NORMAL NEWBORN &

NEONATAL EXAMINATION
 Normal newborn
• Birth weight >2.5kg and gestation of 37wks or
more
• Birth weight between 10th and 90th percentiles as
per intrauterine growth charts
• Absense of maternal illness or intrapartum events
that may put the neonate at risk of illness
• Normal Apgar score, no need of resuscitation at
birth
• No postnatal illness [Link] illness, sepsis,
hypogycemia
Examination should be conducted in warm and
comfortable room with the baby compeletely
undressed and placed on a flat surface at a height
convenient for the physician.A good source of light
should be available and examiner’s hands should be
clean and warm.
The detailed examination is conducted routinely at
birth,with in 24 hr or next day and at time of discharge.

The newborn is best examined one hour after the feed.

 Examination at birth:
• The aim of examination of baby at birth is to ensure and
assess that lungs have expanded and air passage are not
obstructed and to make an early diagnosis of life threatening
congenital malformation and birth injuries.
• Monitoring:
• [Link]
• [Link]
• [Link] rate
• [Link]
• [Link] of respiration
• [Link]
• [Link]
• [Link] of consciousness - monitored every 30 [Link] for 2
hr’s or until stabilization.
 Apgar scoring system
score
Criteria 0 1 2
Breathing Nil Slow, gasping Crying
Heart rate/min Nil Upto 100 More than100
Muscle tone Flaccid In-between Flexed
Reflex response Nil Grimace Cry
Color Pale or Peripheral Pink
blue cyanosis
 General Physical Examination
• 1 POSTURE
• 2 VITALS
• 3 ANTHROPOMETRY
• 4 SKULL
• 5 EYES
• 6 EARS
• 7 NOSE
• 8 MOUTH
• 9 NECK
 Cont’d
• 10 SKIN
• 11 UMBILICAL CORD
• 12 GENITALIAS
• 13 ANUS
• 14 SPINE
• 15 ARMS &LEGS
• 16 HIPS
• 17 HERNIAL ORIFICE
• 18CONGENITAL MALFORMATION’S
• Examination of:
1 RESPIRATORY SYSTEM
2 CVS
3 GIT
4 CNS-gestational age assessment
.
 Neonatal Reflexes
[Link] reflexes:
[Link] reflex
[Link] reflex
[Link] reflex

[Link] reflexes:
[Link] eye response
[Link] reflex
[Link] tap
[Link] carthy’s reflex
[Link] reflexes:
[Link] reflex
[Link] reflex
[Link]’s reflex
[Link] reflex

[Link] reflexes:
[Link] reflex
[Link] reflex
[Link]’s reflex
[Link]&palmer grasp
[Link] adductor reflex
[Link] reflex
[Link] reflexes:
[Link] to sit
[Link] tonic neck reflex
[Link] tonic reflex
[Link] labyrinthine reflex
[Link] reflex
1. POSITION: In prone position –preterm baby lies flat on cough
,with pelvis low &knee at the side of abdomen,hip’s being
flexed .the full term baby lies with pelvis high &knee drawn up
under the abdomen.
In supine position –preterm-lies with lower limbs extended&
hips abducted &upper limbs are in a similar position,full term
lies with limbs strongly flexed.
• [Link]:
• A) Temp- normal temp -36.5c to 37.5c
• mild hypothermia -36.5 to 36.0c
• moderate hypothermia -36.0 to 32.0c
• severe hypothermia - < 32.0c
• the warm & pink feet of baby indicate that baby is in thermal
[Link] feet are cold & abdomen is warm –cold stress ,in
hypothermia both feet & abdomen are cold to touch .
• B) Heart rate -140/min
• rate > 200 -Tachycardia
• rate < 80 -complete heart block
• bradycardia –asphyxia,hypothermia,hypothyroidism,raised ICT
,hyperkalamia,
• C) [Link] -40/min
• D) BP -60/40 mm Hg
• In infant with adequate tissue perfusion,the baby is pink &warm without
any mottling of skin, the difference b/w central& peripheral skin
temperature is < 1.5 c , capillary refill over upper chest is <2 sec.& urine
output is adequate (at least 1.0 ml/hr.)
 Head circumference
In new borns done after 1st day of birth (when
caputsuccedanem and over riding of sutures
would have disappeared)
 Chest circumference
Just below the level of nipple
• SKULL –
• 1. Fontanelles –6 fontanelles
• Ant. 2-3 cm ,closed at 18 mth of age.
• Post.- small (admit tip of finger) closed at birth , max. 2 mth of
age.
• Disorders associated with large ant fontenel
PRETERM IUGR
rickets malnutrition
hydrocephalus Down syn.
Trisomy 13& 18 Thalassemia major
Osteogenesis achondroplasia
imperfecta
[Link] syn. mucopolysaccharidosis
• Buling fontanels–
• Increased I.C.T  meningitis, intra cranial bleed,
subdural hematoma, ICSOL, hydrocephalus,
crying child,
• Benign ICP - (nalidixic acid, tetracycline,
vit A poisoning. )

