Assessment of the newborn infant
- Tiffany M McKee-Garrett, MD
Tiffany M McKee-Garrett, MD
- Assistant Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Teresa K Duryea, MD
Teresa K Duryea, MD
- Section Editor — General Pediatrics
- Associate Professor of Pediatrics
- Baylor College of Medicine
A newborn should have a thorough evaluation performed within 24 hours of birth to identify any abnormality that would alter the normal newborn course or identify a medical condition that should be addressed (eg, anomalies, birth injuries, jaundice, or cardiopulmonary disorders) . This assessment includes review of the maternal, family, and prenatal history and a complete examination. Depending upon the length of stay, another examination should be performed within 24 hours before discharge from the hospital.
The assessment of the newborn infant will be reviewed here. The routine care of the newborn infant is discussed separately. (See "Overview of the routine management of the healthy newborn infant".)
The newborn history includes the following:
●Review of this pregnancy, labor, and delivery including screening tests and risk factors for sepsis.
●Review of past pregnancies including a history of congenital anomalies, still births, and/or genetic or syndromic conditions.
- American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Care of the Newborn. In: Guidelines for Perinatal Care, 7th, Riley LE, Stark AR (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2012. p.265.
- Sengupta S, Carrion V, Shelton J, et al. Adverse neonatal outcomes associated with early-term birth. JAMA Pediatr 2013; 167:1053.
- Olsen IE, Groveman SA, Lawson ML, et al. New intrauterine growth curves based on United States data. Pediatrics 2010; 125:e214.
- Villar J, Cheikh Ismail L, Victora CG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet 2014; 384:857.
- Anderson NH, Sadler LC, McKinlay CJ, McCowan LM. INTERGROWTH-21st vs customized birthweight standards for identification of perinatal mortality and morbidity. Am J Obstet Gynecol 2016; 214:509.e1.
- Lissauer T. Physical examination of the newborn. In: Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant, 9th, Martin RJ, Fanaroff AA, Walsh MC (Eds), Elsevier Mosby, St. Louis 2011. Vol 1, p.485.
- Tveiten L, Diep LM, Halvorsen T, Markestad T. Respiratory Rate During the First 24 Hours of Life in Healthy Term Infants. Pediatrics 2016; 137.
- Southgate WM, Pittard WB. Classification and physical examination of the newborn infant. In: Care of the High-Risk Neonate, 5th, Klaus MH, Fanaroff AA (Eds), WB Saunders, Philadelphia 2001. p.100.
- Rioja-Mazza D, Lieber E, Kamath V, Kalpatthi R. Asymmetric crying facies: a possible marker for congenital malformations. J Matern Fetal Neonatal Med 2005; 18:275.
- Lahat E, Heyman E, Barkay A, Goldberg M. Asymmetric crying facies and associated congenital anomalies: prospective study and review of the literature. J Child Neurol 2000; 15:808.
- Caksen H, Odabaş D, Tuncer O, et al. A review of 35 cases of asymmetric crying facies. Genet Couns 2004; 15:159.
- Feingold M, Bossert WH. Normal values for selected physical parameters: an aid to syndrome delineation. Birth Defects Orig Artic Ser 1974; 10:1.
- Gupta BK, Hamming NA, Miller MT. The Eye. In: Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant, 8th, Fanaroff AA, Martin RJ, Walsh MC (Eds), Mosby, St Louis 2006. p.1721.
- Hernandez P, Hernandez J. Physical Assessment of the Newborn. In: Assessment and Care of the Well Newborn, Thureen PJ, et al (Eds), WB Saunders, Philadelphia 1999. p.114.
- Donahue SP, Baker CN, Committee on Practice and Ambulatory Medicine, American Academy of Pediatrics, et al. Procedures for the Evaluation of the Visual System by Pediatricians. Pediatrics 2016; 137.
- Hudgins L, Cassidy SB. Congenital Anomalies. In: Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant, 8th, Fanaroff AA, Martin RJ, Walsh MC (Eds), Mosby, St Louis 2006. p.561.
- Roth DA, Hildesheimer M, Bardenstein S, et al. Preauricular skin tags and ear pits are associated with permanent hearing impairment in newborns. Pediatrics 2008; 122:e884.
- Wang RY, Earl DL, Ruder RO, Graham JM Jr. Syndromic ear anomalies and renal ultrasounds. Pediatrics 2001; 108:E32.
- Deshpande SA, Watson H. Renal ultrasonography not required in babies with isolated minor ear anomalies. Arch Dis Child Fetal Neonatal Ed 2006; 91:F29.
