Newborn Physical Exam (Part 1)

00:01 In this lecture, I'm going to discuss the newborn physical exam.

00:05 So, before I even start, I wanna say two things about the newborn exam.

00:10 One is, it can be tricky from the standpoint of making sure that the child is adequately warm.

00:18 So sometimes you have to be a little bit quick because if you leave the child unexposed for a period of time they can start getting cold.

00:26 You'll notice that the skin starts to mottle or look like marble a little bit and that's a sign that infant is getting cold.

00:33 If you can, you can do a very careful exam under a warmer.

00:38 The other thing about the newborn exam is it can be frustrated, frustrating especially with auscultation.

00:45 And the reason is, newborn infants might cry and make it hard to hear what's going on.

00:51 It's okay if you leave an infant and then come back to them later when they're sleeping to get the rest of your exam.

00:58 But let's go through the newborn exam really carefully here so we can understand not only for an exam that might happen but also for your general practice on the pediatric wards.

01:09 So first, let's review vital signs and growth parameters.

01:14 It's important that you have the height, the weight and the head circumference on every infant you exam.

01:20 And, it's important we review the vital signs.

01:23 The heart rates should be usually between 120 and 160 RPM in a healthy newborn child.

01:30 The respiratory rate is usually high, between 40 to 60 RPM.

01:35 From the standpoint of blood pressure, we often don't have one this is because it's a bit challenging to make.

01:42 We will use it in infants who are ill but if an infant is well, the blood pressure is not a critical measurement.

01:50 And, remember pulse ox is abnormal in the first day of life and very abnormal in the first 10 minutes.

01:59 So, during the first 10 minutes, it's normal for infants to go from 60% at birth to 90%.

02:06 Then it can take the rest of the day to go up to a hundred percent but expect abnormalities in the pulse ox early.

02:13 In the second day of life that pulse ox should pretty much be normal.

02:17 In fact, many centers use that pulse ox as a screen for congenital heart disease.

02:22 Okay. Now you've got the vitals, you got the height, the weight and head circumference and you plotted them so you have percentiles. Now we're going to do an exam.

02:33 And we're gonna start at the head and work our way down.

02:36 The first thing you're going to do on the head is feel the sutures.

02:39 Early in birth, sometimes they are slightly overriding and elevated but that should stabilize out relatively quickly.

02:48 Also, you should feel a fontanelle in the anterior portion of the skull as is pictured here and a very small sort of finger large posterior fontanelle.

03:00 You should feel both of those. And you should feel all those sutures.

03:03 And if you feel any asymmetries or abnormalities, those should be noted.

03:07 This could be a partial craniosynostosis for example.

03:11 Next, we're gonna check the eyes and we absolutely are going to do a red reflex.

03:17 The red reflex is useful is because when you're looking and you're seeing not only the red reflex but also the possibility of slip lenses which can happen with a variety of infant diseases.

03:28 Also, the red reflex may be absent in a patient with retinoblastoma.

03:33 So it's crucial to check those eyes. Also, look at the irises.

03:38 If a coloboma is present, this might be CHARGE syndrome. Now take a look at the ears.

03:45 As you draw a line backward from the eye, it should intersect the top third of that ear.

03:52 Also, you should note any abnormalities of the ear. Is it posterior placed, but is it rotated? Are there pits? Are there tags? Abnormalities of the ear may be associated with syndromes or maybe even just associated with renal abnormalities.

04:09 For reasons I don't understand, ears and kidneys can sometimes go together in so many different ways.

04:16 Next, we're gonna check the mouth.

04:17 We're gonna look for abnormalities of the lips but we're also gonna put our finger into the mouth and palpate the top of the mouth.

04:26 If there's abnormalities in a cleft palate, you may note them obviously on exam.

04:32 But a pallet on the inside maybe high arched or maybe abnormal as well with a lack of patency on the inside and that should all be noted.

04:42 While we've got our finger in there, check the baby suck. It should be vigorous.

04:47 That's technically part of the neuro exam but I would absolutely do it.

04:50 Also, we're gonna check the nose.

04:53 In pretty much any infant, at some point we may suck out both nares.

04:58 That usually is done in the resuscitating room but we're gonna check patency of the nose.

05:04 If a tube goes in but can't get through, that patient may have choanal atresia which can cause respiratory distress in an infant.