A Comprehensive Newborn Examination: Part I. General, Head and Neck, Cardiopulmonary



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Am Fam Physician. 2014 Sep 1;90(5):289-296.

  This is part I of a two-part article on the newborn examination. Part II, “Skin, Trunk, Extremities, Neurologic,” appears in this issue of AFP.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See the CME Quiz Questions.

Author disclosure: No relevant financial affiliations.

A comprehensive newborn examination involves a systematic inspection. A Ballard score uses physical and neurologic characteristics to assess gestational age. Craniosynostosis is caused by premature fusion of the sutures, and 20% of children with this condition have a genetic mutation or syndrome. The red reflex assessment is normal if there is symmetry in both eyes, without opacities, white spots, or dark spots. If the red reflex findings are abnormal or the patient has a family history of pertinent eye disorders, consultation with an ophthalmologist is warranted. Newborns with low-set ears should be evaluated for a genetic condition. Renal ultrasonography should be performed only in patients with isolated ear anomalies, such as preauricular pits or cup ears, if they are accompanied by other malformations or significant family history. If ankyloglossia is detected, a frenotomy may be considered if it impacts breastfeeding. The neck should be examined for full range of motion because uncorrected torticollis can lead to plagiocephaly and ear misalignment. Proper auscultation is crucial for evaluation of the broncho-pulmonary circulation with close observation for signs of respiratory distress, including tachypnea, nasal flaring, grunting, retractions, and cyanosis. Benign murmurs are often present in the first hours of life. Pulse oximetry should be performed in a systematic fashion before discharge.

Part I of this two-part article discusses the assessment of general health, head and neck, heart, and lungs. Part II focuses on assessing extremities, and neurologic function.1

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

Screening for hypoglycemia should be performed in newborns who are large or small for gestational age, newborns of mothers with diabetes mellitus, and late preterm infants (34 to 36 6/7 weeks gestational age).

C

7

Regardless of red reflex test results, all newborns with a family history of retinoblastoma, cataracts, glaucoma, or retinal abnormalities should be referred to an ophthalmologist who is experienced in the examination of children.

C

17

Hearing should be evaluated in all newborns before one month of age, but preferably before discharge, using the auditory brainstem response or the otoacoustic emissions test.

C

20

Recent data indicate that ultrasonography should be performed in newborns with isolated ear anomalies, such as preauricular pits or cup ears, only when they are associated with one or more of the following characteristics: other malformations or dysmorphic features, teratogenic exposures, a family history of deafness, or a maternal history of gestational diabetes.

C

26, 27

Routine screening for congenital heart disease via pulse oximetry is recommended before discharge at 24 hours of life or later. Diagnostic echocardiography should be performed if screening results are positive.

C

40


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

View Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

Screening for hypoglycemia should be performed in newborns who are large or small for gestational age, newborns of mothers with diabetes mellitus, and late preterm infants (34 to 36 6/7 weeks gestational age).

C

7

Regardless of red reflex test results, all newborns with a family history of retinoblastoma, cataracts, glaucoma, or retinal abnormalities should be referred to an ophthalmologist who is experienced in the examination of children.

C

17

Hearing should be evaluated in all newborns before one month of age, but preferably before discharge, using the auditory brainstem response or the otoacoustic emissions test.

C

20

Recent data indicate that ultrasonography should be performed in newborns with isolated ear anomalies, such as preauricular pits or cup ears, only when they are associated with one or more of the following characteristics: other malformations or dysmorphic features, teratogenic exposures, a family history of deafness, or a maternal history of gestational diabetes.

C

26, 27

Routine screening for congenital heart disease via pulse oximetry is recommended before discharge at 24 hours of life or later. Diagnostic echocardiography should be performed if screening results are positive.

C

40


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

General Assessment

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The Authors

MARY L. LEWIS, MD, is a staff pediatrician and teaching faculty physician in the Department of Family Medicine at Dwight D. Eisenhower Army Medical Center in Fort Gordon, Ga.

Address correspondence to Mary L. Lewis, MD, Dwight D. Eisenhower Army Medical Center, 300 E. Hospital Rd., Fort Gordon, GA 30905 (e-mail: marigoldll@yahoo.com). Reprints are not available from the author.

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