Newborn Physical Exam (Part 1)

by Brian Alverson, MD

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    00:01 In this lecture, I’m going to discuss the newborn physical exam.

    00:06 So before I even start, I want to say two things about the newborn exam.

    00:11 One is it can be tricky from the standpoint of making sure that the child is adequately warm.

    00:18 So sometimes, you have to be a little bit quick because if you leave the child unexposed for a period of time, they can start getting cold.

    00:27 You will notice that the skin starts to mottle or look like marble a little bit and that’s a sign that infant is getting cold.

    00:34 If you can, you can do a very careful exam under a warmer.

    00:39 The other thing about the newborn exam is it can be frustrating especially with auscultation and the reason is newborn infants might cry and make it hard to hear what’s going on.

    00:51 It’s okay if you leave an infant and then come back to them later when they’re sleeping to get the rest of your exam.

    00:59 But let’s go through the newborn exam really carefully here, so we can understand not only for an exam that might happen but also for your general practice on the pediatric wards.

    01:10 So first, let’s review vital signs and growth parameters.

    01:14 It’s important that you have the height, the weight and the head circumference on every infant you exam.

    01:20 And it’s important we review the vital signs.

    01:23 The heart rate should be usually between 90 and 160 in a healthy newborn child.

    01:29 The respiratory rate is usually high between 30 or 60, that’s fine.

    01:35 From the standpoint of blood pressure, we often don’t have one.

    01:40 This is because it’s a bit challenging to make.

    01:43 We will use it in infants who are ill, but if an infant is well, the blood pressure is not a critical measurement.

    01:51 And remember, pulse ox is abnormal in the first day of life and very abnormal in the first 10 minutes.

    02:00 So during the first 10 minutes, it’s normal for him to go from 60% at birth to 90%.

    02:07 Then it can take the rest of the day to go up to 100%, but expect abnormalities in the pulse ox early.

    02:13 In the second day of life, that pulse ox should pretty much be normal.

    02:17 In fact, many centers use that pulse ox as a screen for congenital heart disease.

    02:23 Okay.

    02:24 Now you’ve got the vitals, you got the height, the weight and the head circumference and you’ve plotted them so you have percentiles.

    02:31 Now, we’re going to do an exam and we’re going to start at the head and work our way down.

    02:36 The first thing you’re going to do on the head is feel the sutures.

    02:41 Early in birth, sometimes they are slightly overriding and elevated, but that should stabilize out relatively quickly.

    02:48 Also you should feel a fontanelle in the anterior portion of the skull as is pictured here and a very small sort of finger-large posterior fontanelle.

    03:00 You should feel both of those and you should feel all those sutures and if you feel any asymmetries or abnormalities, those should be noted.

    03:07 This could be a partial craniosynostosis for example.

    03:12 Next, we’re going to check the eyes and we absolutely are going to do a red reflex.

    03:18 The red reflex is useful because when you’re looking in and you’re seeing not only the red reflex but also the possibility of slip lenses which can happen with a variety of infant diseases.

    03:29 Also the red reflex may be absent in a patient with retinoblastoma.

    03:34 So it’s crucial to check those eyes.

    03:37 Also look at the irises, if a coloboma is present, this might be CHARGE syndrome.

    03:43 Now, take a look at the ears.

    03:46 As you draw a line backward from the eye, it should intersect the top third of that ear.

    03:53 Also, you should note any abnormalities of the ear.

    03:56 Is it posterior placed, but is it rotated? Are there pits? Are there tags? Abnormalities of the ear may be associated with syndromes or may be even just associated with renal abnormalities.

    04:10 For reason I don’t understand, ears and kidneys can sometimes go together in so many different ways.

    04:16 Next, we’re going to check the mouth.

    04:18 We’re going to look for abnormalities of the lips.

    04:20 We’re also going to put our finger into the mouth and palpate the top of the mouth.

    04:26 If there is abnormalities and a cleft palate, you may note them obviously on exam.

    04:32 But a palate on the inside may be high arched or may be abnormal as well with a lack of patency on the inside and that should all be noted.

    04:43 While we’ve got our finger in there, check the baby's suck.

    04:46 It should be vigorous.

    04:47 That’s technically part of the neuro exam, but I would absolutely do it.

    04:51 Also, we’re going to check the nose.

    04:53 In pretty much any infant at some point, we may suck out both nares.

    04:58 That usually is done in the resuscitating room, but we’re going to check patency of the nose.

    05:04 If a tube goes in but can’t get through, that patient may have choanal atresia which can cause respiratory distress in an infant.

    About the Lecture

    The lecture Newborn Physical Exam (Part 1) by Brian Alverson, MD is from the course Neonatology (Newborn Medicine).

    Included Quiz Questions

    1. 90-160 beats per minute
    2. 45-90 beats per minute
    3. 60-100 beats per minute
    4. 150-200 beats per minute
    5. 180-220 beats per minute
    1. Mottled skin.
    2. Pale skin.
    3. Cyanosed skin.
    4. Blushing skin.
    5. Rough skin.
    1. Head circumference.
    2. Leg circumference.
    3. Neck circumference.
    4. Chest circumference.
    5. Abdomen circumference.

    Author of lecture Newborn Physical Exam (Part 1)

     Brian Alverson, MD

    Brian Alverson, MD

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    By Roberts V. on 01. December 2017 for Newborn Physical Exam (Part 1)

    Very well explained physiology and very important things in newborn examination.

    Very good overview of the newborn examination
    By Agnes L. on 30. May 2017 for Newborn Physical Exam (Part 1)

    Well explained overview of the process behind the newborn exam, as well as what common abnormalities you may find.