DR.ARUN KUMAR SINGH
Neonatal Examination ,General Physical Examination, In Children Includes ;

• Observation( Inspection)

• Palpation

• Recording of vital signs

1. Pulse

2. Blood pressure

3. Respiratory rate

4. Temperature

MEASURING HEIGHT,WEIGHT AND HEAD CIRCUMFERENCE.

Sequence of examination should be from Head to toe ,But painful examination like thorat and ear examination should be left to the end.

GENRAL APPERANCE (OBERVATION)

Note the following;

• Apparent age

• Built of the child

• Degree of illness mild moderate and severe

• Conscious level

• Posture

• Nutritional status –normal ,obese or undernourished.

• State of hydration

• Behavior

 


Dehydration;,

Indicated by presence of sunken eyes, dry mucous membrane, sunken fontanel ,loss of skin turgor and rapid low volume pulse.

Malnutrion; 

Manifested by weight loss thinness thin shiny skin, loose skin folds, atrophy of subcutaneous fat,brittle nails ,prominent bones, protuberant   abdomen, fat buttocks and hypertonia.

Marasmus ;

Is severe wasting with loss of subcutaneous fat.

Kwashiorkor;

Is characterized by the presence of edema with   hair changes and skin dermatitis.

SKIN ;

                Look for  

• Pallor,cyanosis,jaundice

• Dehydration

• Edema

• Rashes distribution types(Macular,popular,vesicular,pustular,scaly,lichenified etc.)

• Pupuric spots

• Scratch marks

• Pigmentation(Hypo or Hyper)

Examination of the Neonate - A Quick Review

The aim is to screen for abnormality, and to see if the mother has any questions or difficulties.

        The following is a recommended routine before the baby leaves hospital—or during the 1st week of life for home deliveries.

 


Before the examination find out :

If the birth weight was normal?
  Was the birth and pregnancy normal? 
  Is mother Rh–ve?

For Examination

Find a quiet, warm, well-lit room. 
  Enlist the mother’s help. 
  Explain your aims. 
  Does she look angry or depressed? 
  Listen if she talks.

Examine systematically, from head-to-toe.

Wash your hands meticulously.
  Note observations (eg T°; rectal is more reliable than tympanic).

Head:

Circumference (50th centile=35cm, ), 
  shape (odd shapes from a difficult labour soon resolve), 
  fontanelles (tense if crying or intracranial pressure increased; sunken if dehydrated).

Eyes:

Red reflex (absent in cataract & retinoblastoma);
  corneal opacities; 
  conjunctivitis.

Ears:

Shape; 
  position. Are they low set (ie below eyes)?

Nose:

The tip of the nose, when pressed, shows jaundice in white babies.
  Breathing out of the nose (shut the mouth) tests for choanal atresia
  Ensure oto-acoustic screening is done

Complexion:

Cyanosed, pale, jaundiced, or ruddy (polycythaemia)?

Mouth:

Look inside; 
  insert a finger: is the palate intact? 
  Is suck good?

Face:

Does the baby’s face look normal? 
  Dysmorphism can be difficult to detect soon after birth as the baby may have some puffiness in the face.

Arms & hands:

Single palmar creases (normal or Down’s). 
  Waiter’s (porter’s) tip sign of Erb’s palsy of C5 & 6 trunks . 
  Number of fingers. 
  Clinodactyly (5th finger is curved towards the ring finger, eg in Down’s).

Thorax:

Watch respiration; 
  note grunting and intercostal recession (respiratory distress). 
  Palpate the precordium and apex beat.
  Listen to the heart and lungs. 
  Inspect the vertebral column for neural tube defects.

Abdomen:

Expect to feel the liver. 
  Any other masses? 
  Inspect the umbilicus. Is it healthy? Flare suggests sepsis. 
  Next, lift the skin to assess skin turgor.

Genitalia and Anus:

Inspect genitalia and anus. Are the orifices patent? 
  Ensure in the 1st 24 hours the baby passes urine (consider posterior urethral valves in boys if not) and stool (consider Hirschprung’s, cystic fibrosis, hypothyroidism). 
  Is the urinary meatus misplaced (hypospadias), and are both testes descended? 
  The neonatal clitoris often looks rather large, but if very large, consider Congenital adrenal hyperplasia 
  Sometimes bleeding PV may be a normal variant following maternal oestrogen withdrawal.

Buttocks/sacrum:

Is there an anus? 
  Are there ‘mongolian spots’? (blue—and harmless). 
  Tufts of hair ± dimples suggest bifi da occulta? Any pilonidal sinus?

Other important Points:

Legs Test for congenital dislocation of the hip . Avoid repeated tests as it hurts, and may induce dislocation. 
  Can you feel femoral pulses (to ‘exclude’ coarctation)? 
  Note talipes . 
  Toes: too many, too few, or too blue?
  Is the baby post-mature, light-for-dates, or premature ?

CNS

Assess posture and handle the baby. 
  Intuition can be most helpful in deciding if the baby is ill or well. 
  Is he jittery (hypoxia/ischaemia, encephalopathy, hypoglycaemia, infection, hypocalcaemia)? 
  There should be some control of the head. 
  Do limbs move normally. 
  Is the tone floppy or spastic? 
  Are responses absent on one side (hemiplegia)? 
  The Moro reflex rarely adds important information (and is uncomfortable for the baby). It is done by sitting the baby at 45°, supporting the head. On momentarily removing the support the arms will abduct, the hands open and then the arms adduct. 
  Stroke the palm to elicit a grasp reflex.

Discuss any abnormality with the parents after liaising with a senior doctor.