Physical and Gestational Age Assessment of The Newborn Physical

S.T.A.B.L.E.
- Physical Assessment
Principles of Physical Exam

Observe before touching
Physical and Gestational Age Auscultation before

palpation – in quiet
Assessment of the Newborn environment
Kristine A. Karlsen MSN,
MSN, RNC,
RNC, NNP
NNP
Author
Author Gentle palpation
National
National Program
Program Director,
Director, Founder
Founder Avoid if acute abdomen
The
The S.T.A.B.L.E.
S.T.A.B.L.E. Program
Program PowerPoint
PowerPoint®® Design
Design
Park
Park City,
City, Utah
Utah Mary
Mary Puchalski
Puchalski MS,
MS, RNC,
RNC, APN/CNS
APN/CNS
Extra care with
stable@stableprogram.org
stable@stableprogram.org Lombard,
Lombard, Illinois
Illinois premature infants
mary@stableprogram.org
mary@stableprogram.org
Medical
Medical Illustrations
Illustrations
Marilou
Marilou Kundmueller
Kundmueller RN,
RN, BSN,
BSN, MA
MA
© K. Karlsen 2006 © K. Karlsen 2006
Principles of Physical Exam Infant Size

Review history Measurement
Prenatal Weight
Labor/delivery Length
Presentation of illness Head circumference
Use
Consistent Appropriate size for age (AGA)
Organized Well-
Well-nourished appearance
Gentle approach
Principles of Physical Exam Infant Size

Wash hands, wear gloves Small for gestational age (SGA)
Use clean equipment Weight less than10th
percentile for gestational age
Keep infant warm
Symmetric
Perform while infant in quiet Asymmetric
state whenever possible
Shield infant’
infant’s eyes from Appropriate size for age (AGA)
exam light
Large for gestational age (LGA)
Comfort infant during and
after exam Weight greater than 90th
percentile for gestational age
Change soiled diapers / redress following exam
(c) Kristine A. Karlsen 2006. Handout

reproducible for eduational purposes. 1
S.T.A.B.L.E. - Physical Assessment
Infant Size Neurological Status

Use Ballard exam to Normal reflexes in term infant
assess gestational age Root and suck
Gestational
Gestational
age
age assessment
assessment
Infant Size Neurological Status

Normal reflexes in term infant
Root and suck
Moro  arms extend, abduct, hands open,
open, followed by
flexion of arms and closing of hands
Discordant
Discordanttwins
twins
© David A. Clark MD
Neurological Status Neurological Status

Normal Normal reflexes in term infant
Active, alert, good tone, moderate Root and suck
flexion, symmetric strength Moro  arms extend, abduct, hands open,
open, followed by
and movement flexion of arms and closing of hands
Strong, symmetric cry Palmar and plantar grasp

Neurological Status Head

Normal reflexes in term infant Size
Root and suck Indication of normal brain growth
open, followed by Record largest measurement
flexion of arms and closing of hands Above ear and eyebrow ridges
Palmar and plantar grasp Occipitofrontal circumference
Babinski  extension or flexion of toes after stimulating (OFC)
sole of foot
Varies with molding and
scalp swelling

Sutures Anterior
Normal reflexes in term infant fontanel Metopic
suture
Root and suck Approximated
Frontal
open, followed by Overlapping Sagittal bone
suture
flexion of arms and closing of hands Wide-
Wide-spaced Coronal
suture
Palmar and plantar grasp Mobility
Babinski  extension or flexion of toes after stimulating Parietal
Posterior bone
sole of foot fontanel
Tonic neck (fencing position) Squamosal
suture
Truncal incurvation (Galant reflex)  pelvis moves toward
Occipital
side of stimulus bone Lambdoidal
suture

Abnormal Shape
Weak suck or poor feeding Molding
pattern Symmetric
Weak cry Asymmetric
Distressed facies
Lethargy / hypotonia Size of fontanels
Hyperreflexia / hypertonia Anterior
Posterior
Decreased or absent reflexes
Irritability
Scalp swellings
Seizures
Location
Coma Characteristics
© K. Karlsen 2006 © K. Karlsen 2006 © David A. Clark MD

