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Flashcards in Newborn Check Deck (21):

What should you look for on general inspection of a newborn?

• Responsiveness, consciousness
• Colour
• normal infant appears pink 
• Acrocyanosis, a bluish appearance of hands, feet and perioral area is common in the first few days after delivery 
• Pallor may indicate anaemia 
• Jaundiced appearance may be due to hyperbilirubinaemia: risk of bilirubin encephalopathy
• Tone and posture 
• If cephalic presentation, usually flexed posture 
• If breech presentation, legs usually extended 
• Movement
• range, spontaneity, symmetry 
• Breathing 
• Paradoxical movements (abdomen moving outwards and chest wall moving inwards during inspiration) are normal 
• Look for signs of respiratory distress (RR should be timed over 1 minute) 
• Determination of gender 
• Identification of obvious deformations or malformations (e.g. syndromic features) 


What must you check before actually examining the newborn?

- Body measurements: weight, length, head circumference
- Vital signs esp. T>38


Outline the examination of the head of a newborn.

• Inspect for size, shape and symmetry 
• Palpate anterior and posterior fontanelles 
• Palpate sutures 
• Molding (asymmetry) 
• Cephalohaematoma (swelling confined to suture lines) 
• Subgaleal haemorrhage (swelling not confined to suture lines) 
• Premature fusion (craniosynostosis) 


Outline the examination of the face of a newborn.

• Must check size, shape and symmetry for all features
• Eyes 
• Red reflex (concerned about) 
• Inspection of pupil for unequal size, dilatation, constriction, clear appearance (cataracts) 
• Nose 
• Patency of nares 
• Mouth  
• Cleft lip/palate 
• Mouth drooping 
• Tongue-tie 
• Palpate hard palate with little finger 
• Sucking reflex 
• (Gag reflex) 


Outline the examination of the ears of a newborn.

1. Position: top third of pinna should be at or above a horizontal line from inner and outer canthus and < 15° rotation with respect to the tragus 
2. Response to noise 
3. Drainage from ear 


What should we examine in the neck of a newborn, and how?

Look for swellings with neck extended  


Outline the examination of the chest of a newborn.

• Assess work of breathing:
• Respiratory distress in a neonate:
○ Tachpnoea (RR > 60)
○ Recession
○ Expiratory grunt
○ Nasal flaring
○ Cyanosis

• Apnoea (pause in respiration > 20s)
• Palpate clavicles (may be broken if shoulder dystocia) 
• Look at spacing of nipples (may be widened in some syndromes such as Turner's) 
• Auscultation of lungs and heart (HR, murmurs, breath sounds) 
• Pulse


Outline the examination of the abdomen of a newborn.

• General inspection, looking for masses, deformities, distension 
• Look for gastroschisis (protruding intestines from abdominal wall) and omphalocoele (abdominal organs protruding into base of umbilicus) 
• Inspect umbilicus for erythema, infected appearance 
• Palpate for liver - usually 1-3 cm below the costal margin 
• Palpate for spleen - not usually palpable 
• Auscultate for bowel sounds 


Outline the genitourinary examination of a newborn.

• Males 
• Testicular descent 
• Testicular size and symmetry  
• Look for hypospadias 
• Females 
• Size of clitoris, labia
• Vaginal discharge is normal 
• Look for ambiguous genitalia 
• Check if urine has been passed within 24 hours of birth 
• Assess patency of anus 
• Check if meconium has been passed within 24 hours of birth 


Outline the limb examination of a newborn.

• Count number of fingers and toes 
• Check palmar crease 
• Single palmar crease associated with T21 
• Assess tone 
• Brachial and femoral pulses (also look for radio-femoral delay) 
• Symmetry of hip creases 
• Hip manoeuvres (pistol grip) - can feel femoral pulses at same time 


Outline the hip manoeuvres.

- Barlow test:
• One hand stabilises pelvis, other hand grasps other side knee (hand at greater trochanter)
• Flex knee to 90 degrees
• Adduct hip 10-20 degrees, apply posterior force (in/down)
• If subluxing, 'gliding sensation of posterior movement' will be felt from femoral head rubbing against edge of acetabulum
• If dislocating, 'gliding sensation' followed by distinct loss of resistance
○ Confirm by relaxing pressure/Ortolani manouvre

- Ortolani manouevre:
• Used to reduce a dislocated hip
• Both hips and knees flexed to 90 degrees
• Thumb grasps inside of knees, other fingers on greater trochanter
• As hip is abducted, other fingers try to lift femoral head back into acetabulum - anterior force (out and up)
• If reduced, 'clunk' sensation felt


Outline the back examination of a newborn.

• Inspection for symmetry of scapulae and buttocks 
• Palpation down spine


What are the major reflexes in a newborn?

- Eye blink reflex
- Sucking reflex
- Rooting reflex
- Grasp reflex
- Tonic head reflex
- Stepping reflex
- Plantar reflex
- Moro reflex


Rooting reflex:
- Stimulation
- Response
- Age of disappearance
- Function

- Stroke cheek near corner of mouth
- Head turns towards source of stimulation
- 3 weeks (then becomes voluntary)
- Helps infant find nipple


Eye blink reflex:
- Stimulation
- Response
- Age of disappearance
- Function

- Shine light at eyes/clap near head
- Closes eyes
- Permanent
- Protects from strong stimulation


Sucking reflex:
- Stimulation
- Response
- Age of disappearance
- Function

- Place finger in mouth
- Sucks finger rhythmically
- 4 months (then becomes voluntary)
- Helps feeding


Moro reflex:
- Stimulation
- Response
- Age of disappearance
- Function

- Hold infant horizontally on back, let head drop slightly
- Embracing motion: arched back, extended legs and arms -> bringing arms towards body i.e. flexion
- 6 months
- May have helped infant cling to mother in evolutionary past


Grasp reflex:
- Stimulation
- Response
- Age of disappearance
- Function

- Place finger in hand and press into palm
- Spontaneous grasping of finger
- 3-4 months
- Prepares for voluntary grasping


Tonic reflex:
- Stimulation
- Response
- Age of disappearance
- Function

- Turn head to one side while infant is on back
- "Fencing" position: one arm extended in front of eyes on side to which head is turned, other arm is flexed
- 4 months
- Prepares for voluntary reaching


Stepping reflex:
- Stimulation
- Response
- Age of disappearance
- Function

- Hold infant under its arms, permit bare feet to touch a flat surface
- infant lifts one foot after another
- 2 months in heavier babies, later in lighter babies
- Prepares for voluntary walking


Babinski/plantar reflex:
- Stimulation
- Response
- Age of disappearance
- Function

- Stroke sole of foot
- Toes fan out and curl as foot twists in
- 8-12 months
- Function unknown