Patricia Anne R. Gatchalian Mrs.

Eden Malvar
BSN III NICU Task

Physical Assessment of the Newborn

NORMAL ABNORMAL
Skin  Erythema toxicum  Cyanosis- bluish color
 Birthmarks (e.g., hemangiomas,  Acrocyanotic- bluish color of the
Mongolian spots, nevi ) extremities
 Pale color- anemia/decreased
ciculation to body part
 Redness- inflammation
 Jaundice- yellowish color of the
skin
 Poor turgor- dehydration
Head  Molding -due to pressure against  caput succedaneum or
the cervix before birth cephalohematoma - pressure from
 presence of fontanelle through birth
palpation- anterior fontanelle  Hydrocephalus -at least 4 cm
normally closes at 12 to 18 bigger than normal head
months and the posterior circumference
fontanelle by the end of 2 months  Microcephaly- head is smaller than
 Head Circumference: 34 to 35 cm expected when compared to
babies of the same sex and age
 Fontanelle appear indented - sign
of dehydration
 Fontanelle is bulging- sign of
increase intracranial pressure
 Fontanelle appears to be closed
(cannot be palpated) early or too
late depending on the age of
newborn- indicate decreased or
increased brain or ventricle growth
SCALP
 seborrhea (i.e., scaling,
greasy-appearing, salmon-colored
patches)
 cradle cap

Eyes  Pink conjunctiva  Cataract- couldiness ni cornea

 White sclera  Jaundice of sclera
 PERRLA (Pupils equal, round,  Subconjuctival hemorrhage-
reactive to ight, accommodation Hemorrhage in sclera bright red
 normal) spot on the sclera / due to the
 Red reflex assessment- normal if pressure of birth, a small
there is symmetry in both eyes conjunctiva blood vessels has
without opacities, white spots or ruptured
dark spots.  Red reflex assessment;
Black dots- catarct
Whitish color- retinoblastoma
 Strabismus- eyes that is not evenly
aligned
 Esotropia- eyes is always turning in
 Exotropia - eyes is always turning
out

Ears  Exhibit moro reflex in response to  Low set ears - below lateral
noise canthus of eyes
 Top of the pinna should cross the  Malformed ears- associated with
eye-occiput line and be within a down’s or turners syndrome
10 degree angle of perdendicular  Skintags
line drawn from the eye-occiput  No reaction to noise- may suggest
line to the lobe hearing deficit
 Amniotic fluid/vernix may be  Otitis media- purulent serous
present in canal of the ear discharge
 Bloody discharge- suggest trauma
 Perforated tympanic membrane
 White discharge- cerebrospinal
fluid leak

