Physical characteristic of

Newborn

: الطالبات عمل

جادالله اسماءالحشاش فاطمة

الكفارنة ختاممصلح نعمة

المملوك ايةسالمة صابرين

Physical examination

1st examination in delivery room or as soon as possible after delivery

2nd and more detailed examination after 24 h of life

Discharge examination with 24 h of discharge from hospital

Examination precaution

Hand washing Thermal environment Light and noise Brief examination time

APGAR Score

Score 0 1 2

Heart Rate Absent <100bpm >100bpm

Respiratory effort Absent, irregular Slow, crying Good

Muscle tone Limp Some flexion of extremities

Active motion

Reflex irritability (nose suction)

No response Grimace Cough or sneeze

Color Blue, pale Acrocyanosis Completely pink

General Measurements: Birth weight: 2800-4000 g. Head Circumference: 34-38 cm, about 2-3 cm larger than chest circumference.

Chest Circumference: 32.5- 35 cm. Head to heel length: 48-53cm.

Systematic physical examination:

Head Circumference

Head circumference is measured by wrapping the paper tape over the eyebrows and the around the occipital

1.Temperature

Temperature should be taken axillary

The normal temperature for infant is 36.2 – 37.2-0C.

Axillary temp.is 0.5-1 0c lower than rectal

Axillary temperature measurement. The thermometer should remain in place for 3 minutes .

Physical Examination

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. Skin:

General description:

At birth:

Color: bright red.

Texture: soft and has good elasticity.

Edema: is seen around eye, face, and scrotum

or labia.

Cyanosis: of hands & feet (acrocyanosis)

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General description of the skin

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Acrocyanosis

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1. Vernix Caseosa: Soft yellowish cream

layer that may thickly cover the skin of the

newborn, or it may be found only in the

body creases and between the labia.

The debate of wash it off or to keep it.

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Vernix Caseosa

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2. Lanugo hair:

- Distribution: The more premature baby is,

the heavier the presence of lanugo is.

- It disappears during the first weeks of

life

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3. Mongolian spots:

Black coloration on the lower back, buttocks,

anterior trunk, & around the wrist or ankle.

They are not bruise marks or a sign of

mental retardation, they usually

disappear during preschool years without

any treatment.

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Mongolian spots

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Mongolian spots

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4. Physiological Jaundice: will discussed later in

details.

5. Milia:

- Small white or yellow pinpoint spots.

- Common on the nose, forehead, & chin of the

newborn infants due to accumulations of secretions

from the sweat & sebaceous glands that have not yet

drain normally.

They will disappear within 1-2 weeks, they should not

expressed.

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Physiological Jaundice

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Milia

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6. Head:

The Anterior fontanel: is diamond in shape, located

at the junction of 2 parietal & frontal bones. It is 2-3

cm in width & 3-4 cm in length. It closes between 12-

18 months of age.

The posterior fontanel: is triangular in shape,

located between the parietal & occipital bones.

It closes by the 2nd month of age.

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Fontanels should be flat, soft, & firm. It bulge

when the baby cries or if there is increased in

ICP.

Two conditions may appear in the head:

Caput succedaneum & Cephalhematoma

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Caput succedaneum• An edematous swelling on the presenting portion of the scalp of an infant

during birth, caused by the pressure of the presenting part against the

dilating cervix. The effusion overlies the periosteum with poorly defined

margins.

• Caput succedaneum extends across the midline and over suture lines.

Caput succedaneum does not usually cause complications and usually

resolves over the first few days.

• Management consists of observation only.

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Caput succedaneum

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Cephalhematoma:

Cephalhematoma is a subperiosteal collection of

blood secondary to rupture of blood vessels

between the skull and the periosteum, in which

bleeding is limited by suture lines (never cross the

suture lines).

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Cephalhematoma

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7. Eyes:- Usually edematous eye lids

- Gray in color. True color is not determined until the

age of 3-6 months.

- Pupil: React to light

- Absence of tears

- Blinking reflex is present in response to touch

- Can not follow an object (simple fixation on

objects).

