F.

Physical Assessment

5. Eyes
- usually cries without tears
- small subconjunctival hemorrhage
due to pressure during birth causing
rupture of capillaries in the sclera
- completely absorbed in 2-3 weeks
- periorbital edema remain for the
first 2-3 days of life
- eyesight is between 20/200 to
20/400
- sensitive to bright light
F. Physical Assessment

6. Ears
- top part of the external ear should be
in line with the outer canthus of the
eye
- small tags of skin may be associated
with abnormalities but are isolated
findings
- test hearing by ringing a bell 6-inch
beside each ear
- NEWBORN HEARING SCREENING
TEST
- Otoacoustic Emissions Test (OAEs)
- Auditory Brainstem Response Test (ABRs)
F. Physical Assessment

7. Nose
- may appear large for the face
- test for choanal atresia
- has presence of milia
- small pinpoint white or yellow dots
usually found in the nose, forehead
and cheeks
Transnasal Endoscopic Surgery
Milia
F. Physical Assessment

8. Mouth
- Epstein pearls – small, round,
glistening, well circumscribed cysts
on the palate
- thrush – a Candida infection, white
or gray patches on the gums, roof of
the mouth, tongue and sides of the
cheeks
- blowing bubbles of mucus –
suggestive of TEF (tracheoesophageal
fistula)
- natal teeth – teeth present at birth
- neonatal teeth – teeth that erupted
within the first month of life
Epstein Pearls
Thrush / Oral Thrush
Tracheoesophageal
Milia Fistula (TEF)
Natal Teeth
F. Physical Assessment

9. Neck
- short and chubby with creased skin
folds
- not strong enough to support the
weight of the head yet
- head should rotate firmly on the neck
and should be able to flex forward
and back
F. Physical Assessment

10. Chest
- symmetrical
- breasts may be engorged
- witch’s milk – thin, watery fluid
secreted by the newborn’s breast
- retraction should not be present
- abnormal sounds:
1. rhonchi – gurgling sound caused by
air passing through mucus at the
back of the throat
2. grunting – suggestive of RDS
3. high crowing sound- suggestive of
stridor or immature tracheal
development
F. Physical Assessment

11. Skin
A. COLOR
- normally with ruddy complexion
- generalized mottling
- cyanosis
F. Physical Assessment

11. Skin
A. COLOR
1. Acrocyanosis – pink body, blue
extremities (and lips); normal during the
first 24-48 hours after birth
2. Central cyanosis – cyanosis of the
trunk, tongue and mucous membranes
of the mouth and cheek
- indicates underlying disease state or
oxygenation problems
F. Physical Assessment RBC

11. Skin Heme Globin

A. COLOR
3. Jaundice – yellowing of the skin and
sclera due to hyperbilirubinemia Iron Protoporphyrin
- neonate’s immature liver is unable to
conjugate bilirubin
Indirect
a. Pathologic jaundice – present 24
hours after birth bilirubin

b. Physiologic jaundice – from the

2nd or 3rd to the 7th day of life Glucuronyl
- breastfed babies have long transferase
periods of physiologic jaundice
because the human milk has
pregnanediol which depresses
the action of glucuronyl Direct bilirubin
transferase
Jaundice in Newborn
F. Physical Assessment

11. Skin
Kernicterus
- brain damage due to the buildup of
bilirubin
- bilirubin moves into the
bloodstream to the brain tissue
- permanent neurologic damage,
including in cognition
Phototherapy (Bili Light)
F. Physical Assessment

11. Skin
4. Pallor
- usually caused by anemia

5. Harlequin Sign
- a newborn that has been lying on his
side will appear red on the dependent
side of the body and pale on the upper
side
F. Physical Assessment

1!. Skin
B. BIRTHMARKS

Hemangiomas
– vascular tumors of the skin

Three types:
1. Nevus flammeus
- macular purple or dark red lesions
- a.k.a. port wine stain
- typically on the face but also found on
the thighs
F. Physical Assessment

11. Skin

2. Stork’s beak mark

- a nevus flammeus lesions that is
lighter pink in color
- sometimes called telangiectasia
- typically on the back of the neck
F. Physical Assessment

