The Normal Newborn Exam, or Is It?

Abstract

In today's modern world of high technology imaging and sophisticated laboratory examinations, medicine has come to rely on technology much more than in the past. So much so that at times we forget about the power of a thorough physical exam in detecting medical issues. In this article we will explore the normal newborn examination, discuss the importance of knowing normal versus abnormal findings and discuss some common and not so common findings on the newborn examination. In healthy babies, 15% to 20% will have at least one minor anomaly with an associated 3% chance of having a major anomaly. Two, three, or more minor anomalies are found in 0.8% and 0.5% of healthy babies, respectively. In these cases the chances of major anomalies rises to 10% and 20%, respectively [1].Newborn infants may present to the emergency department for a variety of reasons. Almost all of these derive from the parent's perception that something is wrong. In each of these cases, the role of the emergency physician is to recognize abnormality and, if no abnormality exists, to alleviate concerns of the parent. Mostly, parental concern stems from conditions that are self-limited or are variants without physiologic consequence. Less common are that these concerns are the presentation of a medical condition that has the potential to worsen or represents underlying illness. Detection of the latter can be life saving. Unfortunately, illness in the newborn is often subtle and difficult to detect. The primary difficulty lies in that the daily activities of a newborn and the newborn's interaction with the environment are extremely limited. It is therefore imperative that the emergency physician becomes familiar and comfortable with performing a newborn exam.

Comparing the effects of minimal handling protocols on the physiological parameters of preterm infants receiving exogenous surfactant therapy

“…HR was monitored continuously and noninvasively, and values between 90 and 180 bpm were used for data analysis. Adverse bradycardia events were considered for values below 90, and adverse tachycardia events were considered for values above 180 18 . Importantly, the electrocardiogram was not thoroughly evaluated.…”

“…The nursing technician responsible for the NB noninvasively monitored infant axillary temperature every two hours using an Incoterm ® mercury thermometer; axillary temperature values between 36.5 and 37.5ºC 18 were considered normal for data analyses. Values below 36.5 were considered adverse hypothermia events, and those above 37.5 were considered adverse hyperthermia events.…”

Instrumentos De Evaluación Fisioterapéutica en Población Neonatal:

“…Entre las 28 y 32 semanas se desarrolla el reflejo papilar (pares craneanos II y III. El par craneal V se puede evaluar a través del reflejo corneal o con un ligero toque en las áreas de la rama del trigémino que produce una retirada del estímulo, además, los recién nacidos a término a menudo pueden fijar y rastrear objetos grandes, lo que permite realizar pruebas de los pares craneanos II, III, IV y VI (Lowe, 2007).…”

“…Los ruidos fuertes deberían provocar un parpadeo, probando el par craneal VIII; el reflejo de deglución evalúa los pares craneanos IX y X. Las fasciculaciones del músculo esternocleidomastoideo o de la lengua pueden representar una lesión que afecta a los pares craneanos XI o XII, respectivamente. En general, no es necesario un examen detallado de los nervios craneales a menos que se sospeche un problema (Lowe, 2007).…”

Neonatal Care Provider Tasks for Hospitalized Well Newborns

“…Lowe and Woolridge27 published a comprehensive presentation of the newborn examination for emergency department providers when presented with cases of either normal variations or serious problems of newborns at a few days of life. They included a checklist to aid physical assessment and description of concepts to help clinicians diagnose the common problems of the newborn.…”