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Newborn Exam

last authored: August 2012, David LaPierre
last reviewed:

Introduction

It can be very exciting to examine a newborn, especially if you are the one who delivered the baby. It is a very important task as well - newborns are fragile, and it is very helpful to identify and address potential problems early on.

The newborn exam takes much practice. Examine every baby you can, including each delivery you're at, to establish patterns for yourself, recognize the variations of normal, and to better identify signs of disease when present.

General Advice

Always wash your hands! Clean equipment with alcohol before and after use.

Parents are anxious and interested; explain what's happening as you examine the baby.

Hand babies gently but confidently; slower movements are less likely to startle the infant.

Have everything ready; including opthalmoscope.

Learn to sooth baby, and to change diapers. Parents will appreciate this, and will increase their confidence in you.

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The First Few Minutes

The first few minutes are largely focused on ensuring the overall health of the infant, and to identify need for immediate intervention/resuscitation. These are described under APGAR scores and the approach to neonatal resuscitation.

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Full Physical Exam

Once general health is established, allow the mother and others to bind with the infant. In the coming hours or day, perform a thorough physical assessment.

Be systematic; you are less likely to omit parts of the examination if you proceed with an established routine.

general
eyes
reflexes
hips

general

Observe the baby's colour, activity, posture and behaviour.

Start listening to the baby if it is quiet first. Listen to the heart and lungs in the same areas as for an adult.

Examine baby's head for marks, bruising, shape, fontanelles, and sutures.

Look for dysmorphic features, including:

low-set ears
ear abnormalities and cartilage (if skin tags or pre-auricular pit, could be a marker for kidney malformation)

Check the nares for patency: when baby is not crying, occlude one and observe respirations.

Assess the mouth, including the palate (natal teeth can be present). Always use a glove when inserting finger into a baby's mouth.

Palpate the neck for masses and observe for sinuses.

Palpate clavicles, feeling for step deformities that might suggest a fracture.

Open hands, observe creases and grasp reflex

Assess breast tissue.

Examine the abdomen, first with light palpation, then deeper. In particular, feel for a mass suggestive of pyloric stenosis.

Check for bilateral femoral pulses in the suprapubic folds.

check hips (described in a further tab).

Check femur length

examine feet

Turn baby over, palpating the spinous processes and assessing the anus and sacral areas for tufts of hair or openings.

Examine the genitalia. In a boy, gently palpate for the testes. Hold a finger over canal to avoid pushing testes upwards.

measure head circumference (measure 3x) and take biggest measurement

length: mark

Eyes

If eyes are open check red reflex

Reflexes

Primitive reflexes are seen in healthy neonates. If these persist after 6 months, however, an abnormality such as cerebral palsy may be present.

arm recoil: possibly Moreau (one of the most important tests, showing neurologic function); if not, drop baby test

avoid in first 30 minutes due to epinephrine and using up glucose

Rooting reflex

The infant turns towards stimuli near its mouth.

Primitive walking reflex

The infant places a foot down onto a surface, akin to stepping, when it is held in this position.

Moro reflex

The infant is held facing upwards, with the head supported. The head is briefly dropped and then immediately resupported. A normal reflex is arm abduction and extension, followed by adduction and flexion. Absence of reflex suggests CNS abnormality, while assemetry of reflex may be seen with focal motor injury.