Normal Newborn

Normal Newborn: General Appearance
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Well-flexed, full range of motion, spontaneous movement
Common variations
Legs extended with frank breech
Signs of potential distress or deviations from expected findings

Posture limp
Asymmetry of movement
Persistent tremor, twitching
Vital Signs
Temperature - range 36.5 to 37 axillary
Common variations
Crying may elevate temperature
Stabilizes in 8 to 10 hours after delivery

Temperature is not reliable indicator of infection
A temperature less than 36.5
Heart rate - range 120 to 160 beats per minute
Common variations
Heart rate range to 100 when sleeping to 180 when crying
Color pink with acrocyanosis
Heart rate may be irregular with crying

Although murmurs may be due to transitional circulation-all murmurs
should be followed-up and referred for medical evaluation
Deviation from range
Faint sound
Respiration - range 30 to 60 breaths per minute
Common variations
Bilateral bronchial breath sounds
Moist breath sounds may be present shortly after birth

Asymmetrical chest movements
Apnea >15 seconds
Diminished breath sounds
Seesaw respirations
Grunting
Nasal flaring
Retractions
Deep sighing
Tachypnea - respirations > 60
Persistent irregular breathing
Excessive mucus
Persistant fine crackles
Stridor
Blood pressure - not done routinely
Factors to consider
Varies with change in activity level
Appropriate cuff size important for accurate reading
Average newborn (1 to 3 days) oscillometry pressure value: 65/41 in both
upper and lower extremities
Sign of potential distress or deviations from expected findings

Calf systolic pressure 6 to 9 mm Hg less than systolic pressure in upper
extremities may be indicative of coarctation of the aorta
General Measurements
Head circumference - 33 to 35 cm
Expected findings
Head should be 2 to 3 cms larger than the chest
Chest circumference - 30.5 to 33 cm
Common variations
Molding of head may result in a lower head circumference measurement
Head and chest circumference may be equal for the first 24 to 48 hours of
life
Weight range - 2500 - 4000 gms (5 lbs. 8oz. - 8 lbs. 13 oz.)
Length range - 48 to 53 cms (19 - 21 inches)
Skin
Expected findings
Skin reddish in color, smooth and puffy at birth
At 24 - 36 hours of age, skin flaky, dry and pink in color
Edema around eyes, feet, and genitals
Vernix caseosa
Lanugo
Turgor good with quick recoil
Hair silky and soft with individual strands
Nipples present and in expected locations
Cord with one vein and two arteries
Cord clamp tight and cord drying
Nails to end of fingers and often extend slightly beyond
Common variations
Acrocyanosis - result of sluggish peripheral circulation
Mongolian spots in infants of African-American descent

Mottling
Physiologic jaundice
Milia
Erythema toxicum
Petechiae/ bruises over presenting part

Skin tags usually around ears or digits (tied off)
Harlequin color change
Signs of potential distress or deviations from normal findings
Jaundice within 24 hours of birth
General cyanosis
Circumoral cyanosis between feedings
Petechiae or ecchymoses other than on presenting part
All rashes with exception of erythema toxicum
Pigmented nevi
Yellow vernix
Hemangioma
Pallor
Forceps marks
Head
Expected findings
Anterior fontanel diamond shaped 2-3 - 3-4 cms
Posterior fontanel triangular 0.5 - 1 cm
Fontanels soft, firm and flat
Sutures palpable with small separation between each
Common variations
Caput succedaneum
Molding of fontanels and suture spaces
Signs of potential distress or deviations from normal findings
Fontanels that are bulging or depressed
Hydrocephalus
Macrocephaly
Cephalhematoma
Closed sutures
Eyes
Expected findings
Slate gray or blue eye color
No tears
Fixation at times - with ability to follow objects to midline
Red reflex
Blink reflex
Distinct eyebrows
Cornea bright and shiny
Pupils equal and reactive to light
Common variations
Edematous eyelids
Uncoordinated movements
May focus for a few seconds
Signs of potential distress or deviations from expected

findings
Discharges
Chemical conjunctivitis
Opaque lenses
Absence of Red Reflex
Epicanthal folds in newborns not of Oriental descent
"Doll's eyes" beyond 10 days of age
Reflexes absent
Subconjunctival hemorrhage
Expected findings
Pinna top on horizontal line with outer canthus of eye
Loud noise elicits Startle Reflex

Flexible pinna with cartilage present
Common variations
Skin tags on or around ears
findings
Ear placement low
Preauricular sinus
Clefts present
Malformations
Cartilage absent
Nose
Expected findings
Nostrils patent bilaterally
Obligate nose breathers
No nasal discharge
Common variations
Sneezes to clear nostrils
Bridge appears absent
Thin white nasal mucus discharge

findings
Choanal atresia and discharge
Malformation
Nasal flaring beyond first few moments after birth
Mouth and Throat
Expected findings
Mucosa moist. Shortly after birth may visualize sucking calluses on central
portions of lips.
Palate high arched
Uvula midline
Minimal or absent salivation
Tongue moves freely and does not protrude
Well developed fat pads bilateral cheeks
Sucking reflex
Rooting reflex
Gag reflex
Extrusion reflex
Common variations
Epstein's pearls on ridges of gums

