‫]‪[TYPE THE COMPANY NAME‬‬

‫‪neonatal examination‬‬
‫‪By Dr ali bel kheir‬‬

‫‪Common neonatal‬‬
‫‪clinical exam‬‬
‫‪cases:‬‬
‫‪1.‬‬ ‫‪normal‬‬
‫‪2.‬‬ ‫‪jaundice‬‬
‫‪3.‬‬ ‫‪preterm‬‬
‫‪4.‬‬ ‫‪congenital anomali‬‬

‫تعلم فليس المرء يولد عالـمــا ‪ ...‬وليس أخو علم كمن هو جاهـل‬
‫وإن كبير القوم ال علم عـنـده ‪ ...‬صغير إذا التفت عليه الجحافل‬
‫وإن صغير القوم إن كان عالما ‪ ...‬كبير إذا ردت إليه المحـافـل‬
 Neonatal Examination
 First step is sterilization:
 Remove hand watch.
 Wash your hand twice to elbow.
 Wash hand by alcohol.
 General look, posture: Baby full exposed
1. Appearance: Well or notcalm-irritable- crying
2. Built: underweight-overweightconfirmation by weight measurement
3. Color:
 Normalpink
 Pallor anemia-shock-HF
 Cyanosis respiratory or cardiac problems or Hemoglobinopathy
 Plethoric polycythemia / overheating/over oxygenation
 Yellowishjaundice.
 Yellowish brown or greenobstructive Jaundice
4. Dysmorphic feature: Downs syndrome-Edwards syndrome
5. Distressed or not (S/S of RD).
6. Posture:
 Lying in:Incubator-Cot care-Mother arms.
 Normalflexion
 Abnormalflaccid or frog like position-waiter tip
7- Surrounding (mask, cannula, NGT, phototherapy).
 Anthropometric measurements:
1-Weight  normal range (2.5 --> 4)kg.
2-Length normal range (50 ± 2)cm.
3-O.F.C.  normal range (35 ± 2)cm.
 Vital signs:
Pulse Temperature R.R. B.P.
From apex beat by -from axilla. -count abdominal -by using dinamap.
stethoscope or brachial -added 0.5 Cᵒ movement.
-normal -normal 30-60 cycle -normal 90/50mmHg.
110-160 b/min or bearth/min.
-if crying -count for 1 min.
180 b/min

1 Visit us on https://www.facebook.com/groups/easypediatrics >Dr ali bel kheir<

Skin:
 Vernix caseosa  whitish greasy material covered the body at birth, found
especially in skin folds (axilla – groin). It gives the body antibody, and keeps
the body warm.
 Jaundice  (best site for it by pressing on the tip of nose).
 Milia  tiny sebaceous glands (white), seen over nose and cheeks,
disappear after 3-4weeks.
 Capillary Hemangioma  erythromatous patches or maculae over
eyelids/forehead.
 Lanugo hair  fine hair found on forehead, ear auricle, shoulders, sacral
area.
 Mongolian spots  bluish discolouration found on sacral area and
extremities. It’s duo to deposition of melanin. It disappear after few years.
 Erythema toxicum / neonatorum  blanched erythematous papules or
maculae may associated with or without yellow centers.
It’s sterile and started at 2-8th day of life. Found in all over the body specially
chest and extremities.
 Miliaria  collection of tiny vesicles on head and chest, whitish in colour
due to illness or overheating.
 Cradle cap  accumulation of sebaceous glands on scalp as greasy yellowish
crusted layer over scalp / eye brows.
 Head:
As in general examination+ Head injuries
Head injuries:
Caput succedaneum cephalohematoma Facial n palsy
Subcutaneous fluid Subperiosteal blood Peripheral facial nerve
collection seen collection seen few hrs injury result in paralysis of
immediate after birth after birth whole face on same side:
Diffuse scalp Localized scallop 1. absent nasolabial fold
swelling(cross suture) sweeling (not cross 2. asymmetric cry
Over presentimg part suture) 3. deviation of mouth to
Over any bone healty side

