FAMILY DOCTOR WANNABE
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I'll be back. Currently meditating...

Priority Topic: Newborn

8/2/2018

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Key Feature 1: When examining a newborn, systematically look for subtle congenital anomalies (ex: ear abnormalities, sacral dimple) as they may be associated with other anomalies and genetic syndromes.
Skill: Clinical Reasoning
Phase: Hypothesis generation, Physical

My approach to the healthy newborn exam, informed by the UpToDate article "Assessment of the newborn infant," is as follows. Note that any signs of abnormalities warrants a more exhaustive assessment.
  • General inspection
    1. Color (ex: cyanosis, pallor, or jaundice)
    2. Tone (ex: decreased tone)
    3. Signs of distress (ex: respiratory)
  • Body measurements (plot on growth curve)
    1. Weight
    2. Length 
    3. Head circumference
  • Vital signs
    1. Temperature 
    2. Respiratory rate
    3. Heart rate
  • Cardiovascular system
    1. Auscultation of heart sounds (ex: normal heart sounds, presence of any murmurs)
    2. Palpation of femoral pulses
  • Lungs (ex: bronchovesicular vs rales on auscultation)
  • Skin (ex: areas of hyperpigmentation or focal lesions)
  • Head 
    1. Head shape and suture lines (ex: asymmetric or overlapping)
    2. Fontanelles (ex: bulging or sunken)
    3. Face (ex: asymmetries)
    4. Eyes (ex: spacing, movement, red reflex)
    5. Ears (ex: low-set or deformities)
    6. Nose (ex: shape and patency)
    7. Mouth (ex: micrognathia or cleft palate)
  • Neck (ex: masses or torticollis)
  • Chest wall (ex: deformity or breast/nipple abnormalities)
  • Abdomen (ex: organomegaly or masses)
  • Genitalia 
    • If male examine penis (ex: hypospadias) and scrotum (ex: undescended testes)
    • If female examine hymen (ex: imperforate)
  • Anus (ex: patency)
  • Extremities (ex: moving all 4 limbs symmetrically)
  • Neurologic exam (ex: level of alertness, assessment of tone, equality of strength in all 4 limbs, primitive reflexes such as rooting and sucking)
  • Hips (ex: Ortolani and Barlow maneuvers)
  • Trunk and spine (ex: sacral dimple)
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