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Division of PerinatologyDepartment of Child Health Medical
School
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Newborn: complete physical exam within 24
hours of birth
Listen to heart and lung first when the infantis quiet
Warming the statescope before using
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VITAL SIGN
Temperature
Respirations: normal rate is 4!"
breaths#min
$lood %ressure
%ulse rate: normal rate is &!&' beats#min
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HEAD CIRCUMFERENCE, LENGTH,
WEIGHT, AND GESTATIONAL AGE
(ead circumference and percentile: placethe measuring tape around the front of the
head )abo*e the brow+ and the occipital area,the tape should be abo*e the ears, normally-2!-. cm at term/
Length and percentileWeight and percentile
0ssessment of gestational age
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GENERAL APPEARANCE
0cti*ity
1in color
3b*ious congenital abnormality
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SKIN
&/ 3L3R
%lethora )deep, rosy red color+
! common in polycytemia
! can be seen in o*eroxygenation and
o*erheated infant
! 5rythema neonatorum: normal
phenomenon in transition period and can
occur when the infant has been stimulated
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6aundice
%allor )washed!out, whitish appearance+
yanosis! entral cyanosis: bluish sin
including the tongue and lips
! %eripheral cyanosis: bluish sin with pin lips and tongue
! 0crocyanosis: bluish hands and feet only
SKIN
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Polycytemia and Pallor
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Cyanosis
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SKIN
5xtensi*e bruising )ecchymoses+: prolonged anddifficult deli*ery
7$lue on pin8 or 7pin on blue8: poor perfusion,
inadequate oxygenation, inadequate *entilation, orpolycytemia/
(arlequin coloration )clear line of demarcationbetween an area of redness and an area of normalcoloration+
9ottling )lacy red pattern+: maybe seen in healthyinfants and in those with cold stress, hypo*olemia,or sepsis/ Persistent mottling (cutis marmorata)foundin infants with own syndrome, trisomy &- or
trisomy &'/
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Persistent mottling (cutismarmorata)
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;ernix caseosa: substance that co*ers thesin until -'thwee of gestation
ollodion infant: sin resembles parchment,restriction in growth of the nose and ears/
ry sin: postdate or postmature infant,
congenital syphillis, and candidiasis
SIN
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2/ R01(51
9ilia: withish, pinhead!si
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0cne neonatorum: comedones and papules
o*er the chees, chin, and forehead/
(erpes simplex: pustular *esicular rash,
*esicles, bullae, or denuded sin/
SIN
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SIN
-/ Ne*i
9acular hemangioma )7stor bites8+:
dissappear spontaneously within &styear oflife/
%ort!wine stain )ne*us flammeus+: does notblanch with pressure and not disappear with
time/9ongolian spot: dar blue or purple bruise!lie maular spots, most common birthmar
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SIN
a*ernous hemangioma: large, red, cyst!
lie, firm, ill!defined mass/ =f associated withthrombocytopenia (Kasabach-Merritsyndrome)
1trawberry hemangioma )macularhemangioma+: flat, bright red, sharplydemarcated lesions/
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HEAD
0nterior and posterior fontanelles
! anterior fontanelle usually closes at >!&2 mo
and the posterior at 2!4 mo9olding: temporary asymmetry of the sullresulting from the birth process/
aput succedaneumephalhematoma
1ubgaleal hematoma
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=ncreased intracranial pressure:
! bulging anterior fontanelle
! separated sutures
! paralysis of upward ga
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!"#$%&$ '( ('&)*&+##+
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raniosynostosis: premature closure of one
or more sutures
raniotabes: softening of the sull
%lagiocephaly: oblique shape of a head,
asymmetric and flattened/
HEAD
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NEC
5liciting the rooting reflex
%alpate the sternocleidomastoid
1hort nec: Turners, Noonans, and Klippel-Feil
syndromes
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FACE
Note the general shape of the nose, mouth,and chin
Note the presence of hypertelorism )eyeswidely separated+
Note the presence of low!set ears
?acial ner*e in@ury: unilateral branches ofthe facial ner*e