11. Skin

3. Strawberry hemangioma
- elevated areas formed by immature
capillaries and endothelial cells
- may be present at birth or appear
within the first 2 weeks of life
- may continue to enlarge until the
first year of life
- after 1 year old, it begins to be
absorbed by the body and shrinks in
size
- hydrocortisone ointment may be
applied
F. Physical Assessment

11. Skin

4. Cavernous hemangioma
- dilated vascular spaces
- looks like strawberry hemangiomas
but they don’t fade with age
- may be surgically removed
F. Physical Assessment

11. Skin
B. BIRTHMARKS

Mongolian spots
- collections of pigment cells
(melanocytes) that appear as
slate-gray patches across the
sacrum or buttocks and possibly
the arms and legs
- fade without treatment during
school age
F. Physical Assessment

11. Skin
C. VERNIX CASEOSA

- a white, cream cheese-like substance

that serves as a skin lubricant.
- takes the color of the amniotic fluid:
yellow = bilirubin
green = meconium
F. Physical Assessment

11. Skin
D. LANUGO

- fine, downy hair that covers the

shoulders, back, and upper arms
- may also be found on the forehead
and ears
- usually disappears after two weeks
due to rubbing against clothes and
beddings
F. Physical Assessment

11. Skin
E. DESQUAMATION

- within 24 hours from birth, extreme

skin dryness may occur, especially on
the palms and soles
- causes peeling of the skin
- no treatment needed
F. Physical Assessment

11. Skin
F. ERYTHEMA TOXICUM

- newborn rash
- usually appears in the 1st to 4th day of
life and up to 2 weeks
- a.k.a. flea bite rash
- no treatment
F. Physical Assessment

11. Skin
G. SKIN TURGOR

- feels resilient if the underlying tissue

is well hydrated
- good: skin is elastic and falls back
when pinched
- decreased or poor: skin remains e
levated when pinched or falls back
slowly
F. Physical Assessment

12. Abdomen

- slightly protuberant
- bowel sounds should be present
within an hour after birth
- assess the umbilical cord
stump
F. Physical Assessment

13. Anogenital

- passage of meconium during

the first 24 hours
- check the patency of the anus
F. Physical Assessment

13. Anogenital

Male Genital Area

- penis appears small (less than 2 cm)

- scrotum may be edematous and has rugae
- both testes should be present
- cryptorchidism – one or both testicles are not present
- elicit cremasteric reflex to test for the integrity of spinal
nerves T8 to T10
- may be absent in newborns less than 10 days old
Cryptorchidism
F. Physical Assessment

13. Anogenital

Male Genital Area

- urethral opening should be at the tip of the glans

Epispadias – opening at the dorsal surface

Hypospadias – opening at the ventral surface
Epispadias, Hypospadias, Normal Urethral Opening
F. Physical Assessment

13. Anogenital

Female Genital Area

- vulva may be swollen

- may have a mucus vaginal
secretion, sometimes blood-tinged
(called pseudomenstruation)
F. Physical Assessment

14. Back

- flat lumbar and sacral

areas
- observe for spina bifida
F. Physical Assessment

15. Extremities

- arms and legs appear short

- hands are plump and clenched into fists
- hold the arms down to the side and note the length:
the fingertips should cover the proximal thigh
- unusually short arms could indicate achondroplastic dwarfism
- observe for simian crease (single palmar crease)
- associated with Down syndrome
Achondroplastic dwarfism
Simian crease
F. Physical Assessment

15. Extremities

- arms and legs should be symmetrical

Erb-Duchenne palsy (Erb’s palsy)

- the result of a severe tear to a
newborn’s brachial plexus nerves due
to a shoulder dystocia delivery
F. Physical Assessment

15. Extremities

- arms and legs should be

symmetrical

Congenital hip dysplasia

- a.k.a congenital hip dislocation
- neonate is born with an unstable
hip
- abnormal formation of hip joint
F. Physical Assessment

15. Extremities

- assess for digit (fingers and toes)

abnormalities

Syndactyly
- webbing of fingers and/or toes

Polydactyly
- extra fingers and/or toes
F. Physical Assessment

15. Extremities

Talipes deformity
- a.k.a. clubfoot
- the feet does not align readily or
will not turn to a definite midline
position