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PHYSICAL EXAMINATION
Should include:
Evaluation of growth
Observation of behavior

Average weight term NB = 3.4 kg (7.5 lbs) B >

G
Average length (term) = 50 cm (20 in)
Head circumference (term) = 35 cm (14 in)

Nelson Textbook of Pediatrics 20th

edition page 63

Newborn PE (The 1st 24 HOL)

I.

VITAL SIGNS
Temperature
Respirations
Blood Pressure
Pulse Rate

Newborn PE (The 1st 24 HOL)

II.Head Circumference, length, weight and gestational age
HC = measured at the maximum point of occipital protuberance & at a
point 1 ince above the glabella anteriorly
CC = measured at the level of the substernal notch in midinspiration (33
cm [30-36 cm])
Average length (term) = 50 cm (20 in)
Average weight (term) = 3.4 kg (7.2 lbs)
Assessment of gestational age
SGA - <10th percentile, BW of 2,500 or less
AGA - >2500 grams to <4000 grams
LGA - >90th percentile, BW of 4000 grams or more

Newborn PE (The 1st 24 HOL)

III. General Appearance
Activity, skin color, and obvious congenital
abnormalities
IV. Skin
Color, rashes, nevi

Newborn PE (The 1st 24 HOL)

V. Head
Note the general shape of the head
Inspect for any cuts and bruises secondary to
forceps or fetal monitor leads
Check for microcephaly or macrocephaly
Anterior and posterior fontanelles, Molding, Caput
succedaneum, cephalhematoma, hemorrhage

Newborn PE (The 1st 24 HOL)

VI. Neck
Eliciting the rooting reflex causes the infant to turn the
head & allows easier examination of the neck
Palpate the SCM for a hematoma & the thyroid for
enlargement & check for thyroglossal duct cysts
Short neck Turners Noonans, Klippel-Feil syndromes
Webbed neck Turners
Bull-neck - Diphtheria

Newborn PE (The 1st 24 HOL)

VII. Face
Look for obvious abnormalities
Note the general shape of the nose, mouth &
chin, hypertelorism (eyes widely separated) or
low set ears
Facial nerve injury

Newborn PE (The 1st 24 HOL)

VIII. Ears
Look for unusual shape or an abnormal position
IX. Eyes
Check the ROR
X. Nose
Verify patency of the nostrils

Newborn PE (The 1st 24 HOL)

XI. Mouth
Examine the hard & soft palates for evidence of a
cleft palate

XII. Chest
Note whether the chest is symmetric, for
respiratory distress
Listen for the presence & equality of breath sounds

Newborn PE (The 1st 24 HOL)

XIII. Heart
Observe for heart rate, rhythm, quality of heart sounds,
active precordium and presence of murmur
Position of the heart may be determined by auscultation
Palpate the pulses (femoral, pedal, radial & brachial)
Check for signs of CHF (hepatomegaly, gallop, tachypnea,
wheezes & rales, tachycardia & abnormal pulses)

Newborn PE (The 1st 24 HOL)

XIV. Abdomen
Observe for omphalocele, scaphoid abdomen
Listen for bowel sounds
Check the abdomen for distention, tenderness, masses or
organomegaly
XV. Umbilicus
AVA (2 arteries 1 vein)

Newborn PE (The 1st 24 HOL)

VI. Genitalia
Any infant with ambiguous genitalia should not undergo gender
assignment until a formal endocrinology evaluation has been
performed
Male with any question of a penile abnormality should not be
circumcised until he is evaluated by a urologist or a pediatric
surgeon
MALE check for dorsal hood, hypo/epispadia & chordee, penile
length, size of meatus, observe color of scrotum
FEMALE examine labia and clitoris, and any discharges

Newborn PE (The 1st 24 HOL)

XVII. Lymph nodes
Palpable lymph nodes, usually in the inguinal & cervical
areas
XVIII. Anus and Rectum
Check for patency of the anus to rule out imperforate anus
Check the position of the anus
Meconium should pass within 48h of birth for teen infants

Newborn PE (The 1st 24 HOL)

XIX. Extremities
Examine the arms & legs, paying close attention to the
digits & palmar creases
XX. Trunk & Spine
Check for any gross defects of the spine
Any abnormal pigmentation of hairy patches over the
lower back should increase the suspicion that an
underlying vertebral abnormality exists

Newborn PE (The 1st 24 HOL)

XXI. Hips
Evaluate for congenital hip dislocation using Ortolani &
Barlow maneuvers
XXII. Nervous System
Observe the infant for any abnormal movement (e.g.
seizure activity) or excessive irritability
Muscle tone
Reflexes

Newborn PE (The 1st 24 HOL)

Cranial nerves
Note the presence of gross nystagmus, the
reaction of the pupils & the ability of the infant
to follow moving objects with his or her eyes

Movement
Check for spontaneous movement of the limbs,
trunk, face & neck

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