• Sunken fontanels- dehydration.

Cephalohematoma:
Sub periosteal collection of blood,
Does not cross suture lines.
Maxi. size 3rd day
Disapper by 3-6 week.
Caput succedaneum:
Diffuse, baggy, soft swelling of scalp.
Seen at birth.
Cross suture line.
Disapper by 1-2 days.
Eye- congestion ,conjunctivitis
Ear – low set ear ,abnormal ear
Nose – depressed bridge
Cause – 1 Down syn.
2 Cong. Syphlis
Mouth – cleft lip/ palate
Face – salmon patch/ stork mark – capillary hemangioma
on nasal bridge ,upper eye lid , nape of neck .
Micrognathia, Retrognathia Glossoptosis & Cleft palate –
PIERRE ROBIN SYN.
• Neck – short neck
• Skin – jaundice/milia/mongolian spots / erythema
toxicum
• Umbilical cord – no. of art.(2)/vein(1)Infected cord – foul
smelling,Meconium stained cord,Normally cord dried &
falls b/w 5 – 10 days,Delayed separation of cord - in
preterm/CMI deficency disorders & local infections.
• Genitalias – Undescended testis/ retractile testis
• Anus – patency
Spine – spina bifida, sinus tract , tufts of hairs
Arms & Legs
Hips – CDH
Hernial orifices
Mongolian blue spot
 Gestational assessment
Assess gestation by physical and neurological
examination.
• The Physical criteria:
• Skin
• Ear/Eye
• Lanugo Hair
• Plantar Surface
• Breast Bud
• Genitals
 Identification: Preterm LBW

Breast nodule

Preterm Term

Preterm Term

Teaching Aids: NNF LBW- 26

 Identification: Preterm LBW

Male genitalia
Preterm Term

Teaching Aids: NNF LBW- 27

 Identification: Preterm LBW

Female genitalia
Preterm Term

Teaching Aids: NNF LBW- 28

 Identification: Preterm LBW
Sole creases
Preterm Term

Teaching Aids: NNF LBW- 29

 Identification: Preterm LBW

Ear Cartilage

Preterm Term
Teaching Aids: NNF LBW- 30
• The Neurological criteria:
• Posture
• Square Window
• Arm Recoil
• Popliteal Angle
• Scarf sign
• Heel to Ear
 Neonatal Reflexes

Reflex Age of appearance Age of Disappearance Remark in CP

Moros reflex Birth 3-4 months Absent or Less extensive

Grasp reflex Birth 2-3 months Persist

Asymetrical tonic neck reflex Birth 2-3 months Persist

Symetrical tonic neck reflex 2 months when begin to crawl Over active

Neck righting reflex Birth Absent ( Severe cases)

