Newborn Exam by N. Gold | OPENPediatrics

Summary

This video, presented by Dr. Nina Gold, offers a detailed guide to conducting a newborn physical exam, highlighting normal findings and potential signs of congenital anomalies or genetic conditions. It covers a systematic head-to-toe approach, starting from general observations and continuing through head, face, neck, chest, abdomen, and extremities. The video emphasizes key aspects such as measuring head circumference, examining cranial sutures, assessing heart and lung function, and testing reflexes. The goal is to identify any abnormalities early, ensuring prompt follow-up with specialists if necessary, while also focusing on providing a comfortable experience for the newborn and family.

Takeaways

• 👶 Congratulate the family and introduce yourself before starting the newborn exam.
• 📏 Start with a general observation of the newborn, checking vital signs and overall appearance.
• 🧠 Measure the head circumference, examine the shape of the head, and check for any deformities such as cephalohematoma or caput succedaneum.
• 👂 Inspect the ears for position, shape, and possible abnormalities like low-set ears or ear tags, which may indicate genetic conditions.
• 👀 Examine the eyes, checking the red reflex and looking for abnormalities like coloboma or congenital cataracts.
• 👃 Ensure nasal patency, as newborns are preferential nasal breathers. Look for signs of choanal atresia, which may indicate CHARGE syndrome.
• 👄 Inspect the mouth and palate for clefts, check for ankyloglossia (tongue tie), and assess the sucking reflex.
• 🫀 Listen to the heart for murmurs and assess respiration, checking for periodic breathing and any abnormal lung sounds.
• 🦴 Assess the hips using the Barlow and Ortolani maneuvers to check for hip dysplasia, a condition more common in infants with risk factors.
• 🧠 Perform a neurologic exam, checking muscle tone, reflexes (Moro, palmar grasp, rooting), and mental status, ensuring normal function and symmetry.

Q & A

What is the first thing you should do upon entering the room for a newborn exam?

Upon entering the room, you should congratulate the family, introduce yourself, and explain that you would like to examine their infant. Ask if it's a convenient time for the exam.

What general observations should you make before beginning the newborn exam?

You should observe if the baby is asleep or awake, if the skin is warm or cool, check the vital signs, and observe for any signs of difficulty breathing or distress. If any distress is noted, you should stop the exam and notify a supervising physician.

How do you measure the head circumference of a newborn, and why is it important?

To measure the head circumference, wrap a measuring tape above the eyebrows around the most prominent part of the occiput. The measurement should be compared to a newborn growth chart to ensure it falls within the average range for the baby's gestational age and is proportional to length and weight.

What is the significance of bruising or swelling on a newborn's skull?

Bruising that does not cross the suture lines indicates a cephalohematoma, often caused by bleeding below the periosteum. Swelling that crosses the suture lines is typically due to caput succedaneum, a fluid accumulation from delivery pressure. Extensive swelling can indicate a more serious condition like a subgaleal hemorrhage.

What does the presence of a low-set or posteriorly rotated ear indicate in a newborn?

Low-set or posteriorly rotated ears can be a sign of underlying genetic conditions. While not inherently dangerous, these findings may prompt further evaluation for potential genetic anomalies.

How do you assess the patency of a newborn's nares and why is it important?

You can check the patency of the nares by passing a small French catheter through each nostril, especially if there's a history of respiratory distress. Newborns are preferential nasal breathers, so patency is crucial for breathing, and blockage may suggest conditions like choanal atresia.

What should you look for when examining the newborn's mouth and jaw?

You should check the newborn’s sucking reflex, feel for clefts in the hard or soft palate, examine tongue mobility for ankyloglossia (tongue tie), and observe for any unusual findings like natal teeth or cleft lips.

What are the steps to assess a newborn for hip dysplasia?

You assess for hip dysplasia using two maneuvers: the Barlow maneuver (adducting the hip and applying posterior pressure) and the Ortolani maneuver (abducting the legs while flexing the knees). A clunk during these tests may indicate hip dislocation, requiring further follow-up.

What is the significance of a single transverse palmar crease in a newborn?

A single transverse palmar crease is a minor variant found in 1% of the population. It is more common in infants with neurological conditions like Down syndrome but can also be seen in healthy babies.

How do you check a newborn's primitive reflexes, and what do abnormal findings suggest?

Primitive reflexes are assessed by testing for the Moro reflex (startle response), palmar grasp reflex, and rooting reflex. Asymmetry or absence of these reflexes may indicate a neurological or orthopedic condition requiring further investigation.