Neonatal History should: 1. Identify disabling diseases that are amenable to prompt preventive action or treatment (e.g.

rds) 2. anticipate condition that may be of late importance (e.g. gonococcal conjunctivitis) 3. uncovers possible causative factors that may explain pathologic conditions regardless of their immediate future significance (e.g. metabolic diseases) PHYSICAL EXAMINATION OF THE NEWBORN INFANT Three periods of examination: 1. Immediately after delivery (focus on congenital problems and adaptation to extrauterine life, birth injuries) 2. At 24 hours of life (more detailed examination) 3. Upon discharge (if possible together with the mother) Anthropometric measurements Birth weight Birth length: place head on the fixed part of the scale Head circumference Chest circumference Abdominal circumference Physical examination: Pulse / cardiac rate : 120-160 bpm Respiratory rate : 30- 60 breaths/min. Blood Pressure : not routinely taken unless the baby is ill or with heart murmur GENERAL APPEARANCE Posture (flexion) if flaccid, sedated or with neuromuscular problem Physical Activity Edema Muscle tone Level of alertness (18-20 hours sleep) Color (cyanotic, acrocyanotic, pallor, plethoric, jaundice) REVIEW OF SYSTEMS Head / skull Molding Cephalhematoma (10-20% may have skull fractures) Caput succedaneum Skull defects (anencephaly) Anterior and posterior fontanels Craniosynostosis Craniotabes Micro/ macrocephaly /hydrocephaly Cutis aplasia congenita Bruits Face Dysmorphic features : epicanthal folds, widely spaced eyes, microphthalmia, asymmetry, long philtrum, low set ears Asymmetrical face (7th cn palsy) Moebius syndrome (hypoplasia of the 7th nerve nucleus)

Eyes

Dolls eye maneuver Subconjunctival/ retinal hemorrhages Red orange reflex: if you dont have consider for retinoblastoma or cataract Leucokoria (white pupillary reflex): cataracts, tumors, rop Chemical irritation White sclerae Blue sclerae (osteogenesis imperfecta) Chorioretinitis Anotia (treacher-collins syndrome) Microtia Preauricular tags and pits Dull gray tympanic membrane Low set ears Malformed ears Broad in appearance Choanal atresia Ngt need to be firm, insert it and ct scan Can also put cotton to see ait Babies are nose breathers Babies are pinkish if mouth closed Flaring of the ala nasi

Ears

Nose

Mouth Natal teeth (lower incisors) Bifid uvula Cleft lip and palate Sucking pads Small tonsils High-arched palate Large tongue Ankyloglossia tongue tied Retention cysts (ranula) Epsteins pearls Micrognathia (pierre-robin syndrome Excessive salivation Macrostomia big mouth Neck Short neck Hematoma on sternocleidomastoid muscle Cystic hygroma Branchial cleft cysts Thyroglossal duct cyst Webbing turners syndrome Resistant neck to flexion (meningitis or sah) Bruits of thyroid gland Congenital torticollis Clavicular fracture in lga babies

Chest Breast hypertrophy with or without milk (witches milk) normal Mastitis Supernumerary nipples Inverted nipples Widespread nipples Chest circumference : 2 cm < hc

Lungs Breathing is predominantly abdominal Retractions, grunting Asymmetric breathing Stridor obstruction above larynx, increased upon inspiration, urti Bronchovesicular breath sounds Apnea 20 seconds stop breathing Periodic breathing Crackles or rales - lrti Cardiovascular system Normal resting heart rate: 90-160 bpm Pmi at 4th ics In adults its 5th ics Characteristic of pulses: coarctation of aorta Dextrocardia heart is on the right, stronger pulse on the right Benign / pathologic murmur Sinus bradycardia Blood pressure : systolic 40-80 mmhg Diastolic 20-55 mmhg Mean 25-60 mmhg Abdomen Palpable o Liver palpable 2 cm brcm o Palpable splenic tip Gas in rectum by 24 hours, should pass out meconium Umbilical hernia lump in umbilicus with skin Masses Scaphoid abdomen: diaphragmatic hernia, all intestines are the the chest, abdomen is empty Omphalocoele lump in umboilicus with no skin, but with thintransparent covering Gastroschisis intestines are outside the body Omphalitis redness, erythema, inflammation around the umbilicus Umbilical cord : 2 arteries, 1 vein, whartons jelly Tufts of hair Umbilical granuloma Genitourinary system Penis should at least be 2 cm in length, press down the fat to measure Transitory hydrocoele usually temporary, check through transillumination Hypospadias urethral openingis below, ventral Tight prepuce normal, but as they grow older may loosen Ambiguous genitalia (cah) Pseudomenses Erection of the penis Voiding within 24 hours Undescended testes Large labia majora Hymenal tags Testicular torsion More rugae if older, less if baby Inguinal hernia looks like a third testes Prune belly syndrome

Anus

Passage of meconium within the first 12 hours after birth Imperforate anus make sure theres a hole Fistula in ano Meconium pearls

Musculoskeletal system Unequal limbs due to lymphangiomas/ hemangiomas Syndactyly / polydactyly / clinodactyly Ortolani maneuver : congenital hip dislocation Talipes equinovarus/ equinovalgus Amelia / pocomelia Rocker-bottom feet Simian crease Breech presentation Brachial palsy More premature less creases Skin Vasomotor instability : mottling, acrocyanosis, harlequin color change Cyanosis Pallor Plethora Jaundice or icterus: if physiological not seen in the eyes, just in the skin. o If not obvious, press on the skin then let go. Check for yellowish discoloration. Vernix caseosa Erythema toxicum (eosinophils) Pustular melanosis (neutrophils) Milia whitish, erythematous pustules on the tongue Miliaria Mongolian spots Capillary hemangioma group of blood vessels, outpouching Mongolian spots blue spots on the butt Meconium staining of skin, cord and nails Lanugo (preterm) Vellus hair (term) Gelatinous skin Parchment-like skin (post-term) Tuft of hair Amniotic band Storks bite Pigmented nevi Petechiae/purpura