Labyrinth righting reflex 2 months Absent

Body righting reflex 7 –12 months Absent

Landau reflex 3 months before one year Absent

Parachute reflex 6-9 months persist for life Absent

• NEONATAL REFLEXES:
[Link] REFLEXES:
[Link] reflex
[Link] reflex
[Link] reflex
• EYE REFLEXES;
• [Link] reflex
• [Link] reflex
• [Link] Carthy’s reflex – homolatral blinking on tapping the
supraorbital area .( if eye is not open – stimulation of
circumoral area cause opening of eyes ).
• [Link]’s eye response – name given because there is a
delay in the movement of eyes after the head has been
turned.
• The reflex is always present in 1st 10 days, disappearing
as fixation developes. This is asymmetrical in abducens
paralysis.
• SPINAL REFLEXES:
• [Link] reflex (trunk incurvation)– On placing
the child in ventral suspension, stimulation of the
back lateral to the spine, or of lumbar region
cause flexion of trunk toward the side of
stimulus.
• [Link] reflex- child in prone position- pressure is
applied upward along the spine from sacrum
towards the head – produces flexion of arms &
legs, extension of neck &cries.
• LIMBS REFLEXES:
• a. Moro’s reflex- 3 methods
• 1. hold the baby at an angle of 45 & suddenly let
the head fall back a short way.
• 2. baby placed supine &the back of the head is
supported on the palm of the hand an inch above
the table, rapid release of hands.
• 3. by pulling a supine infant by both hands, when
angulation occurs b/w head & trunk, the hands
are sharply released to cause extension of the
neck
Interpretation:
[Link] abduction & extension of upper limbs & opening of
hands f/w by flexion & adduction. This is a vestibular
reflex, dissappear by ¾ months of age .
Appear by 28 week of gastation
ABNORMAL MORO’S REFLEX
a) preterm babies- adduction phase is absent.
b) hypertonic CP
c) HIE
d) maternal sedation
• ASYMMETRAL MORO’S REFLEX
• 1. # humerus
• 2. # clavical
• 3. infantile hemiplagia
• 4. erb’s palcy
• This reflex is also inhibited on holding of object in
hand. Note – When elicting the response the
head should be in middle & the hands should be
open.
• 2. STEEPING / WALKING REFLEX –
Holding the baby upright over a table,
so that the sole of foot pressed against the table,
this will causes reciprocal flexion & extension of
the legs, simulating walking.

• 3. Placing reflex-
elicited by bringing the anterior aspect
of tibia/ulna against the edge of table, causes lifts
the leg up to step on to the table.
• Magnet reflex-
when child is supine, the examinor’s
finger is pussed against the sole of the foot, this
will causes hip & knee flex & fingers is withdrawn,
foot follows the finger.

Crossed extension reflex-

holding one leg extend at knee & apply
firm pressure to sole on same side , will cause the
free leg get flex, adduct, then extend.
• Postural reflex-
• Asymmetric tonic neck reflex-
in supine position, on rotating the head to one side, the arm
& leg of same side will extend & contralateral limbs will flexed.

Symmetric tonic neck reflex-

on extending the neck, the extensor tone in arm increase &
flexor tone in legs increases.

• Righting reflex-
This will responsible for the ability to restore the normal
position of head in space & to maintain the normal postural relationship
of head, trunk & limbs during all activities. This reflex include- 1.
Neck righting reflex- Turning of head to one side is followed by movement
of the body as a whole.
• 2. Labyrinth righting reflex-
act on head, this enables the child to lift
the head up in the prone position & later in
supine position.
--In cerebral palsy this is absent.
• Cranial nerves
• 1: Mother milk
• 2: Fixing at soft light
• 3,4,6: Eye movement
• 5: Rooting reflex
• 7: Observe the child cry
• 8: Behavioral response to sound
(startle,blink,change in heart rate)
• 11: Lift the head off the bed by holding at wrist &
watch sternomastoids
• 5,7,9,10,12: Suck & swallow
 Danger signs : Summary
 Lethargy  Bleeding
 Hypothermia  Yellow palms/ soles
 Respiratory distress  Excessive wt. loss
 Cyanosis  Vomiting
 Convulsion  Diarrhea
 Abd. distension

Teaching Aids: NNF DS- 46