Perinatal Manual of Southwestern Ontario

A collaboration between the Regional Perinatal Outreach Program of Southwestern

Ontario & the Southwestern Ontario Perinatal Partnership (SWOPP)

Chapter 23

NEWBORN PHYSICAL ASSESSMENT

“The baby should have a complete physical examination within 24 hours of

birth, as well as within 24 hours before discharge”.

Family-Centred Maternity & Newborn Care:

National Guidelines 2000

Principles of Examination
1. Provision should be made to prevent neonatal heat loss during the physical
assessment.

2. A rapid overall assessment of the baby will be done at the time of birth, with a
more detailed assessment completed on admission.

3. Where possible, the parents should be present during the assessment.

4. Sequence of examination include:

Examples

Inspection
• Body proportion
• Posture
• Skin
• Amount of subcutaneous fat
• Facial appearance
• Respirations
• Sleep state
• Movement
• Responsiveness
Auscultation
• Heart
• Lungs

Palpation
• Cranium
• Peripheral pulses
• Abdomen, liver, spleen, kidneys

Neurologic Reflexes
• Suck / root
• Moro
Perinatal Outreach Program of Southwestern Ontario
PERINATAL MANUAL CHAPTER 23 - NEWBORN PHYSICAL ASSESSMENT

• Grasp
• Babinski

Other
• Eyes - Red reflex
• Measurement

Vital signs, including BP and Mean Arterial

Pressure (MAP), which should be at least
equal to gestational age

(For clarity sake, the following head-to-toe assessment will be grouped in an

organized fashion indicating common normal findings, as well as abnormalities).

Area Normal Abnormal

• Cephalhematoma
• Fracture
• Molding
Head • Sutures fused
• Overriding sutures
• Fontanelle
• Caput succedaneum
o Full
o Depressed
• Abnormal facies
• Mandibular hypoplasia
Face • Normal configuration • Forceps injury
• Facial palsy
o Partial
o Complete
• Asymmetry
• Symmetrical • Subconjunctival hemorrhage
• Open • Cataracts
Eyes
• Red reflex • Coloboma
• Conjunctivitis
• Brushfield spots
• Nasal flaring
Nose • Symmetrical
• Choanal atresia
• Abnormal configuration
• Low set
• Normal configuration
Ears • No response to sound
• Response to sound
• Forceps injury
• Accessory auricle(s) / tags

Revised February 2006 23-2

Disclaimer
The Regional Perinatal Outreach Program of Southwestern Ontario has used practical experience and relevant legislation to develop this manual chapter. We recommend that this
chapter be used as a reference document at other facilities. We accept no responsibility for interpretation of the information or results of decisions made based on the information in the
chapter(s)
Perinatal Outreach Program of Southwestern Ontario
PERINATAL MANUAL CHAPTER 23 - NEWBORN PHYSICAL ASSESSMENT

Area Normal Abnormal

• Cleft lip/palate
• Normal configuration
• Precocious teeth
Mouth • Epstein’s pearl
• Glossoptosis
• Not tongue tied
• Webbing
Neck • Normal mobility
• Masses
Chest • Two nipples • Extra nipples
• Enlarged breasts • Breast abscess

• Normal respirations • Apnea

(40-60 breaths/minute) • Cyanosis
• Retractions
• Tachypnea
• Grunting

• Normal breath sounds • Diminished air entry

• Crackles/wheezes

• Normal heart rate • Arrythmia

• (110-160 beats/minute) • Murmur
• Tachycardia
• Bradycardia

• Peripheral pulses equal to • Peripheral pulses differ

apical from apical
• Bounding or faint peripheral
pulses

Revised February 2006 23-3

Disclaimer
The Regional Perinatal Outreach Program of Southwestern Ontario has used practical experience and relevant legislation to develop this manual chapter. We recommend that this
chapter be used as a reference document at other facilities. We accept no responsibility for interpretation of the information or results of decisions made based on the information in the
chapter(s)
Perinatal Outreach Program of Southwestern Ontario
PERINATAL MANUAL CHAPTER 23 - NEWBORN PHYSICAL ASSESSMENT

