PE of the Newborn

Eyes
Structure and appearance of the eye and its surroundings ROR
no dullness/irregularities

Dolls eye maneuver

Labyrinthine and neck reflexes More useful in inspecting the eyes thn pulling lids apart

White pupillary reflex (leukocoria)

Cataract Abnormality of the lens, vitreous, or fundus

Subconjunctival hemorrhages
Benign, resolve by 2 weeks

Ears
Shape Size Position
Imaginary horizontal line from inner and outer canthi of the eye across the face Low-set ears in congenital anomalies

Presence of a canal Presence of any tags or pits

Preauricular skin tags Hairy ears (seen in infants of diabetic mothers)

Nose
Shape Size Patency
Choanal atresia (passage of NGT)

Swelling over the nasolacrimal duct Size of philtrum Definition of the nasolabial folds

Mouth
Tongue, buccal mucosa, palate, back of the mouth Palatal/gum/lip clefts Epstein pearls
Keratin-containing cysts

Predeciduous and true deciduous teeth Macroglossia

Beckwiths syndrome; congenital hypothyroidism

Ranula
Cystic swelling of the floor of the mouth

Mucocoele
Small lesion of the oral mucosa 2 to trauma to salivary gland ducts

Neck
Rooting reflex for easier examination SCM for hematoma Thyroid enlargement Thyroglossal duct cyst

*most common neck masses: vascular malformations, abnormal lymphatic tissue, teratomas, cystic hygromas, dermoid cyst

Chest
Chest symmetry
Asymmetry, tachypnea, retractions = respiratory distress Barrel chest = meconium aspiration pneumoniad/t hyperaeration & airtrapping
Clavicular fracture
/(-) movement, pain on movement of affected side Deformity/discoloration Crepitus or irregularity

Breast
1cm in diameter enlarged (3-4cm) d/t maternal estrogen Witchs milk Supernumerary nipples

 Presence and equality of breath sounds

Absent/unequal = pneumothorax/atelectasis Absent + bowel sounds = diaphragmatic hernia

*more bronchial = better transmission of large airway sounds

Heart
Precordium Rate, rhythm, quality of heart sounds
HR 120-160 bpm

Presence/absence of murmurs
Flow murmurs
Represent transition fetal -> neonatal circulation

If persisting > 12h of life = structural abnormality

Abdomen
Defects
Omphalocoele
Centrally located umbilicus with intestines covered by eritoneum

Palpate for distention, tenderness, masses

Start below the umbilicus on both sides and proceed towards the diaphragm Spleen tip at the costal margin; liver 2cm below the costal margin
Splenomegaly - CMV, rubella, sepsis Hepatomegaly - CHF, hepatitis, sepsis

Gastrochisis
Intestines not covered by peritoneum

Scaphoid abdomen
CDH

Bowel sounds
Relatively inactive

Kidney (R)
PKD, RVT, hydronephrosis

 Umbilicus
Bleeding, infection, granuloma, abnormal communication with intra-abdominal organs Discharge, redness, edema around the base
Patent urachus or omphalitis

2A1V Translucent cord (if yellow-green, meconiumstained)

Hips
Barlows Ortolani

Genitalia
Male Normal penile length at birth >2cm Hydrocoeles common (disappear by 1 y/o) Female Redundant hymenal tissue or tags Vaginal discharge (often blood-tinged) d/t maternal estrogen withdrawal
Pseudomenses

Clitoromegaly d/t masculinization or virilizing tumor Ambiguous genitalia EMERGENCY

Extremities
Diminished/absent pulses Syndactyly Polydactyly Simian crease
Downs syndrome; normal variant
Foot turned downward and inward, sole directedmedially

Talipes equinovarus (clubfoot)

Metatarsus varus
Forefoot adduction; corrects spontaneously

Trunk & Spine

Gross defects
Pigmentation or hairy tufts = spina bifida occulta Sacral or pilonidal dimple = menigocoele

Anus & Rectum

Anal patency = r/o imperforate anus Anal position Meconium passage w/in 48h of birth