Assessment of Newborn 

 

Ears

Position

•  Top of pinna must be in linewith the outer canthus of theeye.

• Ears below this line areconsidered to be low set andare found in children withDown Syndrome

 

Structure•  Term: ears should be firm with

cartilage and recoil rapidly afterbending

• Premature: Lack of cartilage inthe ears.

•  There should be no pinpointopenings in front of the ear

• Ototscopic examination is notvisible in newborns

• Ears are considered small if lessthan 2.5cm in term neonates.

 

Function

•  The newborn can hear as soon asmucus is removed

•  They should turn to sound. Loudnoise elicits the startle reflex. If the newborn is affected by aloud noise, it could be a sign of hearing impairment.

• Minor abnormalities may be signsof various syndromes,especially renal problems.

 

Nose

Structure

• Midline on the face

• Symmetrical in placement andsize

• Close infant’s mouth andassess the quality of respiratory effort.

 

• Obstruct one are at a time todetermine choanal atresiawhich blockage in theposterior nasal passage.

• Assess the movement of the airin and out of the nares byplacing finger under thenares to feel air movement.

• May have a small amount of clear or white discharge

 

Mouth and Throat 

Structures

• Lip must be pinkish and shouldopen evenly when infantcries.

• Mouth and jaw should equallymove when baby cries.

• Soft and hard palate should beintact.

• Vulva is located at midine.

 

•  Tongue should be symmetric inshape and movement andshould not protrude.

• Lingual frenulum attaches theunderside of the tongue tothe lower palate. It should notbe too tight to allow freedomof movement.

• Small white cyst may be seenin hard palate. It disappearwithin two weeks.

 

• Patency of the stomach shouldbe checked by passing a stiff rubber catheter into thestomach in the followingsituations:

a.Small-for-dates baby

b. Single umbilical artery

•

 

c. Polyhydramniosd. Excessive drooling of saliva. *If there is no esophageal

atresia and the catheter hasreached the stomach, gastriccontents should be aspirated. If gastric aspirate exceeds 20 mlin volume, it indicates highintestinal obstruction due topyloric or duodenal atresia.

 

Function

• Rooting, sucking, gagging andextrusion reflex should be presentat birth.

a. Assess sucking reflex by placing agloved finger in the infant’s mouthor by monitoring feeding. Thenewborn exhibits a strong suckwhen she is able to form a tightseal around the finger, nipple andbottle. A weak suck occurs if theinfant is either unable to form aseal or unable to suck because of fati ue or deformit .

 

b. Assess gag reflex by gentlystimulating the posterior oralcavity. The infant should havestrong coughing response tothe stimulation. Absence of gagreflex should be considered anemergency situation becausethe neonate cannot protect hisairway without this reflex.

a)

 

c. Assess for rooting reflex bygently stroking the neonate’scheek. The infant should respondby turning his head to the sidethat was stimulated. This is animportant feeding reflex. It’sabsence indicates possibleneurologic abnormalities.

d. The extrusion reflex occurswhen the infant responds toforeign objects in the mouth bypushing them outward with thetongue.

•

 

• It is normal for a newborn tohave scanty saliva due toimmature salivary glands.

• Some newborns have teethafter birth called precociousteeth or natal teeth.

 

Abnormal Findings

• Cleft lip and palate

• Asymmetry in lip movementindicate 7th cranial nervedamage.

• Asymmetric crying is a usefulmarker of associatedcardiovascular anomaliesand congenital dislocation of hips.

 

• Lip cyanosis indicatesrespiratory distress orhypothermia.

• Macroglossia indicateprematurity

• Protruding tongue mayindicate chromosomaldisorder such as Down’sSyndrome

• Excessive saliva may indicateesophageal atresia or

 

• Presence of oral thrush thatbleeds when touched ismoniliasis transferred frommother during delivery/

• A tight frenulum often refferedto as tongue-tie, can preventproper sucking. In this case,frenuloplasty may berequired to correct thedefect.

 

Neck

Structure

• Neck of newborn appears shortand chubby with many skinfolds. It should be symmetricwithout webbing, flexibleenough to allow freemovement of the headequally to both sides.

• Lengthens at 2 to 3 years of age

 

• Although it is not strong enoughto support the head, the infantshould exhibit temporary headcontrol when placed in sittingposition.

• When in prone, newborns can lifttheir head slightly and movefrom side to side.

•  The thymus gland is usuallyenlarged due to rapid growth of glandular tissue and triples insize by 3 years. After 10 years,

 

Abnormal Findings

• Enlarged thyroid gland may bea sign of goiter orhyperactive thyroid.

• Limited neck movementaccompanied by pain is asign of meningeal irritation(opisthothonus).

• Absence of head control is asign of prematurity and

 

• A distended vein is a sign of cardiopulmonary disorder.

• Rigidity of the neck ortorticollis may be due toinjury to sternocleidomastoidmuscle.

• Webbing of the neck, generallynoticed from the back of theneck, may be indicative of chromosomal abnormalities.

 

Chest

Structure

• Chest looks small in relation tothe head.

• Barrel shape in appearance

• Symmetric with claviclesstraight.

• Shoulders are sloping withwidth greater than length.

 

• Heart rate is heard to the leftmidclavicular space at thirdor fourth interspace; mayhave functional murmurs.

• Heart should be examined forits position and any murmurs.

 

Abnormal Findings• Chest retraction• Bulging of chest• Displacement of the heart

towards the right sideaccompanied by respiratorydifficulty and resuscitationproblems is suggestive of eitherdiaphragmatic hernia orpneumothorax on the left side.

• Malformation• Fractured clavicle is manifested

by a lump or bony prominence

 

Breast

Structure

• Newborn’s breast nodule isapproximately 6mm (5-10mm)

•  The nipples are prominent, wellformed and symmetricallyplaced.