1. Newborn Examination Rafat Mosalli MD FAAP FRCP

2. Newborn examination objectives • Indication and importance • Precautions prior to exam ! • Systematic approach • Neonatal reflexes • Normal variants

3. Newborn examination • Earliest possible detection of deviations. • Establishes a baseline for subsequent examinations • Parents assurance and counseling

4. Newborn examination indications • Immediately after birth • Before discharge from maternity unit • Whenever there is any concern about the infant's progress

5. Newborn first exam • Apgar score • Heart rate • Respiratory effort • Color • Tone • Reflex irritability

6. Examination precaution • Hand washing,hand washing ,hand washing • Thermal environment • Light and noise • Brief examination time

7. General(Growth parameters) • Weight (Naked) • Length(straight) • Head circumference(3 measurements)

8. Vital Sign • Heart Rate HR 120-160 • Respiratory Rate RR 40-60 • Temperature 36.5-37.5 C • Blood Pressure

9. General • Well, Distress or not? • skin • Pink is normal • Acro cyanosis is normal • Cyanosis • Bruised part look blue • Jaundice • Common variants skin rash • Erythema toxicum, mongolian spot, Benign Pustular Melanosis

10. Erythema Toxicum

11. Erythema Toxicum • Erythematous macules and firm 1-3 mm yellow or white papules or pustules • Etiology obscure • Pustules contain eosinophils and are sterile • Appear in the first 3-4 days of life • Range: Birth to 14 days • Benign and self limited

12. Erythema Toxicum

13. DD: Impetigo Neonatorum • Vesicular, pustular, or bullous lesions developing as early as day of life 2-3 up to 2 weeks of life • Lesions occur in moist or opposing surfaces of skin • Unroofed lesions do not form crusts • Treat with antibiotics

14. Impetigo Neonatorum

15. Mongolian Spots • 90% of African infants, 81% of Asian, and 9.6% of Caucasian infants • Slate-gray to blue-black lesions • Usually over lumbosacral area and buttocks • Accumulation of melanocytes within the dermis • Generally fade by age 7 years

16. Mongolian Spots

17. Benign Pustular Melanosis of the Newborn

18. Pustular Melanosis

19. General • Obvious Dimorphism or malformations E:g(Down syndrome ear tag neural tube defect ) • Tone & Movements: Flexion of upper and lower extremities -Asymmetric movement • Brachial plexus and fractured clavicle -Ventral, vertical suspension and head control for tone assessment

20. General inspection • Vigorous cry is assuring • Weak cry • sepsis, asphyxia, metabolic, narcotic use • Hoarseness • Hypocalcemia, airway injury • High pitch cry • CNS causes, kernicterus

21. Head and Face • Shape of the head • Fontanels? • Sutures? • Eyes? • Nose? • Mouth,lips,palate? • Ears? • Neck?

22. Head • Forceps and vacuum marks • Caput succedaneum • Boggy edema in presenting part of head • Cross suture lines • Disappear in few days • Cephalhematoma • Subperiosteal • Weeks to resolve • Dose not cross sutures

23. Cephalhematoma

24. Caput Succadaneum

25. Cephalhematoma

26. Caput Succadaneum

27. Newborn Scalp Hematomata

28. Head • Head circumference • Shape :Molding, Brachycephaly: flat occiput • Widening of suture • Fontanelles • Head auscultation: bruits

29. Infant skull

30. Craniosynostosis • Definition: premature closure of one or more cranial suture. • Growth of the skull occurs parallel to the suture(s) involved • Early correction optimizes cosmetic appearance • Can be part of syndromes:Crouzon's , Apert's syndrome

31. Craniosynostosis • Types: • Sagittal synostosis results in scaphocephaly • coronal synostosis results in brachycephaly • coronal, sagittal, and lambdoid synostosis results in acrocephaly • single suture on one side of head can result in plagiocephaly www.uscneurolosurgery.com

32. Chest and Abdomen

33. Chest • Distress signs(Grunting,Tachypnea,Nasal flaring,asymetric chest rise,supra-sternal, intercostal, sub costal retraction). • Deformities(Pectus excavatum, carinatum) • Auscultate • Air entry, symmetry • Early crepitation sound is transmitted upper sound • Late inspiratory crepitation

34. chest • Suprmammary nipple • Breast hypertrophy • Milk production • No redness

35. Supernumerary Nipples • Found in males and females • Pink or brown papules along the milk line, most commonly on the chest or abdomen • May contain breast tissue and in women carry the same relative neoplasia risks • Not considered a marker for other anomalies

36. Supernumerary Nipples

37. Heart • HR 100-160 beats/min • Color, perfusion,Central cyanosis • Murmur • Single S1 • Splited S2 • No split ;single ventricle, pulmonary hypertension

38. Femoral Pulses

39. Abdomen • Inspection • Scaphoid • Distention • Abdominal wall defect (gastroschisis) • Palpation; babysucking and use warm hands • Kidneys are normaly palpable • Liver 2-3 cm • Spleen palpable • Umbilical vessels • 2 artery, one vein • Hernias ; umbilical and inguinal

40. Genitalia • Penile size • Hypospadias, epispadias • Testes • 2% crypoorchid • Hydrocele • Female: • Prominent clitoris and minora • Vaginal skin tag • Vaginal discharge /blood • Labial fusion • Anus : Patency and location

41. Hydrocoeles

42. Inguinal Hernias

43. Hip and Extremities • Erb’s palsy: extended arm and internal rotation with limited movement • Humerous fracture • Digital abnormality • Syndactaly, brachdactaly, polydactaly • Single palmar crease • Hip dislocation • Female, breach

44. Subluxation of the Hip

45. Subluxation of the Hip

46. Feet and Back • Feet deformities • Back and spine • abnormal curvature • Sinus tract, tuft of hair

47. Lumbar hair tuft & haemangioma

48. CNS • Awakenes and alertness • moving extremities • Flexed body posture • Minimal Head lag • Ventral suspension • Vertical suspension

49. Neonatal Reflexes

50. Neonatal reflexes • Also known as developmental, primary, or primitive reflexes. • They consist of autonomic behaviors that do not require higher level brain functioning. They can provide information about lower motor neurons and muscle tone. • They are often protective and disappear as higher level motor functions emerge.