Head  Scalp Anatomy Head  Caput Succedaneum
S kin
C onnective tissue (CT)
A poneurosis (galea)
L oose CT (subgaleal)
P eriosteum
Skull bone Vacuum
Vacuumedema
edema
Superior
Superiorsagittal
sagittalsinus
sinus
––drains
drainsblood
bloodfrom
from
scalp back to heart
scalp back to heart
Head  Scalp Swellings Head  Cephalohematoma
Blood
Blood
accumulation
accumulation
between
betweenskull
skullbone
bone
and
andperiosteum
periosteum
Emissary Superior
vein sagittal sinus
Location Palpation Blood loss Duration

Stops at sutures Initially firm Rarely severe Resolves in
Caput Succedaneum Cephalohematoma Subgaleal Hemorrhage Parietal and occipital More fluctuant X-ray if skull 2 weeks to
bones after 48 hrs fracture suspected 3 months
May be bilateral
Head  Caput Succedaneum Head  Cephalohematoma

Accumulation
Accumulationof of
serosanguineous
serosanguineous
fluid in
fluid in
subcutaneous
subcutaneous
tissues
tissuesofofscalp
scalp
Emissary Superior
vein sagittal sinus

Edema of presenting Soft and spongy Minimal Resolves in
part of scalp – usually Pits on pressure 48 – 72 hours
crosses suture lines –
shifts with positioning

Head  Subgaleal Hemorrhage Head  Abnormal Findings

Subgaleal
Subgalealspace
space––
holds
holdsupuptoto240
240ml
ml
of
ofblood
blood––
potentially
potentiallyentire
entire Craniosynostosis
Craniosynostosis
blood
bloodvolume
volume Apert syndrome
Rupture
Ruptureof
ofemissary
emissary Crouzon syndrome
veins
veins subtle
subtlebut
but
massive
massivehemorrhage!
hemorrhage!
Superior
sagittal sinus

Crosses suture Firm to fluctuant – May lead to Resolves over
lines – may “boggy” severe anemia 2 – 3 wks
extend from eyes Dependent swelling and hypovolemic High morbidity
to nape of neck shock & mortality
© David A. Clark MD © David A. Clark MD
Congenital
Congenital
hydrocephalus
hydrocephalus

Crosses suture Firm to fluctuant – May lead to Resolves over
lines – may “boggy” severe anemia 2 – 3 wks
extend from eyes Dependent swelling and hypovolemic High morbidity
to nape of neck shock & mortality

Anterior Holoprosencephaly 4 P syndrome
Microcephaly
Microcephaly
© Jack Dolcourt MD
Macrocephaly
Macrocephaly
Infant with subgaleal hemorrhage
Note
Notefluid
fluidwaves,
waves,
Note
Notearea
areaof
ofhemorrhage
hemorrhage tachypnea
tachypneaand
andretractions
retractions
Monitoring Video courtesy of Swiss Society of Neonatology

Monitoring guidelines
guidelines
© Jack Dolcourt MD

Head  Scalp Injuries Hair  Abnormal Findings
Congenital
Congenitalabsence
absenceof
of Alopecia
Alopecia
hair
hairgrowth
growth––bald
baldpatch
patch
Scalp
Scalpelectrode
electrode
Head  Scalp Abnormalities Hair  Abnormal Findings
Cornelia de Lange syndrome
Cutis
Cutisaplasia
aplasia © David A. Clark MD
Long
Longlashes,
lashes,low
lowhairline
hairline
Hair  Abnormal Findings Face

Symmetry
Features
Abnormally
Abnormallyplaced
placed whorl
whorl
Trisomy 21 © David A. Clark MD

Low
Lowhairline
hairline
Symmetric
Symmetricfacies
facies

Face  Normal Findings Face  Abnormal Findings

Milia Trisomy 21
Birthmarks Short round head
Nevus simplex (‘(‘stork bite’
bite’) Milia Flat facial profile
Milia
Nevus flammeus (eyelids) Epicanthal folds
Telangiectatic nevus (‘(‘salmon patch’
patch’) Brushfield’
Brushfield’s spots
Up-
Up-slanting palpebral fissures
Short, flat nasal bridge
Protruding tongue
Short, narrow palate
Small, low-
low-set ears
Short neck,
excess nuchal folds

© Jack Dolcourt MD
Face  Abnormal Findings Face  Abnormal Findings

Congenital Trisomy 18
Congenitalfacial
facialparalysis
paralysis
(6
(6thand
th
and77thcranial
th
cranialnerves)
nerves) Prominent occiput
Triangular facies
Small palpebral fissures
Ptosis
Pinched appearance of nose
Low-
Low-set, malformed ears
Micrognathia
Goltz syndrome Small mouth
Prominent
Prominenttelangiectasia
telangiectasia
© K. Karlsen 2006 Moebius syndrome © David A. Clark MD © K. Karlsen 2006

