Thursday, March 23, 2023

Clinical examination of newborns.. Weight, height and head circumference measurements



Comprehensive clinical examination of the newborn:

The doctor performs a comprehensive physical examination of the newborn within the first 24 hours of life, and the examination begins with a series of measurements, including weight, length, and head circumference. The average birth weight is about 7 pounds (3.2 kg), and the average length is 20 inches (51 cm), although a wide range is considered normal.

Elements of the clinical examination of the newborn:

Then the doctor examines the newborn's skin, head, neck, heart, lungs, abdomen, and genitals, and evaluates the newborn's nervous system and reflexes. Doctors also routinely perform imaging examinations to check for problems that cannot be seen during a physical examination.

Skin:

Doctors examine and record the color of the skin. The skin is usually reddish, but it is common to have a blue tinge to the fingers and toes because of poor blood circulation during the first few hours. Sometimes, small reddish-purple spots (petechiae) are found on the skin. Parts of the body that were under a lot of pressure during childbirth, but petechiae all over the body is probably a sign of a disorder and needs to be evaluated by a doctor. Dry and peeling skin often occurs within days, especially in the wrist and ankle folds.

Many newborns develop a rash about 24 hours after birth. This rash, called neonatal toxic fever, consists of flat red spots, usually with a white pimple-like bump in the middle. It's harmless and disappears within 7 to 14 days. .

Head and neck:

Doctors examine the newborn's head, face, and neck to detect any deformities or defects. Some deformities occur during childbirth, and other deformities may result from a congenital defect.

A normal, head-first birth makes the head slightly deformed for several days, as the bones that make up the skull overlap, allowing the head to be compressed for labor. Some swelling and bruising of the scalp is normal. Sometimes, it causes bleeding. From one of the bones of the skull and its outer covering, there is a small bump on the head, which will disappear within a few months (called a cephalhematoma).
When the birth is breech, that is, the buttocks, genitals, or feet come out first, there is usually no deformity of the head. However, swelling or bruising may occur in the buttocks, genitals, or feet, and a breech birth is usually avoided at present.
When the baby is in the breech position, doctors usually recommend a caesarean section (surgical delivery of the baby through an incision in the woman's abdomen and uterus), which reduces the risk to the baby.

The newborn's face may bruise due to pressure during normal delivery. In addition, pressure through the birth canal may cause the face to appear asymmetric at first. Sometimes, this asymmetry results when a facial nerve is damaged during childbirth. Gradually recover over the next few weeks.

The birth process may also lead to the formation of subconjunctival hemorrhages (ruptures of blood vessels on the surface of the eye) in the eyes of the newborn as well. These hemorrhages are common and do not need treatment, and they disappear completely within two weeks, usually.

Doctors check the ears to see if they are shaped normally and in the right place. For example, low-set or improperly shaped ears may mean that the baby has a genetic disorder or hearing loss.

Doctors also check the mouth for any problems. Rarely, babies are born with teeth, which may need to be removed, or they have a cleft lip or palate.
Doctors also check for gingival polyps (noncancerous growths on the gums), because these growths can cause feeding problems and may block the airways.
Doctors check the neck for lumps or growths and for sprains or spasms.

Heart and lungs:

Doctors use a stethoscope to check the heart and lungs for problems, and doctors are able to hear abnormal sounds, such as a heart murmur or lung congestion.
The doctor checks the color of the skin of the newborn, and the blue color of the face and torso may be a sign of congenital heart defects or lung disease. The rate and strength of the pulse are checked, and doctors monitor the breathing of the newborn, and count the number of breaths per minute.
Snoring, nostrils widened with breathing, and breathing too fast or too slow can be signs of problems.

Abdomen and genitals:

The doctor checks the general shape of the abdomen. The doctor also checks the size, shape, and position of the internal organs, such as the kidneys, liver, and spleen. Enlarged kidneys may indicate a blockage in the urethra.

The doctor checks the genitals to ensure that the urethra is open and in the correct position. The doctor also checks whether the genitals are clearly male or female.
In males, the testicles should be in the scrotum, and in females, the labia are prominent due to exposure to the mother's hormones, and remain swollen for the first few weeks.
Discharge from the vagina that is small and contains blood and mucus is normal.
The doctor checks the anus to make sure it is in the correct position and not closed.

Nervous system:

Doctors check the newborn's level of alertness, muscle tone and the ability to move the arms and legs evenly.
Uneven movement can be a sign of a nerve abnormality (eg, nerve palsy).
Doctors check the reflexes of the newborn using various maneuvers as well. The most important reflexes in the newborn are the Moro reflex, the rooting reflex and the sucking reflex.

Nervous system:

Doctors check the newborn's level of alertness, muscle tone and ability to move the arms and legs evenly. Uneven movement can be a sign of nerve abnormalities (such as nerve palsy).
Doctors check the reflexes of the newborn using various maneuvers as well. The most important reflexes in the newborn are the Moro reflex, the rooting reflex and the sucking reflex.

The three common reflexes of newborns:

  • In the Moro reflex, when a newborn starts crying, it opens its arms outward with fingers extended and raises its legs toward its chest.
  • For the rooting reflex, when tapped on one side of the newborn's mouth or lip, it turns its head to that side and opens its mouth, this reflex enables the newborn to find the nipple.
  • For the sucking reflex, when an object (such as a pacifier) is placed in a newborn's mouth, it begins to suck directly.

muscles and bones:

The doctor checks the flexibility and movement of the arms, legs, and hips, and makes sure that the baby does not have any broken bones (particularly the collarbone) during birth, has a missing or unformed limb, or has a dislocated hip joint.
The spine is examined for defects or abnormalities (such as spina bifida).