Newborn physical exam

Check vital signs
Fever may warrant a septic workup for a neonatal infection.
Check height, weight, and head circumference charts.

Perform physical exam
General: Observe for any distress.
HEENT:
Check fontanelles and cranial sutures.
Examine head for cephalohematomas, craniosynostosis, or hydrocephalus.
Elicit red reflexes and check for eye discharge.
Check ear canals and check for any external sinus tracts.
Check for patency of nostrils
Examine for a cleft palate, teeth, or thrush on the tongue.

Neck:
Examine for range of motion and masses.
Chest: Palpate clavicles for fractures and auscultate for breath sounds.
Heart: Listen for the presence of murmurs.
Abdomen: Palpate for any abdominal masses.
Check umbilical cord stump for signs of infection.
Urogenital:
Inspect for ambiguous genitalia.
Check urethral meatus for hypospadias in males.
Palpate the testicles if descended; if not, palpate inguinal canals for location.
Examine for hydroceles, inguinal hernias, and scrotal masses.
Rectum: Look to see if the rectum is patent.
Musculoskeletal:
Perform Ortolani's and Barlow's maneuvers for hip subluxation or dislocation
Inspect spine for dimples or hair tufts, which may indicate spina bifida
Neuro:
Assess for Moro, Babinski grasp, and suck reflexes.
Check hearing grossly by startling with a loud noise.
Skin: Inspect for acne neonatorum, dermal melanocytosis (Mongolian spot), erythema toxicum neonatorum, jaundice, milia, port wine nevus, or facial salmon spot.
Denver developmental assessment of motor, visual, language, and social categories for newborns includes:
Social smile
Regards face
Lifts chin up
Tracks to midline with eyes
Consider the following labs or follow-up laboratories drawn in the hospital:
Newborn screening test
Blood type/Coombs' test for ABO incompatibility


PLAN
Address parental concerns and treat pt if indicated
Review diet
Feeding on demand: Typically, 2-3 ounces every 2-3 hours.
No honey or extra water.
Implement prevention
Definition of fever and instruction of what to do:
If temperature 100.4°F rectally. go to the hospital.
No acetaminophen or aspirin.
Discuss sudden infant death syndrome (SIDS):
• Optimal sleeping position is on the back.
Review safety:
- Parental fatigue
- Second-hand smoke avoidance
- Shaken baby syndrome
- Smoke/carbon monoxide detectors
- Sibling interaction and bonding
- Water temperature for bathing baby
Crib safety: Bumpers, bedding, and fire-retardant sleepwear
Car seat: Importance of correct installation and use o Place in center of the back seat, facing rear
Umbilical cord care.
Anticipatory guidance:
Avoid bottle propping.
Symptoms of infant colic.
Encourage cardiopulmonary resuscitation (CPR) training.
Immunize pt
If hepatitis B was not given in the hospital, can either be given at this visit or at the
2-month visit.
Check vital signs
Fever may warrant a septic workup for a neonatal infection.
Check height, weight, and head circumference charts.

Perform physical exam
General: Observe for any distress.
HEENT:
Check fontanelles and cranial sutures.
Examine head for cephalohematomas, craniosynostosis, or hydrocephalus.
Elicit red reflexes and check for eye discharge.
Check ear canals and check for any external sinus tracts.
Check for patency of nostrils
Examine for a cleft palate, teeth, or thrush on the tongue.

Neck:
Examine for range of motion and masses.
Chest: Palpate clavicles for fractures and auscultate for breath sounds.
Heart: Listen for the presence of murmurs.
Abdomen: Palpate for any abdominal masses.
Check umbilical cord stump for signs of infection.
Urogenital:
Inspect for ambiguous genitalia.
Check urethral meatus for hypospadias in males.
Palpate the testicles if descended; if not, palpate inguinal canals for location.
Examine for hydroceles, inguinal hernias, and scrotal masses.
Rectum: Look to see if the rectum is patent.
Musculoskeletal:
Perform Ortolani's and Barlow's maneuvers for hip subluxation or dislocation
Inspect spine for dimples or hair tufts, which may indicate spina bifida
Neuro:
Assess for Moro, Babinski grasp, and suck reflexes.
Check hearing grossly by startling with a loud noise.
Skin: Inspect for acne neonatorum, dermal melanocytosis (Mongolian spot), erythema toxicum neonatorum, jaundice, milia, port wine nevus, or facial salmon spot.
Denver developmental assessment of motor, visual, language, and social categories for newborns includes:
Social smile
Regards face
Lifts chin up
Tracks to midline with eyes
Consider the following labs or follow-up laboratories drawn in the hospital:
Newborn screening test
Blood type/Coombs' test for ABO incompatibility


PLAN
Address parental concerns and treat pt if indicated
Review diet
Feeding on demand: Typically, 2-3 ounces every 2-3 hours.
No honey or extra water.
Implement prevention
Definition of fever and instruction of what to do:
If temperature 100.4°F rectally. go to the hospital.
No acetaminophen or aspirin.
Discuss sudden infant death syndrome (SIDS):
• Optimal sleeping position is on the back.
Review safety:
- Parental fatigue
- Second-hand smoke avoidance
- Shaken baby syndrome
- Smoke/carbon monoxide detectors
- Sibling interaction and bonding
- Water temperature for bathing baby
Crib safety: Bumpers, bedding, and fire-retardant sleepwear
Car seat: Importance of correct installation and use o Place in center of the back seat, facing rear
Umbilical cord care.
Anticipatory guidance:
Avoid bottle propping.
Symptoms of infant colic.
Encourage cardiopulmonary resuscitation (CPR) training.
Immunize pt
If hepatitis B was not given in the hospital, can either be given at this visit or at the
2-month visit.

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