2 Visit us on https://www.facebook.com/groups/easypediatrics >Dr ali bel kheir<

Soft with ecchymosis of Firm and may associated 4. inability to close the
overlapping skin with anemia and eye firmly
jaundice, linear fracture
Resolve in few days Observation 1. Eye drops and ointment
most of cases resolve 2. Care of feeding
spontaneous within 3. Physiotherapy
weeks 4. Neuroplasty if present
Treat complication for more than 3 mts

 face: as in general examination

 eyes: as in general examination
if eye closed – open them by gentle moving child head up.
Normally eye puffy – greasy – no tears – during crying.
 Ears  as general.
 Nose  as general.
Examine the nose for congenital anomalies as canal atresia by insert (NGT).
 Mouth  as general but concentrate on cleft lip / palate,
Teeth (juvenile teeth which may be removed to prevent aspiration).
In examination of cleft palate: sterile finger introduced to mouth of baby
to feel the upper roof (palate).
Epstein pearls --> two white spots on med line of palate disappear in few
weeks spontaneously.

3 Visit us on https://www.facebook.com/groups/easypediatrics >Dr ali bel kheir<

 Neck  as general
 cystic hygroma = development abnormalities of the lymphoid system that
occur at sites of lymphatic-venous connection, most commonly in the
posterior neck
 Torticollis: asymmetrical head or neck position due Birth trauma or
intrauterine malposition is considered to be the cause of damage to the
sternocleidomastoid muscle
 Hands: as general
- Detect number of fingers.
- Syndactyly = fusion of 2 fingers.
- Clinodactyly = curved little finger.
- Extradactyly = extra digit.
(Note that peripheral cyanosis can be normal in neonate).
 Chest + Heart :
- Breast lump = normal due to Maternal hormone. Don’t squeezemastitis
- Auscultation of chest, examine the heart as chest_ pericardium examination.
 Abdomen :
 Moved or not with respiration.
 Shape distended –scaphoid
 Hernia
 Palpate liver and spleen (which is normally palpable 1-2 cm below costal
margin).

 Examine umbilicus :
 Normally cord contain one vein / 2 arteries
 if there is one artery, one vein, this condition may associated with
Renal anomaly or trachea-oesophageal fistula

4 Visit us on https://www.facebook.com/groups/easypediatrics >Dr ali bel kheir<

 - Fall down or not (fall down 1st week --> 10 days).
- Moist / white --> in the first 3 days.
- Dry / dark/brown in colour --> last 4 – 5 days.
- Erythema around umbilicus --> infection.
- Discharge --> infection.
- Hernia / plugging --> during crying.
- If stump still attachbaby below 7 days old

 Napkin area:
 Genitalia / anus :
- Take permission from the mother to expose her baby genitalia.
- Examine femoral pulse (midway between Asis and sypmphysis pupis), if
absent  COA.
- Genitalia :
Male Female
Circumcised or not. Labia majora prominent, cover
labia minora
Dark in colour.
Performed scrotum, two Also for maturity assessment.
testes or not.
Palpate for testes.
Scrotum normally with
wrinkles, and dark in colour.
Penis  (hypospadius)
In this case circumcision is
C.I.
Also for maturity
assessment.

 Anus  ask mother if baby pass stool / if not use thermometer to exclude
imperforated anus / anal stenosis/ check if there perianal fistula

 Hip joint : for DDH

 screen for developmental dysplasia of the hip used until 3 mts of age
 confirmed by US

5 Visit us on https://www.facebook.com/groups/easypediatrics >Dr ali bel kheir<

 barlow ortholani
Adduct the hip and knee Apply gentel abduction forward
In flexion thumb on lesser trochanter pressure on greater trochanterclunk
then apply outward and backward (dislocated
pressure over inner thigh you will feel
and hear
Click
(dislocatable)

