PHYSICAL

EXAMINATION
OF THE NEWBORN
 Patterns of the Newborn from Birth to
Time of Stability
 Immediate tachycardia  Sleepy, somewhat  Awake, alert
(160-180 bpm) with a unresponsive
gradual drop to 100-120  Crying, easily startled
bpm  HR: 100-120 bpm; transient
 Irregular respirations, tachycardia  Reactive
tachypnea (60-80 cpm);
brief moments of apnea  RR: 50-60 cpm; transient
 Moist-sounding lung fields, tachypnea
transient grunting &
retraction  Passage of meconium
 Awake, moving, alert,
easily startled, crying,
transient tremors

First 15-30 mins Next 60-90 mins Several Hours

I. General Appearance
◦ Posture
◦ Skin color
◦ Activity
◦ Muscle tone
◦ Gross congenital abnormalities
II. Vital Signs

◦ Temperature: 36.5 – 37.5 ˚C (per rectum/axilla)

◦ Cardiac Rate: 120 – 160 bpm
◦ Respirations: 30 – 60cpm (look at upper abdomen)
◦ Blood Pressure: not a routine part
II. Vital Signs

Blood Pressure:

The Flush Method

- upper arm wrapped in cuff (2/3)
- inflate enough to blanch skin
- pressure slowly lowered until there is a flush of color
(estimated diastolic)
II. Vital Signs

Blood Pressure:

The Doppler method

- provides systolic and diastolic pressures
- requires electronic equipment & a quiet infant
 II. Vital Signs
Blood Pressure:

Birth weight (g) Mean Pressure Systolic (mmHg) Diastolic

501-750 38-49 50-62 26-36
751-1000 35.5-47.5 48-59 23-36
1001-1250 37.5-48 49-61 26-35
1251-1500 34.5-44.5 46-56 23-33
1501-1750 34.5-45.5 46-58 23-33
1751-2000 36-38 48-61 24-35
*Heygi, et al: Blood Pressure Ranges in Premature Infants
III. Anthropometric Measurements
◦ Head Circumference: 32-36 cm (13-14 inches)
Level of eyebrows/above the glabella to the most
prominent portion of the infant’s head
◦ Chest Circumference: 30.5-33 cm (12-13 inches)
Level of nipples
◦ Abdominal Circumference: approx. the same with CC
Above the level of umbilicus
◦ Body Length:
Baby lies supine, legs flat, from crown of head to the
nearest 0.1 cm of heal
III. Anthropometric Measurements

◦ Weight:
Normal: 2500 and above
Low Birth Weight: <2500 grams
Very Low Birth Weight: 1000-1500 grams
Extremely Low Birth Weight: <1000 grams
IV. Skin

◦ Color: plethora, jaundice, pallor, cyanosis

◦ Mottling: lacy red pattern, cutis marmorata
◦ Vernix caseosa: greasy white substance w/c
provides a moisture barrier
◦ Rashes & Birthmarks
 IV. Skin
◦ Color:
Plethora – deep, rosy red,
ruddy color

Common in polycythemia,
overoxygenated, or
overheated infants
IV. Skin
◦ Color:
Jaundice
yellowish color – 2˚ to
indirect
hyperbilirubinemia
Greenish color - 2˚ to
direct bilirubinemia
Bilirubun Levels: >5mg/dL
IV. Skin
◦ Color:
Pallor – maybe 2˚
toanemia, asphyxia,
shock, or PDA
IV. Skin
◦ Color:
Cyanosis

Central: bluish skin including tongue & lips

Caused by low oxygen saturation in
the blood
Peripheral: bluish hands & feet only
Maybe normal d/t vasomotor
instability & peripheral circulatory
sluggishness
IV. Skin

◦ Mottling: lacy red

pattern

Cutis marmorata –
persistent mottling;
commonly seen in
Down Syndrome,
Trisomy 13/18
IV. Skin

◦ Vernix caseosa: greasy white substance that covers

the skin until 38th week AOG; moisture barrier
IV. Skin

◦ Rashes & Birthmarks: milia, erythema toxicum,

miliaria crystallina, transient pustular melanosis,
macular hemangioma, port-wine stain (nevus
flammeus), mongolian spots
IV. Skin

◦ Rashes & Birthmarks:

Milia – tiny, sebaceous retention cysts, whitish,
pinhead-sized concretions; disappear weeks after
birth
IV. Skin

◦ Rashes & Birthmarks:

Erythema toxicum – small areas of
red with a yellow-white papule
center; most noticeable 48hrs
after birth, may appear as late as
7-10 days
IV. Skin

◦ Rashes & Birthmarks:

Miliaria crystallina – non-
inflamatory, pinpoint clear
vesicle that may suddenly erupt
in profusion over large areas of
the body surface, leaving
browny desquamation on
healing
IV. Skin

◦ Rashes & Birthmarks:

Port-wine stain (nevus flammeus) - seen at birth,
does not blanch with pressure, does not disappear
in time
IV. Skin

◦ Rashes & Birthmarks:

Mongolian spots – dark blue, or purple bruise-like
macular spots usually located over the sacrum; most
common birth mark
V. HEENT
◦ Head: shape & size, cuts & bruises, fontanels
◦ Eyes: ROR, subconjunctival hemorrhage
◦ Ears: shape, size, position, presence of canal, tags, pits
◦ Nose: shape, size, patency, presence of swelling over
nasolacrimal duct, philtrum size, nasolabial folds
◦ Throat/Mouth: clefts, deciduous teeth, fractures
◦ Neck: presence of thyroid enlargement, thryroglossal
duct cyst, calvicular fracture
V. HEENT
◦ Head: shape & size,
cuts & bruises,
fontanels
V. HEENT
◦ Ears: shape, size,
position, presence of
canal, tags, pits
V. HEENT
◦ Throat/Mouth: clefts, deciduous teeth, fractures
VI. CHEST

◦ Symmetry: retractions, supernumerary nipples

◦ Presence & quality of breath sounds: ROR,
subconjunctival hemorrhage
◦ Bradypnea, Tachypnea
VII. CARDIAC

◦ Precordial activity
◦ Rate & Rhythm
◦ Quality of Heart sounds
◦ Murmurs
VIII. ABDOMEN

◦ Inspection: shape/size, umbilical arteries & veins

◦ Auscultation: Bowel Sounds (inactive on 1st days of
life)
◦ Palpation: distention, masses, tenderness
VIII. GENITOURINARY

◦ Male: Normal Penile Length at Birth = > 2cm

◦ Female: redundant hymenal tissue, tgas of tissue

may extend from 1-15mm beyond the rim of the
hymen, disappear with a few weeks
 IX. EXTREMETIES
◦ Arms, legs, digits, creases
◦ Syndactyly
◦ Polydactyly
◦ Simian Crease
◦ Talipes Equinovarus
◦ Metatarsus varus
IX. NERVOUS SYSTEM

◦ Ballard Score: Neuromuscular & physical maturity

IX. NERVOUS SYSTEM
IX. NERVOUS SYSTEM
APGAR