Chapter 5

Newborns are examined after birth to check for major abnormalities and to make sure the transition to extrauterine life is without difficulty. The newborn infant should undergo a complete physical examination within 24 h of birth. It is easier to listen to the heart and lungs first when the infant is quiet. Warming the stethoscope before using it decreases the likelihood of making the infant cry.

1. Vital signs

1. Temperature. Indicate whether the temperature is rectal (which is usually 1° higher than oral), oral, or axillary (which is usually 1° lower than oral).

1. Respirations. The normal respiratory rate in a newborn is 40–60 breaths/min.

1. Blood pressure. Blood pressure correlates directly with gestational age, postnatal age of the infant, and birthweight. (For normal blood pressure curves, see Appendix C.)

1. Pulse rate. The normal pulse rate is 100–180 beats/min in the newborn (usually 120–160 beats/min when awake, 70–80 beats/min when asleep). In the healthy infant, the heart rate increases with stimulation.

2. Head circumference, length, weight, and gestational age

1. Head circumference and percentile. (For growth charts, see Appendix E.) Place the measuring tape around the front of the head (above the brow [the frontal area]) and the occipital area. The tape should be above the ears. This is known as the occipitofrontal circumference, which is normally 32–37 cm at term.

1. Length and percentile. For growth charts, see Appendix E.

1. Weight and percentile. For growth charts, see Appendix E.

1. Assessment of gestational age. See Chapter 4.

3. General appearance. Observe the infant and record the general appearance (eg, activity, skin color, and obvious congenital abnormalities). Are the general movements normal? Is the skin tone normal?

1. Color

• Plethora (deep, rosy red [ruddy] color). Plethora is more common in infants with polycythemia but can be seen in an overoxygenated or overheated infant. It is best to obtain a central hematocrit on any plethoric infant. Erythema neonatorum is a condition in which an infant has an overall blush to reddish color. It usually appears in the transition period and can occur when the infant has been stimulated. This is a normal phenomenon and lasts only several hours.

• Jaundice (yellowish color if secondary to indirect hyperbilirubinemia, greenish color if secondary to direct hyperbilirubinemia). With jaundice, bilirubin levels are usually >5 mg/dL. This condition is abnormal in infants <24 h old and may signify Rh incompatibility, sepsis, and TORCH (toxoplasmosis, other, rubella, cytomegalovirus, and herpes simplex virus) infections. After 24 h, it may result either from these diseases or from such common causes as ABO incompatibility or physiologic causes.

• Pallor (washed-out, whitish appearance). Pallor may be secondary to anemia, birth asphyxia, shock, or patent ductus arteriosus (PDA). Ductal pallor is the term sometimes used to denote pallor associated with PDA.

• Cyanosis (desaturation of 5 g of hemoglobin usually necessary for one to note a bluish color)

1. Central cyanosis (bluish skin, including the tongue and lips). Central cyanosis is caused by low oxygen saturation in the blood. It may be associated ...

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