A Comprehensive Newborn Examination: Part II. Skin, Trunk, Extremities, Neurologic



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Am Fam Physician. 2014 Sep 1;90(5):297-302.

  This is part II of a two-part article on the newborn examination. Part I, “General, Head and Neck, Cardiopulmonary,” 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.

Skin findings are common during the newborn examination. Although these findings are often benign, it is important to visualize the entire skin surface to distinguish these findings and appropriately reassure parents. The chest should be observed for symmetric movement, pectus excavatum, pectus carinatum, prominent xiphoid, or breast tissue. The infant should be as relaxed as possible so that the physician can more easily detect any abdominal masses, which are often renal in origin. A single umbilical artery may be associated with another congenital abnormality, especially renal anomalies, and intrauterine growth restriction and prematurity. Signs of ambiguous genitalia include clitoromegaly and fused labia in girls, and bilateral undescended testes, a micropenis, or a bifid scrotum in boys. Sacral dimples do not warrant further evaluation if they are less than 0.5 cm in diameter, are located within 2.5 cm of the anal verge, and are not associated with cutaneous markers; dimples that do not fit these criteria require ultrasonography to evaluate for spinal dysraphism. Brachial plexus injuries are most common in newborns who are large for gestational age, and physical therapy may be required to achieve normal function. Patients with abnormal findings on Ortolani and Barlow maneuvers should be evaluated further for hip dysplasia. It is also important to assess newborns for tone and confirm the presence of normal primitive reflexes.

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

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

Routine renal ultrasonography to look for renal anomalies in newborns with isolated cases of a single umbilical artery is not beneficial.

C

11, 12

Bilateral undescended testes, a micropenis, or a bifid scrotum should prompt investigation for ambiguous genitalia.

C

15

Newborns with a hypospadias should not be circumcised because the foreskin may be needed for repair.

C

19

A sacral dimple is simple if it is less than 0.5 cm in diameter, located within 2.5 cm of the anal verge, and not associated with cutaneous markers (discoloration or hypertrichosis). In the absence of these criteria, ultrasonography should be performed before three months of age to evaluate for spinal dysraphism.

C

22

Girls born in the breech position should receive imaging to evaluate for hip dysplasia. Imaging should be considered in newborns with a family history of developmental hip dysplasia and in newborn boys born in the breech position.

C

33, 34


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

Routine renal ultrasonography to look for renal anomalies in newborns with isolated cases of a single umbilical artery is not beneficial.

C

11, 12

Bilateral undescended testes, a micropenis, or a bifid scrotum should prompt investigation for ambiguous genitalia.

C

15

Newborns with a hypospadias should not be circumcised because the foreskin may be needed for repair.

C

19

A sacral dimple is simple if it is less than 0.5 cm in diameter, located within 2.5 cm of the anal verge, and not associated with cutaneous markers (discoloration or hypertrichosis). In the absence of these criteria, ultrasonography should be performed before three months of age to evaluate for spinal dysraphism.

C

22

Girls born in the breech position should receive imaging to evaluate for hip dysplasia. Imaging should be considered in newborns with a family history of developmental hip dysplasia and in newborn boys born in the breech position.

C

33, 34


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.

Skin

A variety of normal and abnormal lesions may be present on newborn skin (Table 1).26 Although these findings are often benign, it is important to visualize the entire skin surface to distinguish these findings and appropriately reassure parents.26 It is common to see bruising and petechiae, which typically resolve over time.

Table 1.

Common Skin Findings in Newborns

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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