 Back :
- Exposure back, examine it if there is any deformity - swelling -->
meningocele, meningomyocele. Tuft of air --> spina bifida occulta
- Palpate spinous process if contact or not spina bifida occulta
………………………………………………………………………………………………………………………..
Primitive reflexes
moro reflex:
time From birth up to 4-6 mts
value Absence bilateral:
1.premature below 28 weeks gestation
2.CNS:depressed by narcotics
3.Bilateral injury to brachial plexus ,clavicle-humerus
Unilateral(asymmetrical):
1.Erbs palsy
2.Fracture of clavicle or Humerus
3.Dislocated shoulder
Sluggish respond:
1.Sedation
2.Sepsis
3.Early kernicterus'
Exaggerated reflex:
1.Cns irritation EX: late kernicterus
2.Persistence beyond 6 mts :CP-MR
Absent:
1.Lesion in brain stem, vestibular nuclei

6 Visit us on https://www.facebook.com/groups/easypediatrics >Dr ali bel kheir<

Spinal laying the newborn on prone and Started
Galant stroking along one side of their spine. The normal at birth
reaction is for the newborn to flex up to 4
sideways toward the stimulated side mts
Palmar Placing the Flexion of 6 months -Abscent in
grasp index finger fingers, fist klumpkes palsy
in the palm making -Can be used to
of the estimation of GA
infant its develop at 28
Plantar Pressing a Flexion of 10 months wks and become
grasp thumb toes fully mature by
(solar) against the 32 weeks
sole just
behind the
toes in the
foot
Rooting Finger Turning of 4-6 mts Abscent of
reflex stimulation mouth to the -Persist up to 7 reflex indicate
near the stimulus mts at sleep sever
angle of the
neurologic
mouth
disorder
Sucking Stimulation Sucking Weak or
reflex of lips movments abscent
indicate
developmental
delay
Stepping Infant is held Walking 6 wks Persistanc is
reflex upright with movement ab normal
his soles
touching flat
surface

7 Visit us on https://www.facebook.com/groups/easypediatrics >Dr ali bel kheir<

 Placing The infant is The baby will 6wks
reflex held upright flex then
with sole of extend the
one foot leg to place it
touching on upper
surface of surface of
table and the table
dorsum of
other foot
touching the
under edge
of the table
Maturity assessment
Physical crereria
Activity:
Birth wt below 2.5 (except IDM) 1. Weak crying
Birth length below 47 cm 2. hypotonia,frog like position
OFC below 33 3. Startles' to loud sound

Scalp hairfine wooly

Nailsdon’t reach
finger tips Ear:
Flat pinna
Breastvery small Soft lobule
Below 3 mm diameter No recoil
Not palpable
Genitalia:
Skinvery thin-red
Maleflat smooth
lanugo hair
creases on
Planter creases: scrotum,undescende
Lower third32 wks d test
Middle third36 wks Femaleclitoris
All overfull term prominent, flat labia,
Labia majora not
cover minora

8 Visit us on https://www.facebook.com/groups/easypediatrics >Dr ali bel kheir<

Neuromuscular criteria
1.Postureflaccid/frog like position
2.Square windowangle between hand and forearm in preterm (90)
In term (0)
3.Arm recoil180 in premature (in term 90)
4.Scarf signelbow cross midline or not crosspreterm
5.heel to ear
6.popliteal angle

sign 0 1 2
Appearance(color) Blue or pale Pink with blue All pink
extremities
Pulse(heart rate) absent Under 100/min Over 100/min
Grimace(respond No response grimace Cough, sneezing
to nasal catheter)
Activity (muscle Flaccid limps Some flexion Active motion
tone)
respiration absent Slow, irregular Normal and crying

‫علي بالخير‬.‫ د‬- ‫ بالتوفيق للجميع‬-‫التنسونا من صالح الدعاء‬

9 Visit us on https://www.facebook.com/groups/easypediatrics >Dr ali bel kheir<