Please enable JavaScript.
Coggle requires JavaScript to display documents.
Neonatal examination (Normal variations (Cranium Moulding: overriding…
Neonatal
examination
Overview
Timing
1+ in week 1
(usually 1st day)
Purpose
Maternal reassurance
Health education
(common variations)
Detecting asymptomatic problems
Screening for rare but serious conditions
Process
Preparation
Midwife
Concerns/problems
Mother
Check notes (current pregnancy, POH, PMH,
DH, FH congenital disorders, SH etc.)
Is baby feeding well
Passed meconium/urine
Introduce and consent
Introduce self
Explain procedure and consent
Wash hands
Examination
Face
Inspection:
dysmorphism, nose and chin size, check mouth, visualise palate (clefts)
Palpation:
hard and soft palate (clefts), nostrils (patency)
Chest
Inspection:
shape, symmetry, nipple position, RR (40-60/min), resp pattern, effort, accessory muscles (subcostal/sternal recess)
Palpation:
precordium, apex
Auscultation:
precordium (heart and lungs)
Neck
Inspection:
movement side to side
Palpation:
clavicles (swelling/tenderness from birth injury)
Ears
Inspection:
position, size, shape, patency EAM
Cranium
Inspection:
skull shape, bruising, forceps marks, fontanelles
Palpation:
measure max occupito-frontal circ (33-37cm term);
fontanelles: position, tension, size (anterior max 4x4cm, posterior 1cm)
Abdomen
Inspection:
shape, umbilical stump, inguinal hernias
Palpation:
masses, liver (normally <2cm below costal margin),
spleen (normally <1cm), kidneys (normally palpable), bladder
Genitalia
Female: inspect (clitoris and labia normally large)
Male: inspect (size, shape, urinary meatus), palpate (descended testes)
Both: palpate femoral pulses (aortic coarctation)
Anus
Inspection:
position, patency
Spine
Inspection:
deformity, sacral naevi/dimple/pit/hair patch/pigmentation/lipoma (?underlying abnormality)
Limbs
Inspection:
symmetry, shape, passive and active movement,
digit number and shape, palmar creases
Palpation:
hip movements - Orlatani and Barlow (DDH)
Reflexes and tone
Grasp, suckling, stepping, moro
Tone during handling, posture, movements
Head holding (almost horizontal)
Eyes
Inspection:
size, strabismus, red reflex (cataract, retinoblastoma)
General
Settled/agitated
Colour - cyanosed, pink, jaundiced
Appearance
Normal
variations
Cranium
Moulding: overriding bones, palpable ridges; resolves 2-3d
Pre-auricular pits/tags/accessory auricles: often isolated, can be associated with hearing difficulties so need hearing check
Eyes
Sticky eye (blocked lacrimal duct): if purulent swab MCS/CT, abx drops
Subconj haemorrhage: assisted delivery or cord round neck, resolves few wks
Skin
Vernix: normal white substance at birth
Peripheral cyanosis: normal first few days
Post-mature skin: dry, peeling, cracking
Spots: Mongolian blue, cherry red
Mouth
Epsteins pearls: white inclusion cysts on palate/gums, self resolve
Tongue tie: shortened tongue frenulum, may have feeding issue
Ranula: bluish mouth floor swelling (mucus retention cyst), self resolve
Oral candidiasis: white flecks, erythema; antifungal e.g. nystatin
Chest
Murmurs: evaluate in context of other findings; may be innocent; check sats, ECG and BP, ECHO if concern
Breast swelling: maternal hormones, may lactate, spontaneously resolve in wks
Abdomen
Umbilical hernia: swelling of umbilicus, usually self resolve <12m
Single umbilical artery: usually not significant, but can be
associated with some syndromes and IUGR
Genitalia
Undescended testes: check not retractile (can be encouraged into the scrotum); refer if still undesc at 1y
Hydrocoele: common, self resolve by 1y
Vaginal discharge (mucous/blood): maternal oestrogen withdrawal, spontnaeously resolves
Vaginal hymen/skin tags: spontaneously resolve
Inguinal hernias: rare, refer (risk strangulation/incarceration)
Anus
Sacral coccogeal pits: check blind ending/not patent
if higher up (?spinal), will need spinal imaging
Limbs
Single palmar crease: 2% normal, associated Down's
Polydactyly: isolated or syndromic, refer to surgeon
Syndactyly: often familial, refer if hands involved
Postural deformity: positional talipes; if correctable then can massage back to neutral, if fixed refer to surgeon/physio