Newborn Physical Examination

The newborn infant should undergo a complete physical examination within 24h of birth.
I. Vital Signs
A. Temperature. -indicate whether temperature is rectal (which is usually 1 degree
higher than oral), oral, or axillary
B. Respirations -Normal rate between 40-60 breaths/min
C. Blood pressure correlates with gestational age, postnatal age of infant, birth
weight
D. Pulse rate
-normal pulse rate is between 100-180 in newborn
II. Head Circumference, length, weight
a. Head Circumference and percentile
Place measuring tape around the front of the head (above the brow) and the
occipital area. The tape should be above the ears. This is known as occipitofrontal
circumference, which is normally 32-37 cm at term.
b. Length and percentile growth charts
c. Weight and percentile growth charts
III. General Appearance
-observe the infant, and record the general appearance (eg activity, skin colour,
and obvious congenital anomalies)
IV. Skin
A. Colour
1. Plethora (deep, rosy red colour)
Plethora is more common in infants with polycythemia but can be seen in
an overoxygenated or overheated infant. It is best to obtain a central Ht on
any plethoric infant.
2. Jaundice bilirubin level usually > 5mg/dL.
- abnormal in infants <24h old
- may signify Rh incompatibility, sepsis, TORCH infections
- after 24h it may result either from these diseases or ABO
incompatibility
3. Pallor
May be secondary to anemia, birth asphyxia, shock, PDA
4. Cyanosis
a. central cyanosis (bluish skin including the tongue and lips)
- caused by low oxygen saturation level, may be associated with
congenital heart disease or lung disease
b. peripheral cyanosis (bluish skin with pink lips and tongue)
- methemoglobinemia occurs when Hb oxidizes from the ferrous to
ferric form; blood can have a chocolate hue. Incapable of transporting
oxygen or CO2
c. Acrocyanosis (bluish hands and feet only)

-may be normal for an newborn infant or for one experiencing cold stress.
If the condition is seen in older infant with a normal temperature,
decreased peripheral perfusion secondary to hypovolemia should be
considered.
5. Extensive bruising
May be associated with prolonged and difficult delivery and may result in
early jaundice
6. Mottling (lacy red pattern)
May be seen in healthy infant or one with cold stress, hypovolemia, or
sepsis. Persistent mottling referred to as cutis marmorata is found in infants
of Down syndrome, trisomy 13 or trisomy 18.
B. Rashes
1. Milia
A rash in which tiny, whitish, sebaceous retention cysts are seen usually on
the chin, nose, forehead. Benign, usually disappear within a few weeks
2. Erythema toxicum
Numerous small areas of red skin are seen, with yellow-white papule in the
center. Lesions are most noticeable at 48h after birth but may appear as late
as 7-10 days. Resolves spontaneously.
C. Nevi
Hemangiomas near the eyes, nose or mouth
i. macular hemangioma true vascular nevus, disappear
spontaneously
ii. Port-wine stain does not blanch with pressure, does not disappear
iii. Mongolian spot dark blue or purplish located over sacrum
iv. Strawberry hemagioma flat, bright red, sharply demarcated, on the
face
V. Head
Note the general shape of the head, inspect for cuts and bruises secondary to forceps or
fetal monitor leads
A. Anterior and posterior fontanelles
Anterior fontanelles usually closes at 9-12 months, post fontanelles at 2-4
months.Bulging font (increased ICP, meningitis, hydrocephalus). Sunken font
(dehydration).
B. Molding
A temporary asymmetry of the skull resulting from birth process, most often with
prolonged labor and vaginal deliveries. Normal shape regained in 1 week.
C. Caput Succedaneum
A diffuse edematous swelling of soft tissues of scalp that may extend across suture
lines. Secondary to pressure of the uterus or vaginal wall on areas of the fetal head
bordering the caput, usually resolves within days
D. Cephalhematoma
Subperiosteal hemorrhage that never extends across suture line. Traumatic
delivery or forcep delivery. Most resolve within 6 weeks.

VI. Neck
Palpate sternocleidomastoid for a hematoma and thyroid enlargement, and check for
thyroglossal duct cysts. A short neck is seen in Turners, Noonans syndromes.
VII. Face
Note the general shape of nose, mouth and chin. Hypertelorism (eyes widely separated)
or low set ears should be noted.
VIII. Ears
Look for unusual shape and abnormal position. Normal position is determined by
drawing an imaginary line from the inner and outer canthus of the eye across the face,
perpendicular to vertical axis of the head. If the ear is below this line, it is designated as
low-set ears. Preauricular skin tags (papillomas).
IX. Eyes
Check red reflex with opthalmoscope. Conjunctivitis. Subconjunctival hemorrhage.
X. Nose
Choanal atreasia, verify patency by gently inserting NGT. Nasal flaring indicates
respiratory distress. Sniffling and discharge are typical of congenital syphilis.
XI. Mouth
Examine the hard and soft palate for evidence of cleft palate. Oral trush infection due to
C. albicans.
XII. Chest
A. observation
Chest asymmetric tension pneumothorax. Tachypnea, sternal and intercostals
retractions, and grunting on expiration may indicate respiratory distress
B. Breath sounds
Absent or unequal sound may indicate pneumothorax or atelectasis
C. Pectus excavatum
Is a sternum that is altered in shape
D. Breasts in newborn
Are usually 1 cm in diameter in term male and female infants. May be abnormally
enlarged (3-4cm) secondary to effects of maternal estrogen.
XIII. Heart
Observe for heart rate, rhythm, quality of sounds, presence of murmur, position of heart.
Palpate for pulses; femoral, pedal, radial and brachial.
XIV. Abdomen
Omphalocele intestines are covered by peritoneum and the umbilicus is centrally
located. Auscultation listen for bowel sounds. Palpation distension, tenderness,
masses, liver and spleen enlargement.

XV. Genitalia
A. Male
Check for dorsal hood, hypospadia, epispadia. Normal penile length is >2cm.
Palpate testicles and examine for groin hernia
B. female
Examine the labia and clitoris. If the labia are fused and clitoris enlarged, adrenal
hyperplasia should be suspected.
XVI. Anus
Check for patency to rule out imperforate anus. Meconium should pass within 48 h after
birth.
XVII. Extremities
A. Syndactyly abnormal fusion of the digits, most commonly involves the 3rd
and 4th fingers and the 2nd and 3rd toes
C. Polydactyly supernumerary digits on hands or feet
D. Simian Crease transverse palmar crease most commonly in Down syndrome
E. Talipes Equinovarus (clubfoot) foot is turned downward and inward and
the sole is directed medially
F. Metatarsus varus adduction of forefoot