© Jack Dolcourt MD
Face  Abnormal Findings Face  Abnormal Findings

Fetal Alcohol Syndrome Trisomy 13
Flattened midface Microcephaly, sloping forehead
Broad nasal bridge Wide sagittal sutures and fontanels
Short, up-
up-turned nose Holoprosencephaly
Central facial anomalies, midface hypoplasia
Smooth, long philtrum
Anophthalmia, microphthalmia,
Thin upper lip hypotelorism
Hypoplastic maxilla Cataracts, coloboma of iris
Broad, bulbous nose
Cleft lip, palate
Philtrum Low-
Low-set, malformed ears Microphthalmia
Microphthalmia
Scalp defects Anophthalmia,
Anophthalmia,
 cutis aplasia holoprosencephaly
holoprosencephaly


Face  Injury Eyes  Position and Size

Outer
Outercanthal
canthaldistance
distance
Location Normal eye spacing 
Extent of injury inner canthal distance
Inner
Innercanthal
canthaldistance
distance
= palpebral fissure length
Eye involvement  ophthalmology
evaluation
Assess for symmetry when crying
Asymmetry  nerve injury
Interpupillary
Interpupillarydistance
distance
Asymmetric
Asymmetricfacies
facies
following
followingforceps
forceps
assist delivery
assist delivery
Palpebral
Palpebralfissure
fissurelength
length(size
(sizeof
ofeye)
eye)
Face  Injury Eyes  Abnormal Findings

Hypertelorism
Hypertelorism
Trisomy 21
Epicanthal
Epicanthalfolds
folds
Strabismus
Strabismus Upward-
Upward -slanting
Upward-slanting
palpebral
palpebralfissures
fissures
Forceps
Forcepsmarks
marks Microphthalmia
Microphthalmia
© K. Karlsen 2006 Rubinstein-

Rubinstein-Taybi syndrome
© K. Karlsen 2006
Face  Injury Eyes  Abnormal Findings

Bruising  face presentation Brushfield
Brushfieldspots
spots
Sclerocornea
Sclerocornea
© Jack Dolcourt MD
Congenital
Congenitalcataracts
cataracts
© Jack Dolcourt MD
© K. Karlsen 2006 © K. Karlsen 2006 © David A. Clark MD © Jack Dolcourt MD

Eyes  Abnormal Findings Ears  Minor Anomalies

Coloboma
Coloboma
Goldenhar syndrome
Blocked
Blockedlacrimal
lacrimalduct
duct Ear
Earpits
pits
Preauricular
Preauricularskin
skintags
tags
Epibulbar
Epibulbardermoid
dermoidcyst
cyst
© K. Karlsen 2006 © David A. Clark MD © K. Karlsen 2006
Ears Ears  Abnormal Findings

Goldenhar syndrome
Helix
Helix
Triangular
Triangular © David A. Clark MD
fossa
fossa
Antihelix Trisomy 13
Antihelix
Tragus
Tragus © Jack Dolcourt MD
Beckwith-
Beckwith-Wiedemann
Concha
Concha syndrome
Antitragus
Antitragus
Lobule
Lobule
Extra
Extracreases
creases
© K. Karlsen 2006 Treacher

© K. Karlsen 2006 Collins syndrome
Ears  Position Nose

Choanal Atresia
Normal
Normal One or both nares obstructed
Cyanotic at rest but
‘pinks up’
up’ with crying
If bilateral, may need
Low
Lowset
set oral airway or
endotracheal intubation
Oral airway sizes
Area of
00 – small infants obstruction
0 – term or large
infants

Mouth Neck  Abnormal Findings

Lips Short
Gums Nuchal thickening
Cheeks Webbing
Tongue Macroglossia Short Torticollis
Macroglossia Shortfrenulum
frenulum
Palate – hard, soft Masses
© Jack Dolcourt MD
Natal Cleft
Cleftsoft
softpalate
palate
© K. Karlsen 2006
Natalteeth
teeth © K. Karlsen 2006
© Jack Dolcourt MD © David A. Clark MD
Mouth and Chin  Abnormal Findings Neck  Abnormal Findings

