ASSESSMENT OF A NEWBORN

Assessment of a Newborn
Nuruddin Lakhani, M.D., M.P.H.
Pediatrician




HISTORY
Important to review Mother’s chart
- Mother’s age
- Mother’ s gravida / para status
- Pregnancy complications
- Labor events
- Rupture of membranes (SROM, AROM, PROM, PPROM)
- Mother’s labs (blood group, HBsAg, HIV, VDRL, GC / Chlam)
- ? Fever, medications (antibiotics, narcotics etc)
- Mode of delivery

Important to review the events immediately after birth
- Resuscitation
- Any medications given
- APGARS

SCORE 0 1 2
Heart Rate Absent < 100 >100
Resp Effort Absent/irr Slow, Crying Good
Muscle Tone Limp Some flexion Active motion
Reflex irritability No response Grimace Cough or sneeze
Color Blue. Pale Acrocyanosis Pink



NEONATAL EXAMINATION

General
- Appearance, size, color, vitals, gestational age assessment and growth parameters

Systemic
- Head and Neck - CNS
- Respiratory - Skin
- Cardiovascular - Musculoskeletal
- Abdominal - Primitive Reflexes
- Genitourinary


Size
- PAGA, PSGA, PLGA
- TAGA, TSGA, TLGA
- PTAGA, PTSGA, PTLGA
Gestational Age Assessment
- Ballard Score based on neuromuscular and physical maturity
- Ballard chart for the gestational assessment is used

HEAD
- Birth trauma (caput succedaneum, cephalhematoma)
- Size (microcephaly, macrocephaly)
- Fontanelles
EYES
- Red reflex
- Neonatal conjunctivitis

MOUTH / OROPHARYNX
- Cleft lip / palate
NOSE
- Obstructions
EARS
- Position
NECK
- Masses

RESP
- Rate, distress
- Apnea, cyanosis (? Causes)
- Auscultation
CVS
- Distress, apnea, cyanosis (? Causes)
- Palpation (apical impulse, thrills)
- Auscultation (murmurs)







ABDOMEN
- Abdominal wall defects, umbilical cord, shape
- Palpation
- Auscultation
- Check anal area for patency
GU
- Males – check for testes in scrotum or in the canal
- Females – check for ambiguous genitalia

MUSCULOSKELETAL
- Brachial plexus injury
- Range of motion
- Barlow’s and Ortolani test for hip dysplasia
- Check spine
CNS
- Movements and tone
- Primitive reflexes




SKIN
- Color (jaundice)
- Skin hair
- Texture
- Neonatal rashes
- Lower back hair or sacral dimple