- Habel A, Elhadi N, Sommerlad B, Powell J. Delayed detection of cleft palate: an audit of newborn examination. Arch Dis Child 2006; 91:238.
- Jones KL. Normal standards. In: Smith's Recognizable patterns of Human Malformation, 6th, Elsevier Saunders, Philadelphia 2006. p.851.
- Mimouni F, Merlob P, Reisner SH. Occurrence of supernumerary nipples in newborns. Am J Dis Child 1983; 137:952.
- de Almeida CM, Gomide MR. Prevalence of natal/neonatal teeth in cleft lip and palate infants. Cleft Palate Craniofac J 1996; 33:297.
- Arlettaz R, Archer N, Wilkinson AR. Natural history of innocent heart murmurs in newborn babies: controlled echocardiographic study. Arch Dis Child Fetal Neonatal Ed 1998; 78:F166.
- Hansen LK, Birkebaek NH, Oxhøj H. Initial evaluation of children with heart murmurs by the non-specialized paediatrician. Eur J Pediatr 1995; 154:15.
- McCrindle BW, Shaffer KM, Kan JS, et al. Cardinal clinical signs in the differentiation of heart murmurs in children. Arch Pediatr Adolesc Med 1996; 150:169.
- Smythe JF, Teixeira OH, Vlad P, et al. Initial evaluation of heart murmurs: are laboratory tests necessary? Pediatrics 1990; 86:497.
- Lissauer T. Physical examination of the newborn. In: Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant, 7th, Fanaroff AA, Martin RJ, Walsh MC (Eds), Mosby, St Louis 2006. p.513.
- Klatt J, Kuhn A, Baumann M, Raio L. Single umbilical artery in twin pregnancies. Ultrasound Obstet Gynecol 2012; 39:505.
- Murphy-Kaulbeck L, Dodds L, Joseph KS, Van den Hof M. Single umbilical artery risk factors and pregnancy outcomes. Obstet Gynecol 2010; 116:843.
- Hernandez P, and Hernandez J. Physical Assessment of the Newborn. In: Assessment and Care of the Well Newborn, Thureen PJ, et al (Eds), WB Saunders, Philadelphia 1999. p.135.
- Kriss VM, Desai NS. Occult spinal dysraphism in neonates: assessment of high-risk cutaneous stigmata on sonography. AJR Am J Roentgenol 1998; 171:1687.
- McGovern M, Mulligan S, Carney O, et al. Ultrasound investigation of sacral dimples and other stigmata of spinal dysraphism. Arch Dis Child 2013; 98:784.
- Robinson AJ, Russell S, Rimmer S. The value of ultrasonic examination of the lumbar spine in infants with specific reference to cutaneous markers of occult spinal dysraphism. Clin Radiol 2005; 60:72.
- Gibson PJ, Britton J, Hall DM, Hill CR. Lumbosacral skin markers and identification of occult spinal dysraphism in neonates. Acta Paediatr 1995; 84:208.
- Sneineh AK, Gabos PG, Keller MS, Bowen JR. Ultrasonography of the spine in neonates and young infants with a sacral skin dimple. J Pediatr Orthop 2002; 22:761.
- Ben-Sira L, Ponger P, Miller E, et al. Low-risk lumbar skin stigmata in infants: the role of ultrasound screening. J Pediatr 2009; 155:864.
- Kucera JN, Coley I, O'Hara S, et al. The simple sacral dimple: diagnostic yield of ultrasound in neonates. Pediatr Radiol 2015; 45:211.
- Drolet BA. Cutaneous signs of neural tube dysraphism. Pediatr Clin North Am 2000; 47:813.
- Zywicke HA, Rozzelle CJ. Sacral dimples. Pediatr Rev 2011; 32:109.
- Prenatal screening tests
- Risk factors for sepsis
- PHYSICAL EXAMINATION
- General appearance
- Vital signs
- - Fontanelles
- - Sutures
- - Craniotabes
- - Extracranial findings
- - Facial palsies
- - Asymmetric crying facies
- - Masses
- - Torticollis
- - Excess skin
- - Clavicles
- - Chest wall movement
- - Breast
- - Auscultation
- Cardiovascular system
- - Murmurs
- - Pulses
- - Palpation
- - Umbilical cord
- - Female
- - Male
- - Ambiguous genitalia
- Trunk and spine
- - Sacral dimple
- Neurologic examination
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS