Highlights of the

Neonatal

Assessment

Newborn Assessment

• Newborn historical data

• Gestational Age assessment

• Head to toe PE

“Ballard”

Neonatal Gestational

Maturity Assessment

Heel-to-ear maneuver. The position for assessing the heel-to-ear maneuver is demonstrated.

The degree of extension seen is consistent with a 28- to 30-week infant.

General posture. The typical, marked flexor posture of the term infant.

Square window test. The position for assessing the square window is shown. The 45-degree angle

seen between the palm and forearm is consistent with a gestational age of 30 to 32 weeks.

Scarf sign. The elbow cannot be drawn, with gentle traction on the upper extremity, across this

term infant’s chest. This is in contrast to the marked flexibility of a preterm infant.

Female at 28 weeks’ gestation:

prominent clitoris, small labia majora

Female at 32 weeks’ gestation:

increased fat deposit in labia majora

Female at 36 weeks to term gestation:

labia majora nearly covering

labia minora

Male at 28 weeks’ gestation:

tests high in scrotum

Male at 32 weeks’ gestation:

tests descending some scrotal rugae

Male at 36 weeks to term gestation:

testes well descended, increased

scrotal pigmentation

28 weeks’ gestation:

smooth sole

32 weeks’ gestation:

creases in anterior one third

36 weeks to term gestation:

creases over the majority of sole

28 weeks’ gestation:

no breast tissue, areola barely visible

32 weeks’ gestation:

visible areola, little breast tissue

36 weeks to term gestation:

well-defined areola, breast nodules

28 weeks’ gestation:

little cartilage, pliable

32 weeks’ gestation: increased cartilage,

in-curvi outer pinna

36 weeks to term gestation:

firm ear , well-formed margin

Lanugo. This fine body hair resembling “peach fuzz” is present on infants of 24 to 32 weeks’

gestation.

Premature skin. This premature infant demonstrates

translucent paper-thin skin with a prominent venous pattern

Postterm skin. Peeling and cracking of the skin are characteristics

of the infant delivered after 42 week’s gestation

Babies come in different sizes!!!

SGA LGA

AGA

Neonatal Physical Exam

Mottling

Skin abnormalities : color

AcrocyanosisBruising

Sebaceous HyperlasiaErythema toxicum

Neonatal pustular melanosis

Skin abnormalities : Rashes

Neonatal pustular melanosis

Macular hemangioma (stork bites)

Mongolian spotMongolian spot

Skin abnormalities : Nevi

Caput succedaneumMolding

Cephalohematoma

Head : Shape

Head : Eyes :Red Reflex

Epstein’s pearls

Natal teeth

Cleft lip and palate

Head: Mouth

Cleft lip and palate

Ebstein’s pearls

Genitalia (male)

• The penis: length > 2 cm, marked phymosis

• The meatus: hypospadias, epispadias

• Scrotum:

– Palpate the testes,

– Hydrocele (disappears in on year)

– Blue color (testicular torsion )

Hypospadias

Hydrocele

Ambiguous genitalia

Polydactyly

Syndactyly

Tied accessory digits

Extremities

Club footMetatarsus varus

Simian Crease

Extremities

Hair in the sacral

area

Dimple

Trunk and spine

Hips

Rooting Moro reflex

ATNRGrasp reflex

Nervous system :Tone and Neonatal reflexes

Plantar Grasp Reflex