Priority Topic: Newborn

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)