Micrognathia
Micrognathia
Treacher Collins syndrome
Mobius syndrome
© David A. Clark MD Cystic hygroma
Cystichygroma soft,
soft,fluctuant,
fluctuant,transilluminates
transilluminates
Mouth and Chin  Abnormal Findings Chest  Abnormal Findings

Pierre-
Pierre-Robin Sequence Shape
Very small jaw Broad
Tongue obstructs airway Narrow
May have cleft palate Bell shaped
Short
Broad
Broadchest
chestand
andwide
wide
spaced
spacednipples
nipples
© Jack Dolcourt MD
Short
Shortsternum
sternum
Cleft
Cleftpalate
palate
Stabilization
Stabilization
© K. Karlsen 2006
© Jack Dolcourt MD
© K. Karlsen 2006 © David A. Clark MD Turner syndrome © David A. Clark MD

Chest  Abnormal Findings Chest and Airway

Accessory
Accessorynipple
nipple
Breasts and nipples Retractions
Placement Subcostal – below the rib cage
Shape
Suprasternal – above the sternum
Pigmentation
Secretions
Broad
Broadchest
chestand
andwide
wide
spaced
spacednipples
nipples
© K. Karlsen 2006 Gynecomastia

Gynecomastia Turner syndrome © David A. Clark MD
© K. Karlsen 2006
Chest and Airway Chest and Airway

Respiratory rate Airway obstruction
Normal Nose
30 – 60 breaths per minute Mouth and jaw
Easy breathing effort
Larynx or trachea
Abnormal
Respiratory rate > 60  ‘tachypnea’
tachypnea’ Bronchii
Respiratory rate < 30 plus labored
breathing  sign of exhaustion
! Gasping  sign of impending
cardiorespiratory arrest
Grunting
Flaring
Retractions
Chest and Airway Chest and Airway CDH

CDH Stabilization
Stabilization
Retractions Diaphragmatic hernia
Intercostal – between the ribs Bowel in chest
Substernal – under the sternum UAC tip  aorta
shifted to right
Gastric tube tip 
stomach in chest

Chest and Airway Abdomen  Abnormal Findings

Tracheoesophageal fistula Appearance  scaphoid, distended, visible loops
Color  erythema, bluish discoloration
Bowel sounds  hypo or hyperactive
Palpation  firm, tender
Type A Type B Type C Type D Type E

8% 1% 86% 1% 4%
Congenital diaphragmatic hernia

© Jack Dolcourt MD
Chest and Airway Abdomen  Abnormal Findings

Tracheoesophageal fistula Appearance  scaphoid, distended, visible loops
Assess for VATER / VACTERL association Color  erythema, bluish discoloration
Vertebral Bowel sounds  hypo or hyperactive
Anal atresia Palpation  firm, tender, masses
Cardiac
TE fistula
Renal
© Jack Dolcourt MD
Radial
Limb
TEF
TEF stabilization
stabilization
© Jack Dolcourt MD
Abdomen  Normal findings Abdomen  Abnormal Findings

Full appearance Appearance  scaphoid, distended, visible loops
No discoloration Color  erythema, bluish discoloration
Active bowel sounds Bowel sounds  hypo or hyperactive
Soft and non-
non-tender to palpation Palpation  firm, tender, masses
Normal Visible
Visiblebowel
bowelloops
loops
Normalabdomen
abdomen Bilious
Biliousgastric
gastricdrainage
drainage

© Jack Dolcourt MD

Abdomen  Abnormal Findings Abdomen  Abnormal Findings

Appearance  scaphoid, distended, visible loops Umbilical cord
Color  erythema, bluish discoloration Umbilical
Umbilicalhernia
hernia
Bowel sounds  hypo or hyperactive
Palpation  firm, tender, masses
Small
Smallomphalocele
omphalocele
Mild
Mildomphalitis
omphalitis
Eagle-
Eagle-Barrett syndrome
(Prune belly syndrome)
© David A. Clark MD © Jack Dolcourt MD

Omphalocele
Bladder
Bladderexstrophy
exstrophy
Distended
Distendedbladder
bladder
Note
Noteherniation
herniationof
of
abdominal
abdominalcontents
contentsthrough
through
© K. Karlsen 2006
© K. Karlsen 2006
base
baseof
ofumbilical
umbilicalcord
cord

