Newborn Physical Exam (Part 2)

00:01 Next, we’re going to look at the neck.

00:03 The neck is important in infants because it can have abnormalities that are hard to see unless you really extend the neck and look at it.

00:10 Examples are a thyroglossal duct cyst which is midline or a branchial cleft cyst which is lateral, so we’ll look for abnormalities.

00:19 Next, palpate the clavicles.

00:22 It’s common for clavicular fractures to happen in large babies or with bad shoulder dystocia.

00:28 Next, listen to the heart and lungs.

00:31 Remember that half of normal newborns will have a murmur in the first day of life.

00:37 Okay.

00:38 We’re moving down to the liver.

00:40 It’s normal to feel a liver in a baby.

00:43 In fact, if you examine a baby well and you don’t feel a liver, you probably didn’t examine them well enough.

00:50 In boys, look for hypospadias, where the urethra isn't emerging from the end of the penis.

00:56 This is important because boys with hypospadias shouldn't be circumsized until a urologist sees them.

01:03 Urologists may use the forskin during the repair of the hypospadia.

01:08 Also look to make sure both testes are descended.

01:11 Undescended testes may put children at risk for testicular cancer if they don't descend or get repaired before puberty.

01:21 You should be able to palpate livers in most babies.

01:24 It’s even normal to be able to palpate kidneys in babies.

01:28 So you’re going to feel that liver and it should be generally no larger than 3 cm below the costal margin.

01:36 Three centimeters is a pretty big distance.

01:39 Babies can have big livers.

01:40 The spleen and the kidneys may be palpable and that may be normal.

01:45 Next, check for the patent rectum.

01:49 Don’t forget to check during that first newborn exam, because an inpatent rectum can be a real critical surgical emergency in an infant, so take a look and make sure that rectum is present.

02:02 While you’re down there, inspect the genitalia.

02:05 Here’s an example of an abnormal genitalia.

02:08 This child has ambiguous genitalia which are probably associated with congenital adrenal hyperplasia.

02:15 This child is a girl with a very large clitoris and a fused labia majora.

02:22 Okay.

02:23 We’re done with the genitalia, we’re going to move on to the extremities.

02:26 Check the stability of the hips.

02:28 Do a little bit of an Ortolani and Barlow to make sure that’s okay.

02:31 Next, inspect the spine and look for sacral dimples or tufts.

02:36 Acrocyanosis or blue hands and feet is normal and common, but syndactyly such as this patient has or polydactyly which is even more common with an accessory digit is very common.

02:51 We need to look and count fingers and toes in every patient and make sure they look normal.

02:56 Even subtle findings like a palmar crease may be your sign that the patient has, for example, Down’s syndrome.

03:05 Lastly, we’re going to do our neurologic exam.

03:08 We’ve already done the suck reflex, but we’re going to comment on it during the neurologic exam.

03:14 Check for their overall tone.

03:16 Babies should prefer to be all balled up.

03:19 They don’t want to have their extremities relaxed.

03:22 If a child is relaxed and open, something is wrong neurologically.

03:27 Check the suck.

03:29 Check for a rooting reflex where you stroke their chin and they move towards it to suck.

03:35 Check their grasp.

03:36 This infant should want to hold your finger.

03:39 Holding your finger is a normal reflex in infants.

03:43 It’s nice to not tell the mother that this is a reflex.

03:47 Let her think her child wants to hold her finger.

03:50 Also, check the Moro reflex.

03:53 The Moro, which should be done carefully, is when you suddenly lower the head and the infants arms will come out and spread, they may shake a little bit and then come back in again.

04:04 If infants do that, that is normal.

04:06 What we’re looking for is asymmetry of the Moro reflex.

04:10 If only one arm comes out, that could be a sign of nerve damage, perhaps from a brachial plexus nerve injury as a result of birth.

04:21 Lastly, it is good to check the DTRs.

04:24 The deep tendon reflexes are easy to appreciate in the knees for example of infants and we can also check the heels for clonus.

04:31 A little bit of clonus might be okay early in infancy.

04:36 So that’s my summary of the neurologic exam from head to toe in infants.

04:41 Thanks for your time.