Nose  color of mucus membranes-  Flaring of nostrils - sign of increase

pinkish respiratory effort/needs oxygen
 septum is in the midline, nostrils  Color of mucus membranes:
are patent Pale- allergies
Redness- infection
 displaced septa - interfere with
respiration and make nasal
intubation in emergencies difficult
 Choanal atresia- congenital
narrowing of the back of the nasal
cavity that causes difficulty
breathing
Mouth  Lips - should be pink and  Thrush - white patches in the
symmetrical and moist. buccal area or tongue that cannot
 Considerable mucus in the mouth scrape away, common but
- newborns are less able to handle abnormal finding caused by fungi.
 swallowing due to immature  Tongue-tie (ankyloglossia) - is a
muscle coordination. condition present at birth that
 White patches - normal if the restricts the tongue's range of
patches can be scraped away motion.
easily because this is only caused  Cleft lip/palate - a gap or opening
by formula or breast milk. in the upper lip/palate. This
 Epstein pearls - are small, happens when the baby's lip and
harmless cysts that form in a palate did not form properly early in
newborn's mouth during the early pregnancy, resulting in a split.
weeks and months of
development
Chest Location of chest pathology:  Chest retractions and indentations-
Midclavicle sign that baby is not getting
Midmammary enough air and probably needs
Midsternum points on the front oxygen
Midaxilla on the side  Barrel chest/ chest rounded than
Midscapula on the back usual - possible lung disease
Other helpful means of locating  Pectus excavatum (Funnel Chest)
pathology:  Thoracic Kyphoscoliosist
Suprasternal notch  diaphragmatic hernia- (i.e.,
Ribs intestine herniated into the chest
Intercostal spaces cavity) may have a chest enlarged
Proportion of the anteroposterior to the on that side
lateral diameter (normally 1:2)  atelectasis (i.e., collapsed lung)
may have a chest smaller on the
affected side.
 has an enlarged heart- the left side
of the chest may appear larger
Breast  Presence of breast buds  Palpable mass
 Supernumerary nipples- extra
nipple is notes in the chest or
abdomen
Abdomen  slightly protuberant  Bowel distention: high “pinging”
 Bowel sound: high “pinging” sounds more frequent; may
sounds with 5-10s interval indicate pyloric stenosis- narrowing
 Liver: should be palpable no more of pylorus- muscle in the
than 2cm below the costal margin stomach, that can lead to
(if palpable lower in the abdomen dehydration
consider hepatomegaly).  bowel is blocked- no movement
 Spleen: may be palpable at the left of contents, sounds will be absent
costal margin in healthy infants (if below the obstruction (listen for3
easily palpable, consider to 5 mins)
splenomegaly).  Umbilical hernia - baby's umbilical
  Kidneys: normally only palpable cord area seems to push outward
using deep bimanual palpation (if when crying(increase abdominal
easily palpable consider pressure)
polycystic kidney disease).  Umbilical granuloma - a small,
 Bladder: should not be palpable in reddened mass of scar tissue that
healthy infants (if easily palpable, stays on the belly button after the
considering urinary tract umbilical cord has fallen off
obstruction)  Inguinal hernia- tissue, such as part
of the intestine, protrudes through a
weak spot in the abdominal
muscles
 umbilical cord stump infection- the
umbilical area oozes pus, the
surrounding skin becomes red and
swollen, or the area develops a pink
moist bump
 Scaphoid abdomen -
malnutrition/dehydration
Genitals MALE MALE
Male  Urethral opening - should be  Paraphimosis - when the foreskin is
Female split-like and and centered at the retracted but can't move back up.
penis at the penis tip This can prevent normal blood flow
 Phimosis - a tight foreskin is in the penis, and may cause serious
normal in babies and young boys. problems.
Most boys' foreskins do not pull  Hypospadias - urinary meatus on
back (retract) before the age of 5, the ventral surface of the glans.
but sometimes it's not possible  Epispadias - urinary meatus on the
until they're 10 or older. dorsal surface of the glans.

FEMALE FEMALE
 Hymenal tissue- light pink seen  vaginal mass (ex: paraurethral cyst-
between labia minora small (average size, 1–2 cm), yellow
 Has central opening or whitish interlabial mass
 Vernix- cheesy white materia on  Imperforate hymen- hymen
the interior surface of the labia covering the whole opening of
majora. vagina
 Premature -baby girls may have a
very prominent clitoris and inner
labia.
 Full-term- girls have larger outer
labia, small amount of whitish
discharge or blood-tinged mucus
from the vagina in the first few
 weeks. This is a normal
occurrence related to the mother's
hormones.
Extremities  Normal crease- has 2 major  Polydactyly- presence of one or
crease, neither extend from one more additional fingers or toes
side to another  Syndactyly- two fingers are fused
 Transverse palmar crease -
asssociated with down’s syndrome
and other genetic disorder
 Talipes Disorder - ankle–foot
disorders, popularly called
clubfoot
Types of Talipes Disorder :
Plantarflflexion (an equinus or
“horsefoot” position, with the forefoot
lower than the heel)
Dorsiflflexion (the heel is held lower
than the forefoot or the anterior foot is
flexed toward he anterior leg)
Varus deviation (the foot turns in);
or valgus deviation (the foot turns out)

Back  Straight spinal cord  Spina bifida occulta

Reflexes  Palmar grasp reflex- disappears in
10-12 months
 Sucking reflex
 Rooting reflex
 Stepping reflex- newborn
stepping one foot forward
 Moro reflex- startle