Neonatal Exam

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)