findings
Cleft lip or cleft palate
Circumoral pallor
Lip movement asymmetrical
Reflexes absent or incomplete
Protruding tongue
Candida Albicans
Diminished tongue movement
Percocious teeth
Neck
Expected findings
Short and thick
Turns easily side to side
Clavicles intact
Tonic neck reflex present
Neck-righting reflex present
Some head control

findings
Torticollis-stiff neck drawing head to one side
Resistance to flexion
Webbing of neck
Large fat pad on back of neck
Palpable crepitus, movement with palpation of clavicle
Chest
Expected findings
Evident xiphoid process
Equal anteroposterior and lateral diameter
Bilateral synchronous chest movement
Symmetrical nipples
Common variations
"Witch's milk"
Enlarged breasts
Accessory nipples

findings
Asymmetrical chest movements
Sternum depressed
Marked retractions
Absent breast tissue
Flattened chest
Supernumerary nipples
Nipples widely spaced
Bowel sounds auscultated
Abdomen
Expected findings
Dome-shaped abdomen
Abdominal respirations
Soft to palpation
Well formed umbilical cord
Three vessels in cord
Cord dry at base
Liver papable 2 - 3 cms below right costal margin
Bilaterally equal femoral pulses
Bowel sounds auscultated within two hours of birth
Voiding within 24 hours of birth
Meconium within 24 - 48 hours of birth
Common variations
Small umbilical hernia

findings
Bowel sounds absent
Peristaltic waves visible
Abdominal distention
Palpable masses
Scaphoid-shaped abdomen
Omphalocele
Base of cord with redness or drainage
Cord with two vessels
Female Genitalia
Expected findings
Edematous labia and clitoris
Labia majora are larger and surrounding labia minora
Vernix between labia
Common variations
Hymenal tag
Pseudomenstruation
Smegma
Increased pigmentation
Ecchymosis and edema after breech birth
"Red brick" pink-stained urine due to uric acid crystals

findings
Labia fused
Fecal discharge from vaginal opening
Imperforate hymen
Ambiguous genitalia
Widely separated labia
Male Genitalia
Expected findings
Urinary meatus at tip of glans penis
Palpable testes in scrotum
Large, edematous, pendulous scrotum, with rugae
Smegma beneath prepuce
Stream adequate on voiding
Common variations
Prepuce covering urinary meatus
Erections
Increased pigmentation
Edema and ecchymosis after breech delivery

findings
Non palpable testes
Hypospadius
Epispadius
Scrotum smooth
Ambiguous genitalia
Back and Rectum

Expected findings
Intact spine without masses or openings
Trunk incurvature reflex
Patent anal opening
"Wink reflex" present

findings
Limitation of movement
Fusion of vertebrae
Spina bifida
Tuft of hair
Imperforate anus
Anal fissures
Pilonidal cystExtremities
Expected findings
Maintains posture of flexion
Equal and bilateral movement and tone
Full range of motion all joints
Ten fingers and ten toes
Legs appear bowed
Feet appear flat
Palmar creases present

Sole creases present
Negative hip click

Grasp reflex present

findings
Unequal tone
Asymmetrical movement of extremities
Polydactyly
Syndactyly
Unequal leg length
Asymmetrical skin creases posterior thigh
Dislocation of hip
Simean crease
Persistent cyanosis of nail beds
Marked metatarus varus
Neuromuscular System
Expected findings
Maintains postion of flexion
When prone, turns head side to side
Holds head and back in horizontal plane when held prone
Ability to hold head momentarily erect

findings
Hypotonia
Quivering
Limp extremities or straightening of extremities
Clonic jerking
Paralysis

Normal Newborn

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Normal Newborn: General Appearance

Well-flexed, full range of motion, spontaneous movement

Signs of potential distress or deviations from expected findings

Temperature - range 36.5 to 37 axillary

Signs of potential distress or deviations from expected findings

Heart rate - range 120 to 160 beats per minute

Signs of potential distress or deviations from expected findings

Respiration - range 30 to 60 breaths per minute

Signs of potential distress or deviations from expected findings

Blood pressure - not done routinely

Sign of potential distress or deviations from expected findings

Chest circumference - 30.5 to 33 cm

Weight range - 2500 - 4000 gms (5 lbs. 8oz. - 8 lbs. 13 oz.)

Length range - 48 to 53 cms (19 - 21 inches)

Mongolian spots in infants of African-American descent

Petechiae/ bruises over presenting part

May focus for a few seconds

Signs of potential distress or deviations from expected

Loud noise elicits Startle Reflex

Signs of potential distress or deviations from expected

Palate high arched

Signs of potential distress or deviations from expected

Signs of potential distress or deviations from expected

Signs of potential distress or deviations from expected

Signs of potential distress or deviations from expected

Signs of potential distress or deviations from expected

Signs of potential distress or deviations from expected

Back and Rectum

Signs of potential distress or deviations from expected

Palmar creases present

Negative hip click

Signs of potential distress or deviations from expected

Signs of potential distress or deviations from expected

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