is directed mediallyMetatarsus varus: adduction of the forefoot
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TRUNK AND SPINE
Check for
- any gross defect of the spine
- abnormal pigmentation
- hairy patches over the lower back
- sacral or pilonidal dimple: small
meningocele
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HIPSCongenital hip dislocationOrtolani and Barlow maneuvers:- place in the frog position- abduct the hips by using middle finger to apply
gentle inward and upward pressure over the greater trochanter (Ortolani’s sign)
- adduct the hips by using the thumb to apply outward and backward pressure over the inner thigh (Barlow’s sign)
- a click of reduction and a click of dislocation: hip dislocation.
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NERVOUS SYSTEM
Observe for abnormal movement or excessive irritabilityMuscle tone: hypotonia, hypertoniaReflexes: rooting, glabellar, grasp, neck-righting, and moroCranial nervesMovementPeriveral nerves: Erb-Duchenne paralysis, Klumpke’s paralysis
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General sign of neurologic disorder:- Symptom of increased ICP- Hypotonia or hypertonia- Irritability or hyperexcitability- Poor sucking and swallowing reflexes- Shallow, irregular respirations- Apnea- Apathy- Staring- Seizure activity- Asymmteric reflexes
NERVOUS SYSTEM