The Newborn
Last Sunday, we started our discussion on the detailed physical examination of a normal newborn baby.Today, we will continue our discussion and start on the neck portion of the newborn baby.
Laxity or webbing of the neck is found in Down and Turner syndrome. Also, the neck is the frequent site of cystic hygromas and this appears as a fluctuant mass with indefinite borders usually on the lateral side and may reach the axilla and the scapular region.
In difficult normal vaginal deliveries, palpation of the base of the neck along the clavicular area will detect any fracture of the bone.
In examination of the chest, the size, shape and movement of the chest is noted. Sometimes, the mammary glands may be engorged and gentle pressure will produce a milk. This is called “ witch’s milk”.
Occasionally, supernumerary nipples are seen. If there is difficulty in breathing, chest retractions can be observed.
During percussion, pneumothorax, pneumomediastinum and mediastinal shifts can be detected.
Also, on chest auscultation, abnormal heart sounds can be heard too.
In the abdomen, it is normally globular but not distended. Distention suggests intestinal obstructions and is usually associated with vomiting and absence of passage of stools.
Diastasis recti which is the separation of the recti muscles is commonly seen. Umbilical hernias may be present but this usually closes when the abdominal muscles become stronger in about three years.
If the defect is large with intestinal contents protruding, surgical intervention is needed for repair.
The liver is easily palpable in contrast to the spleen which is not easily palpable. Dermal sinuses at the sacral area are occasionally encountered and the more common is the pilonidal dimple.
This tiny pore is surrounded by hair and may exude a whitish secretion.
The genitals of the female infant may show mucoid nonpurulent ot sometimes bloody vaginal discharges and this is not significant.
In the male, the size of the penis and scrotum varies. The testes may not have descended fully but are palpable in the canals. Hydrocele may be present with or without accompanying hernia.
The extremities are examined for the presence of poly or syndactyly and or club foot.
Hemimelia is the term when the distal portions are absent and the extremity ends in a stump.
Phocomelia is a term which refers to a condition when the proximal portion is absent so that the hand or foot seems to arise from the trunk.
Dislocation of the hip is suspected if the thighs cannot be abducted and a click sound is heard or elicited in doing the Ortolani’s maneuver.
The creases of the soles and palms are also noted for any Simian line which is particular in Down ‘s syndrome. Also, the maturity of the newborn can be assessed by observing the creases.
Muscle tone and reflexes of the newborn are also tested. Moro reflex, grasp, rooting and sucking reflexes are elicited. Neurologic examination of the newborn will show deficits of the central nervous system as well as for clinical evaluation of gestational age.
The thorough physical examination and assessment of the newborn is very important for the overall survival of the newborn baby and must be done by a trained health care worker.