Neonatal Exam

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    Neonatal Exam

    • General Appearance: (Alertness, Vitals, weight/length/HC, Apgar Score)
    • HEENT
      • Appearance (Dysmorphic Features)
        • Head (shape, size, fontanelles)  Caput succedaneum (cone head), Cephalohematoma?
      • Eyes (red reflex, pupils, no conjunctivitis [Ophthalmia neonatorum])
      • Ears & Nose (Shape/size/position)
      • Throat/mouth (cleft lip and/or palate) (can check root reflex, and also exam palate for clefts) [Ankyloglossia - cleft tongue]
      • Neck (Midline/lateral masses) {Thyroglossal duct cyst, cystic hygroma, brachial cleft cyst}
    • CVS/Resp
      • Resp: Chest deformity, cyanosis, accessory muscle use, resp rate
      • CV: HR, S1, S2 (no S3/4), no murmurs.
    • Abdomen
      • Inspection (Size, shape, masses, herniations, anus [patent?])
        • Gastroschisis (lateral to umbilicus, herniated intestine no sac)
        • Omphalocele (herniated bowel or other organs, peritoneum present).
        • Umbilical Hernia
    • Genito-Urinary
      • Male: Genital anatomy, bilat descended testes, hernia, hydrocele
      • Female: Genital anatomy, swollen labia, dischrage (maternal estrogen withdrawal).
    • MSK
      • Barlow (adduct hip, attempt to dislocate posteriourly)
      • Ortolani (abduct hip, attempt to dislocate anteriourly) [looking for "clunk"]
      • Birth injuries: clavicle intact, Erb palsy (C5, C6 - extended, pronated forearm), Klumpke's paralysis (C8, T1, forearm supinated, fingers hyperextended).
    • Neuro/Spine
      • Primitive Reflexes
        • Rooting (suck)
        • Galant (stroke abdo side)
        • Palmer/Plantar grasp (finters/toes curl)
          Pick up baby
        • Placing (upright, simulate walking)
        • Moro (parachute)
        • ATNR (fencing)
      • Spine
        • Spina bifida occulta (10% of pop'n, incidental on x-ray, sometimes dark or hair growing)
        • Meningocele (Herniated meninges, spinal cord ok)
        • Myelomeningocele (Herniated meninges + spinal cord)
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