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EARS
Loo for unusual shape or position
Low!set ears: congenital anomalies
%reauricular sin tags )papillomas+: benign
(airy ears: infants of a diabetic mothers
Aross hearing: when infant blins in
response to loud noises
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EES
hec the red reflex with anophthalmoscope
3pacification of the lens: cataract
1clera bluish tint: premature1clera deep blue: osteogenesis imperfecta
$rushfield8s spots )salt!and!pepper specling
of the iris+: own syndrome1ubcon@uncti*al hemorrhage: BC newborninfant/
on@uncti*itis
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NOSE
Nasal flaring: respiratory distress
1niffing and discharge: congenital syphilis
1nee
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MOUTH
Ranula: cystic swelling in the floor of themouth/
5pstein8s pearls: eratin!containing cysts9ucocele: small lesion on the oral mucosa
Natal teeth:
! Predeciduous teeth: supernumerary teeth! True deciduous teeth: true teeth that erupt
early/
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9acroglossia: enlargement of the tongue,
can be seen in Bec!iths syndrand Pompes
disease?rothy or copious sali*a: esophageal atresia
with tracheoesophageal fistula/
Thrush: sign of infection / albicans/
MOUTH
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Drooling
of saliva
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CHEST
3bser*ation
$reath sound
%ectus exca*atum$reast in a newborn:
! usually &cm in diameter in term
! abnormally -!4 cm: effects of maternal estrogens
! witch8s mil: white discharge
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HEART
9urmur: ;1, %0, oarctatio aorta, %1, %0,
T0, TA0, etc
%alpate the pulses )femoral, pedal, radial,and brachial+
hec for signs of (?: gallop, tachypnea,
hepatomegaly, whee
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A!DOMEN
3bser*ation: omphalochele, gastroschisis,
scaphoid abdomen/
0uscultation
%alpation: chec for distention, tenderness,
or masses/
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Scaphoid abdomen Abdomen distention
GastroschisisOmphalocele
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UM!ILICUS
Two arteries and one *ein
Normal cord: translucent
Areenish!yellow color: meconium staining
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GENITALIA
9ale
! chec dorsal hood, hypospadias,
epispadias, and chordee/! normal penile leghth at birth is D 2 cm
! etermine site of meatus, *erife the
testicles and the color of scrotum?emale
! examine the labia and clitoris
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LMPH NODES
%alpable lymph nodes usually in the inguinal
and cer*ical --C of normal neonates/
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ANUS AND RECTUM
hec for patency of the anus
hec the position of the anus
9econium should pass within 4' h
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Imperforate analmembrane
Atresia ani
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E-TREMITIES
1yndactyly : abnormal fusion of the digits
%olydactyly: supernumerary digits
1imian crease: a single trans*erse palmarcrease )own syndrome+
Talipes equino*arus )clubfoot+: foot is turn
downward and inward and the sole isdirected medially
9etatarsus *arus: adduction of the forefoot
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TRUN AND SPINE
hec for
! any gross defect of the spine
! abnormal pigmentation
! hairy patches o*er the lower bac
! sacral or pilonidal dimple: small
meningocele
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Fetal Phenytoin syndrome
Hirsutism
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HIPS
ongenital hip dislocation
3rtolani and $arlow maneu*ers:
! place in the frog position
! abduct the hips by using middle finger to apply gentle inward and upward pressure o*er the
greater trochanter )"rtolanis sign+
! adduct the hips by using the thumb to apply
outward and bacward pressure o*er the inner thigh (Barlo!s sign)
! a clic of reduction and a clic of dislocation: hip
dislocation/
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NERVOUS SSTEM
3bser*e for abnormal mo*ement or excessi*eirritability
9uscle tone: hypotonia, hypertoniaReflexes: rooting, glabellar, grasp, nec!righting, and moro
ranial ner*es
9o*ement%eri*eral ner*es: #rb-$uchenne paralysis,Klumpes paralysis
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Aeneral sign of neurologic disorder:
! 1ymptom of increased =%
! (ypotonia or hypertonia
! =rritability or hyperexcitability! %oor sucing and swallowing reflexes
! 1hallow, irregular respirations
! 0pnea
! 0pathy! 1taring
! 1ei
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