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COVER ARTICLE

The Newborn Examination: Part I.
Emergencies and Common Abnormalities Involving the Skin, Head, Neck, Chest, and Respiratory and Cardiovascular Systems
MAMTA FULORIA, M.D., and SHELLEY KREITER, M.D., Wake Forest University School of Medicine, Winston-Salem, North Carolina The routine newborn assessment should include an examination for size, macrocephaly or microcephaly,changes in skin color, signs of birth trauma, malformations, evidence of respiratory distress, level of arousal, posture, tone, presence of spontaneous movements, and symmetry of movements. A newborn with one anatomic malformation should be evaluated for associated anomalies. Total and direct bilirubin levels should be measured in newborns with jaundice, and a complete blood count should be obtained inthose with pallor or a ruddy complexion. Neurosurgical consultation is necessary in infants with craniosynostosis accompanied by restricted brain growth or hydrocephalus, cephaloceles, or exophytic scalp nodules. Neck masses can be identified by their location and include vascular malformations, abnormal lymphatic tissue, teratomas, and dermoid cysts. Most facial nerve palsies resolvespontaneously. Conjunctivitis is relatively common in newborns. Infants with chest abnormalities may need to be evaluated for Poland’s syndrome or Turner’s syndrome. Murmurs in the immediate newborn period are usually innocent and represent a transition from fetal to neonatal circulation. Because cyanosis is primarily secondary to respiratory or cardiac causes, affected newborns should be evaluatedexpeditiously, with the involvement of a cardiologist or neonatologist. (Am Fam Physician 2002;65:61-8. Copyright© 2002 American Academy of Family Physicians.)

ILLUSTRATION BY STEVEN OH

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TABLE 1 This is part I of a twopart article on the newborn examination. Part II, “Emergencies and Common Abnormalities Involving the Abdomen, Pelvis, Extremities, Genitalia, and Spine” will appear in the next issue.careful examination at delivery helps the physician detect anomalies, birth injuries, and cardiorespiratory disorders that may compromise a newborn’s successful adaptation to extrauterine life. A detailed

examination should also be performed after the newborn has completed the transition from fetal to neonatal life. The examination may begin with an evaluation of neonatal size (Table 1).The presence of one anatomic malformation should prompt an evaluation for associ-

Factors to Consider in Evaluating Size in Newborns
Small for gestational age (birth weight below 10th percentile) Symmetric Features: onset early in gestation; brain size corresponding with body size; glycogen and fat content corresponding with body size (hence, lower risk of hypoglycemia) Etiology: environmentalfactors such as smoking or drugs (heroin, methadone, ethanol, phenytoin [Dilantin]); genetic factors such as small maternal size or chromosomal disorder (trisomy 13, 18, and 21 syndromes, Turner’s syndrome); intrauterine infections such as TORCH, bacterial (tuberculosis), or spirochetic (syphilis); metabolic disorders such as phenylketonuria Asymmetric Features: onset late in gestation; no effector minimal effect on fetal brain growth; reduced glycogen and fat content relative to body size (hence, increased risk of hypoglycemia); increased risk of perinatal asphyxia and polycythemia (hyperviscosity) Etiology: uteroplacental insufficiency with chronic fetal hypoxia Large for gestational age (birth weight above 90th percentile) Features: increased incidence of perinatal asphyxia and birthinjuries; respiratory distress syndrome; hypoglycemia Etiology: maternal diabetes (increased likelihood of large birth size, respiratory distress syndrome, and hypoglycemia)

TORCH = toxoplasmosis, other viruses, rubella, cytomegaloviruses, herpes [simplex] viruses.

JANUARY 1, 2002 / VOLUME 65, NUMBER 1

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AMERICAN FAMILY PHYSICIAN

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Congenital exophytic scalp...