Assessment of Newborn

Ears
Position Top of pinna must be in line with the outer canthus of the eye. Ears below this line are considered to be low set and are found in children with Down Syndrome

Structure Term: ears should be firm with cartilage and recoil rapidly after bending Premature: Lack of cartilage in the ears. There should be no pinpoint openings in front of the ear Ototscopic examination is not visible in newborns Ears are considered small if less than 2.5cm in term neonates.

Function The newborn can hear as soon as mucus is removed They should turn to sound. Loud noise elicits the startle reflex. If the newborn is affected by a loud noise, it could be a sign of hearing impairment. Minor abnormalities may be signs of various syndromes, especially renal problems.

Nose
Structure Midline on the face Symmetrical in placement and size Close infants mouth and assess the quality of respiratory effort.

 Obstruct one are at a time to determine choanal atresia which blockage in the posterior nasal passage. Assess the movement of the air in and out of the nares by placing finger under the nares to feel air movement. May have a small amount of clear or white discharge

Mouth and Throat

Structures Lip must be pinkish and should open evenly when infant cries. Mouth and jaw should equally move when baby cries. Soft and hard palate should be intact. Vulva is located at midine.

 Tongue should be symmetric in shape and movement and should not protrude. Lingual frenulum attaches the underside of the tongue to the lower palate. It should not be too tight to allow freedom of movement. Small white cyst may be seen in hard palate. It disappear within two weeks.

 Patency of the stomach should be checked by passing a stiff rubber catheter into the stomach in the following situations: a.Small-for-dates baby

b. Single umbilical artery

c. Polyhydramnios d. Excessive drooling of saliva. *If there is no esophageal atresia and the catheter has reached the stomach, gastric contents should be aspirated. If gastric aspirate exceeds 20 ml in volume, it indicates high intestinal obstruction due to pyloric or duodenal atresia.

Function Rooting, sucking, gagging and extrusion reflex should be present at birth. a. Assess sucking reflex by placing a gloved finger in the infants mouth or by monitoring feeding. The newborn exhibits a strong suck when she is able to form a tight seal around the finger, nipple and bottle. A weak suck occurs if the infant is either unable to form a seal or unable to suck because of fatigue or deformity.

b. Assess gag reflex by gently stimulating the posterior oral cavity. The infant should have strong coughing response to the stimulation. Absence of gag reflex should be considered an emergency situation because the neonate cannot protect his airway without this reflex. a)

c. Assess for rooting reflex by gently stroking the neonates cheek. The infant should respond by turning his head to the side that was stimulated. This is an important feeding reflex. Its absence indicates possible neurologic abnormalities. d. The extrusion reflex occurs when the infant responds to foreign objects in the mouth by pushing them outward with the tongue.

 It is normal for a newborn to have scanty saliva due to immature salivary glands. Some newborns have teeth after birth called precocious teeth or natal teeth.

Abnormal Findings Cleft lip and palate Asymmetry in lip movement indicate 7th cranial nerve damage. Asymmetric crying is a useful marker of associated cardiovascular anomalies and congenital dislocation of hips.

 Lip cyanosis indicates respiratory distress or hypothermia. Macroglossia indicate prematurity Protruding tongue may indicate chromosomal disorder such as Downs Syndrome Excessive saliva may indicate esophageal atresia or

 Presence of oral thrush that bleeds when touched is moniliasis transferred from mother during delivery/ A tight frenulum often reffered to as tongue-tie, can prevent proper sucking. In this case, frenuloplasty may be required to correct the defect.

Neck
Structure Neck of newborn appears short and chubby with many skin folds. It should be symmetric without webbing, flexible enough to allow free movement of the head equally to both sides. Lengthens at 2 to 3 years of age

 Although it is not strong enough to support the head, the infant should exhibit temporary head control when placed in sitting position. When in prone, newborns can lift their head slightly and move from side to side. The thymus gland is usually enlarged due to rapid growth of glandular tissue and triples in size by 3 years. After 10 years,

Abnormal Findings Enlarged thyroid gland may be a sign of goiter or hyperactive thyroid. Limited neck movement accompanied by pain is a sign of meningeal irritation (opisthothonus). Absence of head control is a sign of prematurity and

 A distended vein is a sign of cardiopulmonary disorder. Rigidity of the neck or torticollis may be due to injury to sternocleidomastoid muscle. Webbing of the neck, generally noticed from the back of the neck, may be indicative of chromosomal abnormalities.

Chest
Structure Chest looks small in relation to the head. Barrel shape in appearance Symmetric with clavicles straight. Shoulders are sloping with width greater than length.

 Heart rate is heard to the left midclavicular space at third or fourth interspace; may have functional murmurs. Heart should be examined for its position and any murmurs.

Abnormal Findings Chest retraction Bulging of chest Displacement of the heart towards the right side accompanied by respiratory difficulty and resuscitation problems is suggestive of either diaphragmatic hernia or pneumothorax on the left side. Malformation Fractured clavicle is manifested by a lump or bony prominence

Breast
Structure Newborns breast nodule is approximately 6mm (510mm) The nipples are prominent, well formed and symmetrically placed.