Umbilical cord Omphalocele High
Highincidence
incidence(30
(30––50%)
50%)of
ofsignificant
significant
chromosomal,
chromosomal,cardiac,
cardiac,gastrointestinal,
gastrointestinal,
genitourinary, musculoskeletal,
genitourinary, musculoskeletal,
central
centralnervous
nervoussystem
systemanomalies
anomalies
Two Peritoneal
Peritonealsac
sacprotects
protects
Twovessel
vesselcord
cord herniated
herniatedorgans
organs
Stabilization
Stabilization guidelines
guidelines


Gastroschisis Malrotation
Mesentery fails to attach to
entire posterior abdominal wall
Instead abnormally attaches in
region of duodenum  Ladd’
Ladd’s
bands
Midgut volvulus (twisting)

Defect
Defectininabdominal
abdominalwall
wall Clockwise rotation with
to
toRIGHT
RIGHTof ofumbilical
umbilicalcord
cord
No peritoneal sac protects strangulation  blood supply
No peritoneal sac protects
the herniated organs
the herniated organs to small intestine cut off
Stabilization
guidelines Stabilization
guidelines
Abdomen  Abnormal Findings Abdomen  Liver

Normal size < 2 cm below right costal margin
Located in right abdomen
Malrotation
Malrotation//Midgut
MidgutVolvulus
Volvulus
Abdomen  Abnormal Findings Abdomen  Liver Abnormal Findings

Normal Intestinal Development Midline location  asplenia or polysplenia syndrome
Between 6 and 12 weeks gestation Left abdomen location
bowel enters abdomen Heart in right side  situs inversus totalis –
Cecum rotates counterclockwise usually normal heart
to right lower quadrant Heart in left side  usually indicates complex CHD
Intestine fixed to posterior abdominal
wall by wide fan of mesentery
Note points of fixation
Mesenteric artery supplies
blood to intestine
Heart
on
right
Liver
on left

Abdomen  Liver Abnormal Findings Spine  Abnormal Findings Myeloschisis

Myeloschisis
Myelomeningocele
Membrane intact vs. disrupted
Size and location
Evaluate motor, sensory and
Cytomegalovirus
Cytomegalovirus–– sphincter function and reflexes
hepatosplenomegaly
hepatosplenomegaly Evaluate for hydrocephalus
Myelomeningocele
Myelomeningocele
Myelocystocele
Myelocystocele
Biliary
Biliaryatresia
atresiawith
withliver
liver
enlargement
enlargementandandacholic
acholicstool
stool
Stabilization
guidelines © David A. Clark MD
Spine Skin Color  Normal Findings

Inspection from base of skull Acrocyanosis – bluish discoloration of hands and feet
down to coccyx Often resolves by 48 hours of age
Skin disruption Rule out hypothermia
Tufts of hair
Masses
Acrocyanosis
Acrocyanosis
Dimples
Sinus tracts
Palpate for
Abnormal curvature 
scoliosis, lordosis, kyphosis
Vertebral alignment

Spine  Abnormal Findings Skin Color  Abnormal Findings

Lipomeningocele
Lipomeningocele Pallor
Anemia
Sacral
Sacraldimple
dimple Cutis
Cutisaplasia
aplasia
Twin-
Twin -to-
to-twin transfusion
Twin-to-twin transfusion

Skin Color  Abnormal Findings Skin Perfusion  Normal Findings

Plethora Neonatal
Neonatalpolycythemia
polycythemia
Perfusion reflects cardiac output
Polycythemia Normal capillary refill time (CRT) ≤ 3 seconds
Press
Press Release
Release Count
Countseconds
seconds
until
untilskin
skinrefills
refills
Twin-
Twin -to-
to-twin transfusion
Twin-to-twin transfusion Compare
Compareupper
upper
Normal to
tolower
lowerbody
body
Normalmale
malehand
hand
Maternal
Maternalanemia
anemia
Skin Color  Abnormal Findings Skin Perfusion  Abnormal Findings

AAP Prolonged capillary refill time
AAP hyperbilirubinemia
hyperbilirubinemia and
and
phototherapy
phototherapy nomograms
nomograms Pallor
Jaundice Cool extremities
Jaundice
Mottling  abnormal if associated with other signs of
poor perfusion
Skin mottling
Skin Color  Abnormal Findings Skin Perfusion  Abnormal Findings

Central cyanosis Cutis marmorata
Bluish discoloration of tongue and mucous Bluish marbling / mottling
membranes Caused by dilation of
Caused by desaturation of arterial blood capillaries and venules in
Indicates cardiac / respiratory dysfunction response to chilling or
Hemoglobin carrying no O2 appears stress
purple  “reduced hemoglobin”
hemoglobin” Persistent cutis
Cyanosis visible marmorata
with 3 – 5 gm/dL with some trisomies
reduced or syndromes
hemoglobin

