PHYSICAL EXAMINATION

General Survey  Neonatal jaundice first becomes visible in the

face and forehead. Identification is aided by
The patient is awake, conscious but agitated? pressure on the skin, since blanching reveals
the underlying color. Jaundice then gradually
becomes visible on the trunk and extremities.
This cephalocaudal progression is well
described. Jaundice disappears in the opposite
direction.
 The jaundiced neonate requires a full physical
examination with emphasis on the following:
 General: Does the child look well or unwell? 
You may be able to observe the child feeding –
is the baby having difficulty feeding? Is the
baby consolable?
Vitals · Vitals: If febrile, the newborn will require a
full septic work-up. In hemolytic states, there
Temp can be an increase in heart rate and respiration
PR : 118 bpm?
rate as well as poor perfusion.
RR :: 40 breaths/min
· Growth Parameters: Obtain length, weight
Growth parameters and head circumference and compare to
measurements taken at birth. Depending on
Weight : the newborn’s age, excessive weight loss or
Height BMI : insufficient weight gain may point to
dehydration.
HEENT: HEENT: Is there pallor? Sclerae and mucous
membranes should be closely inspected for
Head :
jaundice. Look for cephalohematoma or
Eyes :
bruising. Remember that jaundice first
becomes clinically apparent at the cephalic end
Ears : of the body, and only progresses caudally as
serum levels increase.
Nose:

Throat: :
Cardiovascular: · Cardiovascular: Heart rate, pulse volume,
blood pressure, apex location, perfusion.
Severe haemolytic processes can result in
heart failure.
· Respiratory: Respiration rate and rhythm
Respiratory: and oxygen saturation. If the neonate is in
heart failure, there may be respiratory signs.
· Abdomen: Is the abdomen distended? Is
there caput medusa (evidence of portal
hypertension)? Are there any masses? Check
Abdomen: for hepatomegaly and splenomegaly. Are there
any areas of tenderness?, petechiae, and
microcephaly may be associated with hemolitic
anemia , sepsis, and congenital infections and
should trigger a diagnostic evaluation directed
towards these diagnoses. Neonatal jaundice
may be exacerbated in these situations.
Neurologic:
Neurologic: Level of
consciousness. Cranial nerves,
tone, gross motor movements,
quality of the cry, and primitive
reflexes (Moro, grasps, tonic-
neck, step).Overt neurologic
findings, such as changes in
muscle tone, seizures, or altered
cry characteristics, in a
significantly jaundiced infant are
danger signs and require
immediate attention to prevent
kernicterus.