Neonatal Examination Overview

Introduction

• Common short case in pediatric clinical exams.
• Necessary skill for medical undergraduates.
• Often performed in postnatal wards.

Preparing for Examination

• Gather necessary equipment:
  • Tape measure for head circumference.
  • Torch and tongue depressor for oral examination.
  • Stethoscope for heart sounds.
• Offer fundoscopic examination.
• Obtain consent from the mother.
• Hygiene practices: Clean hands, wear gloves, keep baby warm, warm hands.

Examination Procedure

Initial Steps

• Start with inspection when baby is quieter.
• Check for respiratory distress, icterus, dysmorphic features.

Head-to-Toe Approach

Head

• Inspect scalp and head.
• Check fontanelles (anterior and posterior) and suture lines for abnormalities like wide separation or ridging.
• Look for kefal hematoma and caput.

Face

• Inspect eyes for cataracts, pupillary abnormalities, low set ears.
• Check ears using an imaginary line from medial to lateral canthus.

Oral Cavity

• Check for tongue tie, neonatal/natal teeth, Epstein pearls.
• Inspect and palpate hard palate for cleft palates.

Neck

• Palpate for sternomastoid tumors.
• Check clavicles for fractures.

Hands and Arms

• Inspect for polydactyly, syndactyly, clinodactyly.
• Look for abnormal palmar creases like simian crease.

Chest

• Look for chest abnormalities (pectus excavatum/carinatum).
• Auscultate heart sounds.

Abdominal Examination

• Check for abdominal distension, scaphoid abdomen.
• Inspect umbilical cord, inguinal region for hernias.
• Feel femoral and radial pulses for radiofemoral delay.

Genitalia and Anus

• Check for ambiguous genitalia, descended testicles in boys.
• Inspect anus for abnormalities.

Lower Limbs and Feet

• Examine for limb asymmetry, cyanosis, foot deformities (talipes, calcaneovirus).

Spine

• Palpate spine for spina bifida, meningocele, meningomyelocele.

Hip Examination

• Perform Barlow’s and Ottolani’s tests for hip dislocation.

Fundoscopic Examination

• Check for red reflexes, signs of cataract or retinoblastoma.

Reflexes and Maturity

• Assess primitive reflexes, physical maturity (planter creases, labia majora development, breast bud development, lanugo hair, ear cartilage recoil).

Clinical Findings in Example

• Healthy term neonate with normal examination results:
  • Normal fontanelles, no hematomas or caput.
  • Normal facial features, no oral or neck abnormalities.
  • Normal limb and digit examination.
  • No heart murmurs, normal lungs and abdomen.
  • Normal genital and spine examination.
  • Negative Ottolani and Barlow's tests.
  • Normal red reflex, symmetrical Moro reflex.
• Conclusion: Neonate is healthy; parents reassured about routine care.