Skin  Non-pathologic Findings Skin  Non-pathologic Findings

Erythema toxicum
Common benign rash  small white
or yellow papules or vesicles with
erythematous base
Vitiligo
Vitiligo
Most common on face, trunk, extremities
Smear reveals numerous eosinophils
Hemangiomas
Hemangiomas
Skin  Non-pathologic Findings Skin  Abnormal Findings

Transient neonatal pustular melanosis
Superficial vesiculopustular lesions
Usually rupture within 12 to 48 hours after birth
After rupture, pigmented
macules are seen
Disappear by 3 months Goltz syndrome
Aspiration of pustules
reveals neutrophils Pustular
Pustularlesions
lesions
PPoikiloderma
oikiloderma

Skin  Non-pathologic Findings Skin  Abnormal Findings

Staphylococcal
Staphylococcalscalded
scaldedskin
skin
© Jack Dolcourt MD
Harlequin
Harlequinsign
sign
Mongolian
Mongolianspots
spots
Sucking
Suckingblisters
blisters

Skin  Abnormal Findings Extremities  Fractures

Congenital
CongenitalCMV
CMV
““Blueberry
Blueberry Muffin
MuffinSyndrome”
Syndrome”
Syndrome”
Clavicle
Clavicle
Congenital
Congenitalvaricella
varicella
Skin  Abnormal Findings Extremities  Fractures
Humerus
Humerus
Congenital
Congenitalherpes
herpeslesions
lesions
Femur
Femur
Skin  Abnormal Findings Extremities  Abnormal Findings
Edema
Edema Breech
Breechpresentation
presentation

Extremities  Abnormal Findings Extremities  Abnormal Findings

Arthrogryposis
Arthrogryposis
multiplex
multiplexcongenita
congenita Cornelia
Corneliade
deLange
Lange
––phocomelic
phocomelic
Erb’
Erb’s palsy
Erb’s palsy
Triploidy
Triploidy
Rubinstein-
Rubinstein -Taybi
Rubinstein-Taybi
–– bbroad
road thumb
thumb
Zellweger
Zellwegersyndrome
syndrome
––ulnar
ulnardeviation
deviation

Achondroplasia
Achondroplasia Thanotrophic
Thanotrophicdwarf
dwarf
Postaxial
Postaxialpolydactyly
polydactyly
© Jack Dolcourt MD
Lymphedema
Lymphedema––
Turner’
Turner’s Syndrome
Turner’s Syndrome
Syndactyly
Syndactyly
© Jack Dolcourt MD
© Jack Dolcourt MD
Club
Clubfeet
feet
© Jack Dolcourt MD
© Jack Dolcourt MD © Jack Dolcourt MD

Amniotic
Amnioticband
band Dorsiflexed
Dorsiflexedhallux
hallux
constriction
constriction
Amniotic
Amnioticband
bandamputation
amputation
Zellweger
Zellwegersyndrome
syndrome
––prominent
prominentknees
knees
Trisomy
Trisomy18
18––short
short
hallux
halluxsyndactyly
syndactyly
Goltz
Goltzsyndrome
syndrome

Extremities  Trisomy 21 Genitalia  Intersex

Wide
Widespace
spacebetween
between
great
greatand
andsecond
secondtoe
toe
© Jack Dolcourt MD © Jack Dolcourt MD © Jack Dolcourt MD
Short,
Short,broad
broad
hands
handsandandfeet
feet
© Jack Dolcourt MD © Jack Dolcourt MD © Jack Dolcourt MD

© Jack Dolcourt MD
Simian
Simiancrease
crease
Extremities  Trisomy 18 Genitalia  Male Hypospadias

Hypospadias
Rocker-
Rocker-bottom feet
Rocker-bottom feet © Jack Dolcourt MD
© David A. Clark MD © Jack Dolcourt MD
© Jack Dolcourt MD
Hernia
Hernia Hydrocele
Hydrocele
Hypospadias
Hypospadias
Overlapping,
Overlapping, chordee
tapered chordee––
taperedfingers
fingers bifid
Hypoplastic bifidscrotum
scrotum
Hypoplasticnails
nails
Extremities  Trisomy 13 Genitalia  Male
Tapered,
Tapered,thin
thinfingers
fingers
Polydactyly
Polydactyly
Absent
Absentright
righttesticle
testicle Testicular
Testiculartorsion
torsion
Rocker-
Rocker-bottom feet
Rocker-bottom feet

