The Newborn

Last Sunday, April 13, 2025, we talked about the management of the newborn at birth. Today, we will continue to tackle the detailed examination of a stable newborn. 

This starts with measurements of the weight, height or length, head, chest, abdomen and midarm circumference, cardiac and respiratory rates and body temperature.

On the baby’s skin, it is usually covered by vernix caseosa that protects the skin of the fetus from maceration while in the mother’s womb. It usually disappears after a few days after birth and through daily bathing.

Then, lanugo hair may be present in the back, shoulders and upper arms.

Term infant is pinkish, smooth and elastic with a fair amount of subcutaneous tissue; whereas preterm infant has less of this layer so their skin is transparent.

A transient harlequin color change is sometimes observed. What is seen here is a sharp line of demarcation in the midline of the whole body from head to extremities separating a red and pale half. It is still unclear as to the reason of this finding.

Mottling of the skin is observed when the body is exposed to cold and this is due to the instability of the circulation of the newborn and will disappear as the baby gets older.

Mongolian spots are bluish grey pigmented areas in the buttocks, back and extremities and common among us Filipinos and Asians. These mongolian spots have no clinical significance and will disappear within a year or two.

Milia are small whitish papules that cover the nose and are made up of distended sebaceous glands

Erythema toxicum, are small papules with vesicles at the tip

On the infants head:

Babies born by Cesarian section have rounded head.

Babies delivered by vaginal delivery have varying degrees of molding that may result in asymmetry with overlapping of the sutures. It could either result to Caput succedaneum or to cephalhematoma which is the result of subperiosteal bleeding. This will not cross suture lines and may disappear longer in 2-3 months.

Craniotabes elicited when the parietal bones are palpated and soft area like a pingpong ball is felt. This has no significance in the newborn but if it persists beyond infancy, then it could be a sign of bone pathology.

The face of the newborn may become asymmetrical due to the positioned while in the womb. It is also checked for facies like that of Down’s syndrome. Subconjunctival hemorrhages of the eyes are also present especially in difficult vaginal deliveries. Ears are checked for ear tags, whether low set or not. The patency of the nose should be established. Mouth should be checked for cleft lips and cleft palate and presence of tongue tie. Whitish shiny cysts in the palate and gum margins called Epstein or epithelial pearls can also be seen. Sometimes, supernumerary teeth are seen at birth. They are usually pulled out or are shed early.
We will continue to learn more about the normal newborn on next issue.