Newborn assessment

Skin
⁃ color and appearance
⁃ Perfusion : normal / mottling
⁃ Skin condition, Anamolies

Temperature and sugar

Head and neck

⁃ fontanelle and suture
 to determine the width and the presence of pre mature fusion
or cranial synostosis
 Normal should be soft and nonbulging, with the anterior
larger than the posterior
⁃ Caput / cephalohematoma
 subperiosteal hemorrhage ( btw
skull and periosteum) that does
not cross the suture lines
surrounding the respective bone

⁃ Chignon ( caput succedaneum )

 diffuse, edematous, often
dark swelling of the soft
tissue of the scalp that
extends across the midline
and suture lines.
 A/w head molding
  Due to prolong labor

⁃ Subaponeurotic hemorrhage

⁃ Sternocleidomastoid / torticollis
 Torticollis >> wry neck ( twisted), due to dystonia
 fixed or dynamic posturing of the head and neck in tilt,
rotation, and flexion
⁃ Cranial anomalies

Face and oral cavity

⁃ neck : short and symmetrical
⁃ Dysmorphic features
⁃ Eye + fundus
 Red reflex
 White reflex (leukokoria) >> result of cataracts, ocular
tumor, severe chorioretinitis, persistent hyperplastic
primary vitreous, or retinopathy of prematurity
 Before 28 weeks’ gestational age, the eyelids may be fused.
⁃ Nose
⁃ Ear
⁃ Mouth , hard and soft palate

CVS, chest and respi

⁃ chest symmetry , nipple , breast
  Asymmetry >> abs ensue of pectoralis muscle
⁃ Clavicles >> fracture
⁃ Apex, pectus , abnormalities
⁃ Thrill, murmur, abnormalities
⁃ Respi rate
⁃ Sign of respi distress
⁃ Auscultation
⁃ Femoral pulse
⁃ Pre discharge Lower limb SPO2

Abdomen and GI tract

⁃ Appearance
⁃ Palpate :
 Mass
 Kidney
 Liver
 Spleen
⁃ Umbilicus : 2 arteries , 1 vein
⁃ Feeding : vomiting
⁃ Anus
 Location
 Patency

Groin and genitalia

⁃ genitalia : male / female/ ambiguous(uncertain)


Male
⁃ Location of urethra meatus
⁃ Penis
⁃ Scrotum : testis descended / hydorocele/ hernia

Female
⁃ Location of urethral meatus
⁃ Clitoris
⁃ Labia majora/ minora
⁃ Hymenal opening , tags

Hips
⁃ hip stability :
 Barlow
 Ortani
 Hip click/ clunk


⁃ Crease asymmetry / abnormal limb length
⁃ Gluteal fold asymmetry or leg length discrepancy is suggestive
of dysplasia

Spine ( felt from cervical to sacrum)

⁃ sacral pits
 associated with occult spinal dysraphism (e.g. spina
bifida occulta , tethered cord syndrome >>The spinal
cord normally hangs freely within the spinal canal.
 Tethered cord syndrome is a disorder that occurs when
tissue attached to the spinal cord limits its movements)
⁃ Mass :lipomas or meningomyelocele
⁃ Tuft of hair >> spina bifida
⁃ Others




Limbs
⁃ arm , hands and fingers
⁃ Syndactyly
⁃ Limb anomalies
⁃ Legs, feet and toes
⁃ Talipus equinovarus
⁃ Webbed toes



CNS and reflexes

⁃ good cry
⁃ Tone
 ⁃ Moro/ startle
 Moro : present at birth and gone in 3 to 6 month
 elicited by sudden, slight dropping of the supported
head from a slightly raised supine position (sudden loss
of support, when the infant feels as if it is falling),
which should elicit opening of the hands and extension
and abduction (opening) of the arms, followed by upper

extremity flexion and a cry.



⁃ Sucking/ rooting
 Turning of head toward light tactile stimulation of
perioral area
 Present by 32 weeks gestation
⁃ Palmar/plantar grasp
⁃ Palmar : present by 28 weeks’ gestation and gone by 4 months
of age.