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Eyelid Edema

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Dysconjugate Eye Movements

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Congenital Glaucoma

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Congenital Cataracts

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8. Ears:

Position:

Startle Reflex:

Pinna (صيوان االدن) flexible, cartilage present.

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Normal Ears

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Ear Tag

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9. Nose:

Nasal Patency:

Nasal discharge –

thin white mucous

Normal Nose

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Dislocated Nasal Septum

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10. Mouth & Throat:

- Intact, high arched palate.

- Sucking reflex – strong and coordinated

- Rooting reflex

- Gag reflex

- Minimal salivation

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11. Neck:

Short, thick, usually surrounded by skin

folds.

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System assessment of the

neonates:

1. Gastrointestinal System:

Mouth should be examined for

abnormalities such as cleft lip and/or cleft

palate.

Epstein pearls are brittle, white, shine spots

near the center of the hard palate. They

mark the fusion of the 2 hollows of the

palate. If any; it will disappear in time.

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Cleft Palate

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Cleft Lip

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Cheeks: Have a fat appearance due

to development of fatty sucking pads

that help to create negative pressure

inside the mouth which facilitates

sucking.

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Normal Tongue Ankyloglossia

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Ankyloglossia

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Gum: May appear with a quite irregular

edge.

Sometimes the back of gums contain whitish

deciduous teeth that are semi-formed, but

not erupted

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Irregular edges with Natal Teeth

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Natal Tooth

Heart : •Observation : heart rate, rhythm, quality of heart sounds,

active precordium•Position of heart : may be determined by auscultation•Presence of murmur•Palpate the pulses (femoral) & define whether its normal,

weak or absent.•Check for perfusion•Signs of congestive heart failure : gallop, tachycardia &

abnormal pulses

RESPIRATIONS.The respirations of a newborn infant are

irregular in depth, rate, and rhythm and vary from 30 to 60 beats per minute.

Respirations are affected by the infant's activity (that is, crying). Normally,

respirations are gentle, quiet, rapid, and shallow. They are most easily observed by watching abdominal

movement because the infant's respirations are accomplished mainly by the diaphragm and abdominal muscles.

No sound should be audible on inspiration or expiration

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12- Abdomen

• Cylindrical in Shape

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Normal Umbilical Cord

• Bluish white at birth with 2 arteries & one vein.

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Meconium Stained Umbilical Cord

Normally, the newborn has urine in his bladder and voids at birth or some hours later.

Female genitalia: Labia and clitoris usually edematous. Urethral meatus behind clitoris. Vernix caseosa between labia..

Urinary System:

Physical ExaminationAmbiguous Genitalia Closed Rectum

Urethral opening is at tip of glans pens.

Testes palpable in each scrotum. Scrotum usually large edematous, pendulous and covered with rugae and pigmented

Male genitalia:

Physical Examination

Normal TestesUndescended

Testes

Male Genitalia

ASSESSMENT

.Anus :• Check to ensure anus patent• Insert rectal temperature into the anus as far

as 2.5cm• Place baby in lateral position for this

procedure

There are maternal hormones that have crossed through the placenta to

the baby. After birth these are withdrawn and cause some normal

such as:

Endocrine system:

Swollen breasts: This appears on 3rd day in both males and females. It lasts for 2-3 weeks and gradually disappears without treatment. Sometimes there is also breast secretion called “Witch’s milk”.

Infantile menstruation: a few spots of blood for 1-2 days can be seen in the diaper.

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Maternal hormonal withdrawal

• Female genitalia, normal with vaginal discharge

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Infantile menstruation

ASSESSMENT

.Check baby’s back :• Turn baby to the side and ensure baby’s back

is straight and flat.• Use the fingers and check from neck to

sacrum• Ensure there is no curves ,lumps ‘hair patches’

and spinal bifida.

Neural tube defects

ASSESSMENT

.Check feet:• Both leg are of same length• No fracture and paralysis • Both legs have same toes and no decrease

number of digits on the toes.

ASSESSMENT.Basic neurological test :

Grasp reflexMoro reflex

Sucking reflexRooting reflex

Examination

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Thank you