Area Normal Abnormal

Abdomen • Slight protrusion • Convex
• Distended

• 3 umbilical vessels • 2 vessels

• Cord drying • Umbilical inflammation,
drainage

• Normal palpation • Enlarged

(Liver 2 cm below costal o Liver
margin) o Spleen
o Kidneys

• Bowel sounds present • Bowel sounds absent

Skin • Vernix • Jaundice
• Pink colour • Cyanosis
• Acrocyanosis • Pallor
• Milia • Petechiae
• Erythema toxicum • Bruising
• Telengiectatic nevi • Strawberry hemangioma
• Mongolian spots • Port wine stains
Genitalia
Female • Normal configuration • Abnormal configuration
• Mucousy vaginal
discharge
• Pseudo menstruation

Male • Normal configuration • Hypospadias

• Testes in scrotum • Epispadias
• Hydrocele • Undescended testes

Anus • Patent • Imperforate anus

• Fistula
• Patulous

Revised February 2006 23-4

Disclaimer
The Regional Perinatal Outreach Program of Southwestern Ontario has used practical experience and relevant legislation to develop this manual chapter. We recommend that this
chapter be used as a reference document at other facilities. We accept no responsibility for interpretation of the information or results of decisions made based on the information in the
chapter(s)
Perinatal Outreach Program of Southwestern Ontario
PERINATAL MANUAL CHAPTER 23 - NEWBORN PHYSICAL ASSESSMENT

Area Normal Abnormal

Extremities
Arms, Legs, • Normal • Abnormal
Hands, Feet • Fractures
• Paralysis
• Weakness
• Polydactyly
• Syndactyly
Hips • Abnormal skin creases

• Range of motion • Congenital hip dislocation

adequate • Clunk
Spinal
Column • Click
• Sinus
• Normal • Mass
• Myelomeningocele
Extremities
Neurologic • Normal activity • Hypotonic
Exam
• Normal tone • Hypertonic
• Normal DTRs • Jittery
• Primitive reflexes present • Seizures
(Suck, Root, Moro, Step,
Place)
• Ventral suspension, Head
lag

Charting

1. A checklist format is recommended for ease of charting.

2. The birth weight, length and head circumference should be plotted against
gestational age to identify disparities and those babies who are large,
appropriate, or small for dates.

3. Another way of assessing the baby’s well being and to organize care is to use
the Primary Survey from the ACoRN Manual.

Revised February 2006 23-5

Disclaimer
The Regional Perinatal Outreach Program of Southwestern Ontario has used practical experience and relevant legislation to develop this manual chapter. We recommend that this
chapter be used as a reference document at other facilities. We accept no responsibility for interpretation of the information or results of decisions made based on the information in the
chapter(s)
Perinatal Outreach Program of Southwestern Ontario
PERINATAL MANUAL CHAPTER 23 - NEWBORN PHYSICAL ASSESSMENT

Baby at risk
The ACoRN Process
Unwell
Risk factors
Post-resuscitation
requiring stabilization

Resuscitation Support
Ineffective breathing
Heart rate < 100 bpm
Central cyanosis

Infection
Risk factor for infection
ACoRN alerting sign with *
Clinical deterioration

Respiratory Thermoregulation
Laboured respiration* T < 36.3 or > 37.2ºC axillary*
Respiratory rate > 60/min* Increased risk for
Receiving respiratory support* temperature instability

Problem List
Respiratory
Cardiovascular
Neurology
Surgical conditions
Cardiovascular Fluid & glucose Fluid & Glucose Management
Pale, mottled, or grey* Thermoregulation Blood glucose < 2.6 mmol /L
Weak pulses or low BP* Infection At risk for hypoglycemia
Cyanosis unresponsive to O2 Not feeding or should not be fed
Heart rate > 220 bpm

Sequences

Consider transport

Neurology Surgical Conditions

Abnormal tone* Anterior abdominal wall defect
Jitteriness Vomiting or inability to swallow
Seizures* Abdominal distension
Delayed passage of meconium
or imperforate anus

(Reprinted with permission from the ACoRN Editorial Board 2006)

Revised February 2006 23-6

Disclaimer
The Regional Perinatal Outreach Program of Southwestern Ontario has used practical experience and relevant legislation to develop this manual chapter. We recommend that this
chapter be used as a reference document at other facilities. We accept no responsibility for interpretation of the information or results of decisions made based on the information in the
chapter(s)