Chapter 23 NEWBORN PHYSICAL ASSESSMENT - MNCYN
Perinatal Manual of Southwestern Ontario
A collaboration between the Regional Perinatal Outreach Program of Southwestern Ontario & the Southwestern Ontario Perinatal Partnership (SWOPP)
Chapter 23
NEWBORN PHYSICAL ASSESSMENT
"The baby should have a complete physical examination within 24 hours of birth, as well as within 24 hours before discharge".
Family-Centred Maternity & Newborn Care: National Guidelines 2000
Principles of Examination
1. Provision should be made to prevent neonatal heat loss during the physical assessment.
2. A rapid overall assessment of the baby will be done at the time of birth, with a more detailed assessment completed on admission.
3. Where possible, the parents should be present during the assessment.
4. Sequence of examination include:
Inspection
Auscultation Palpation Neurologic Reflexes
Examples
? Body proportion ? Posture ? Skin ? Amount of subcutaneous fat ? Facial appearance ? Respirations ? Sleep state ? Movement ? Responsiveness
? Heart ? Lungs
? Cranium ? Peripheral pulses ? Abdomen, liver, spleen, kidneys
? Suck / root ? Moro
Perinatal Outreach Program of Southwestern Ontario PERINATAL MANUAL CHAPTER 23 - NEWBORN PHYSICAL ASSESSMENT
? Grasp ? Babinski
Other
? Eyes - Red reflex ? Measurement
Vital signs, including BP and Mean Arterial Pressure (MAP), which should be at least equal to gestational age
(For clarity sake, the following head-to-toe assessment will be grouped in an organized fashion indicating common normal findings, as well as abnormalities).
Area
Head
Normal
? Molding ? Overriding sutures ? Caput succedaneum
Face
? Normal configuration
Eyes Nose Ears
? Symmetrical ? Open ? Red reflex
? Symmetrical
? Normal configuration ? Response to sound
Abnormal
? Cephalhematoma ? Fracture ? Sutures fused ? Fontanelle
o Full o Depressed ? Abnormal facies ? Mandibular hypoplasia ? Forceps injury ? Facial palsy o Partial o Complete ? Asymmetry
? Subconjunctival hemorrhage
? Cataracts
? Coloboma
? Conjunctivitis
? Brushfield spots
? Nasal flaring
? Choanal atresia
? Abnormal configuration
? Low set
? No response to sound
? Forceps injury
? Accessory auricle(s) / tags
Revised February 2006
23-2
Disclaimer
The Regional Perinatal Outreach Program of Southwestern Ontario has used practical experience and relevant legislation to develop this manual chapter. We recommend that this
chapter be used as a reference document at other facilities. We accept no responsibility for interpretation of the information or results of decisions made based on the information in the
chapter(s)
Perinatal Outreach Program of Southwestern Ontario PERINATAL MANUAL CHAPTER 23 - NEWBORN PHYSICAL ASSESSMENT
Area
Mouth
Normal
? Normal configuration ? Epstein's pearl
Neck Chest
? Normal mobility
? Two nipples ? Enlarged breasts
Abnormal
? Cleft lip/palate ? Precocious teeth ? Glossoptosis ? Not tongue tied ? Webbing ? Masses ? Extra nipples ? Breast abscess
? Normal respirations (40-60 breaths/minute)
? Apnea ? Cyanosis ? Retractions ? Tachypnea ? Grunting
? Normal breath sounds
? Diminished air entry ? Crackles/wheezes
? Normal heart rate ? (110-160 beats/minute)
? Arrythmia ? Murmur ? Tachycardia ? Bradycardia
? Peripheral pulses equal to ? Peripheral pulses differ
apical
from apical
? Bounding or faint peripheral pulses
Revised February 2006
23-3
Disclaimer
The Regional Perinatal Outreach Program of Southwestern Ontario has used practical experience and relevant legislation to develop this manual chapter. We recommend that this
chapter be used as a reference document at other facilities. We accept no responsibility for interpretation of the information or results of decisions made based on the information in the
chapter(s)
Perinatal Outreach Program of Southwestern Ontario PERINATAL MANUAL CHAPTER 23 - NEWBORN PHYSICAL ASSESSMENT
Area
Abdomen
Normal
? Slight protrusion
Abnormal
? Convex ? Distended
? 3 umbilical vessels ? Cord drying
? 2 vessels
? Umbilical inflammation, drainage
? Normal palpation
(Liver 2 cm below costal margin)
? Enlarged o Liver o Spleen o Kidneys
Skin
Genitalia Female
? Bowel sounds present ? Vernix ? Pink colour ? Acrocyanosis ? Milia ? Erythema toxicum ? Telengiectatic nevi ? Mongolian spots
? Normal configuration ? Mucousy vaginal
discharge ? Pseudo menstruation
? Bowel sounds absent ? Jaundice ? Cyanosis ? Pallor ? Petechiae ? Bruising ? Strawberry hemangioma ? Port wine stains
? Abnormal configuration
Male Anus
? Normal configuration ? Testes in scrotum ? Hydrocele
? Patent
? Hypospadias ? Epispadias ? Undescended testes
? Imperforate anus ? Fistula ? Patulous
Revised February 2006
23-4
Disclaimer
The Regional Perinatal Outreach Program of Southwestern Ontario has used practical experience and relevant legislation to develop this manual chapter. We recommend that this
chapter be used as a reference document at other facilities. We accept no responsibility for interpretation of the information or results of decisions made based on the information in the
chapter(s)
Perinatal Outreach Program of Southwestern Ontario PERINATAL MANUAL CHAPTER 23 - NEWBORN PHYSICAL ASSESSMENT
Area
Normal
Extremities Arms, Legs, ? Hands, Feet
Normal
Hips
Abnormal
? Abnormal ? Fractures ? Paralysis ? Weakness ? Polydactyly ? Syndactyly ? Abnormal skin creases
Spinal Column
Extremities Neurologic Exam
? Range of motion adequate
? Click
? Normal
? Congenital hip dislocation ? Clunk
? Sinus ? Mass ? Myelomeningocele
? Normal activity
? Normal tone
? Normal DTRs
? Primitive reflexes present (Suck, Root, Moro, Step, Place)
? Ventral suspension, Head lag
? Hypotonic ? Hypertonic ? Jittery ? Seizures
Charting
1. A checklist format is recommended for ease of charting.
2. The birth weight, length and head circumference should be plotted against gestational age to identify disparities and those babies who are large, appropriate, or small for dates.
3. Another way of assessing the baby's well being and to organize care is to use the Primary Survey from the ACoRN Manual.
Revised February 2006
23-5
Disclaimer
The Regional Perinatal Outreach Program of Southwestern Ontario has used practical experience and relevant legislation to develop this manual chapter. We recommend that this
chapter be used as a reference document at other facilities. We accept no responsibility for interpretation of the information or results of decisions made based on the information in the
chapter(s)
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