Newborn Physical Exam – Full

Newborn Physical Exam:

A detailed newborn examination should begin with general observation for normal and dysmorphic features. A term newborn should have pink skin, rest symmetrically with the arms and legs in flexion, cry vigorously when stimulated, and move all extremities equally. Table 1 shows the normal ranges for newborn vital signs at 40 weeks’ gestation. The new Ballard score (http://www.ballardscore.com) was designed to assess a newborn’s gestational age through a scoring system that combines physical characteristics with neuromuscular development. Once the child’s gestational age is established, weight, length, and head circumference should be plotted on a nomogram to determine percentiles. Using this information, the newborn can be classified as average, large, or small for gestational age.

 

Table 1.
Normal Vital Signs in Newborns Born at 40 Weeks’ Gestation.

VITAL SIGN NORMAL RANGE

Heart rate

120 to 160 beats per minute*

Respiratory rate

40 to 60 breaths per minute

Systolic blood pressure

60 to 90 mm Hg†

Temperature

97.7°F to 99.5°F (36.5°C to 37.5°C)‡

Weight

Females: 3.5 kg (7 lb, 12 oz); range, 2.8 to 4.0 kg (6 lb, 3 oz to 8 lb, 14 oz)

Males: 3.6 kg (8 lb); range, 2.9 to 4.2 kg (6 lb, 7 oz to 9 lb, 5 oz)

Length

20 in (51 cm); range, 19 to 21 in (48 to 53 cm)

Head circumference

14 in (35 cm); range, 13 to 15 in (33 to 37 cm)


*—May decrease during sleep.

†—Varies with gestational age.

‡—Overbundling can elevate temperature, thus temperature should be retaken after a period of unbundling. However, not providing appropriate warmth may produce a low temperature. A low temperature may also signify infection or a metabolic or electrolyte abnormality.


A newborn is considered small for gestational age if birth weight is below the 10th percentile. Intrauterine growth restriction occurs when the baby’s growth during pregnancy is poor compared with norms. Measurements that are symmetrically decreased suggest that the newborn has a chronic exposure (e.g., maternal smoking or drug use) that impacted growth, or a congenital infection such as a TORCH infection (toxoplasmosis, other agents, rubella, cytomegalovirus, herpes simplex), a metabolic disorder, or a chromosomal abnormality (e.g., Turner syndrome, trisomies). Newborns with these conditions often display dysmorphic features or are simply constitutionally small. If the causative factor occurred later in pregnancy (e.g., uteroplacental insufficiency), the head circumference will be preserved relative to other measurements. A newborn with a birth weight above the 90th percentile is considered large for gestational age. The most common cause is maternal diabetes mellitus, although other causes include a metabolic or genetic syndrome such as Beckwith-Wiedemann syndrome.

Because of an increased risk of hypoglycemia, the American Academy of Pediatrics recommends scheduled glucose screening for newborns who are large or small for gestational age, newborns of mothers with diabetes, and late preterm newborns (34 to 36 6/7 weeks gestational age), and provides protocols for their management.

 

Text reference for Newborn Physical Exam: http://www.aafp.org/afp/2014/0901/p289.html#sec-1

 

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