Genitalia  Male Anal Atresia
Inguinal
Inguinalhernia
hernia
Monitor
Monitorfor
for
evidence
evidenceof
offistula
fistula
Genital
Genitalhypoplasia
hypoplasia
© K. Karlsen 2006 © David A. Clark MD © K. Karlsen 2006 © David A. Clark MD © Jack Dolcourt MD
Genitalia  Female Pseudo

Pseudomenses
menses
Bruising
Bruisingfrom
frombreech
breech
vaginal
vaginaldelivery
delivery
Inguinal
Inguinalhernia
hernia
Anal Atresia
© K. Karlsen 2006 © Jack Dolcourt MD © David A. Clark MD


Physical and Gestational Age Assessment of The Newborn Physical

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Physical and Gestational Age Assessment of The Newborn Physical

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S.T.A.B.L.E.

Principles of Physical Exam

Physical and Gestational Age Auscultation before

Principles of Physical Exam Infant Size

© K. Karlsen 2006 © K. Karlsen 2006

Principles of Physical Exam Infant Size

© K. Karlsen 2006 © K. Karlsen 2006

(c) Kristine A. Karlsen 2006. Handout

Infant Size Neurological Status

© K. Karlsen 2006 © K. Karlsen 2006

Infant Size Neurological Status

Neurological Status Neurological Status

© K. Karlsen 2006 © K. Karlsen 2006

(c) Kristine A. Karlsen 2006. Handout

Neurological Status Head

© K. Karlsen 2006 © K. Karlsen 2006

Neurological Status Head

© K. Karlsen 2006 © K. Karlsen 2006

Neurological Status Head

© K. Karlsen 2006 © K. Karlsen 2006 © David A. Clark MD

(c) Kristine A. Karlsen 2006. Handout

Head  Scalp Anatomy Head  Caput Succedaneum

© K. Karlsen 2006 © K. Karlsen 2006

Head  Scalp Swellings Head  Cephalohematoma

Location Palpation Blood loss Duration

Head  Caput Succedaneum Head  Cephalohematoma

Location Palpation Blood loss Duration

(c) Kristine A. Karlsen 2006. Handout

Head  Subgaleal Hemorrhage Head  Abnormal Findings

Location Palpation Blood loss Duration

Head  Subgaleal Hemorrhage Head  Abnormal Findings

Location Palpation Blood loss Duration

Head  Subgaleal Hemorrhage Head  Abnormal Findings

Monitoring Video courtesy of Swiss Society of Neonatology

(c) Kristine A. Karlsen 2006. Handout

Head  Scalp Injuries Hair  Abnormal Findings

© K. Karlsen 2006 © K. Karlsen 2006

Head  Scalp Abnormalities Hair  Abnormal Findings

Cornelia de Lange syndrome

© K. Karlsen 2006 © K. Karlsen 2006

Hair  Abnormal Findings Face

Trisomy 21 © David A. Clark MD

© K. Karlsen 2006 © K. Karlsen 2006

(c) Kristine A. Karlsen 2006. Handout

Face  Normal Findings Face  Abnormal Findings

© K. Karlsen 2006 © K. Karlsen 2006

Face  Abnormal Findings Face  Abnormal Findings

© K. Karlsen 2006 Moebius syndrome © David A. Clark MD © K. Karlsen 2006

Face  Abnormal Findings Face  Abnormal Findings

© K. Karlsen 2006 © K. Karlsen 2006

(c) Kristine A. Karlsen 2006. Handout

Face  Injury Eyes  Position and Size

Face  Injury Eyes  Abnormal Findings

© K. Karlsen 2006 Rubinstein-

Face  Injury Eyes  Abnormal Findings

© K. Karlsen 2006 © K. Karlsen 2006 © David A. Clark MD © Jack Dolcourt MD

(c) Kristine A. Karlsen 2006. Handout

Eyes  Abnormal Findings Ears  Minor Anomalies

© K. Karlsen 2006 © David A. Clark MD © K. Karlsen 2006

Ears Ears  Abnormal Findings

© K. Karlsen 2006 Treacher

Ears  Position Nose

© K. Karlsen 2006 © K. Karlsen 2006