The physical examination is performed once stabilized the newborn preferably twelve hours after birth. The player must be sent first to the history of the mother to know the position, design and type of birth (eutopic or dystocic) or other information that can guide clinical findings.
Sex and development in relation to gestational age and the presence of major malformation or deformation must be noticed. The presence of asymmetry in movement may indicate injury of brachial plexus or cervical cancer.
A vertex presentation is observed: arms and legs in moderate flexion clenched fists resistance to limb extension or measurement. If the presentation was breech legs will be stiff and extended takes the position in utero.
Monitor the heart rate and pulse. Pulso Apical (fourth intercostal space) 120 to 160 beats / min. In sleep 100 bpm. In tears 160 beats / minutes.
For measurement place fingers along the inguinal ligament near the midpoint between the symphysis pubis and the iliac crest. Feel both sides at the same time, both must be equal and strong.
Observe your breath when the infant is at rest. There is one minute, observe respiratory effort. Find average 40 x min. Normal variation of 40 to 60-min. In the normal RN expiratory grunt should not exist, or nasal flaring. At mourn, especially the most premature babies can have discrete subdiaphragmatic thoracic retraction and sternum.
At birth: 78 Systolic Diastolic 42 mmHg
At 12 hours systolic 60-80 diastolic 40-50 mmHg
At 10 days Systolic 95-100 mmHg, diastolic = slight increase
Variations with changes in activity levels: awake, crying, sleeping.
Weight average finding 2.500Kgs to 4.000kg. Average discovery size 45 to 55cms.
32 to 37cms head circumference Thoracic Circumference 30 to 33 cm (-2cm CC)
Waist circumference 30 to 33cm. Iguala chest circumference.
Check the color, look at the naked baby in a well lit and warm. May appear: Acrocyanosis with cold (cyanosis of hands and feet), Harlequin phenomenon (the area of the body is supported more red and one pale), telangiectasia (stork bites or capillary hemangiomas), Toxic Erythema Neonatorum (rash the newborn), Milium (small white papillae of sebaceous origin, seen in the nose, chin and forehead). Palpate skin integrity, assess hydration and texture, check presence of vernix caseosa and lanugo. If jaundice is seen, it means that the bilirubin is at least on 5mg%. In the early skin is very thin, almost transparent, red, with little subcutaneous tissue. (Vernix: It is a fatty material, white can cover the body, which is produced by the sebaceous glands from 20-24 weeks of gestation, decreasing from 36 weeks and disappeared at 41 weeks.)
Examine the form and size, palpable anterior fontanelle is depressed or if bulky, triangular posterior fontanelle smaller than the previous one, is located between the occipital and parietal bones, is closed after two months of age. Shape and size: (It is large relative to the body, usually has a plastic deformation straddling with varying degrees of bone and is due to their adaptation to the birth canal, except for those born by Caesarean section.)
Note the appearance of symmetry. The cheeks are a casus fullness of fat accumulation which produces “suction pads” their facial movements should be symmetrical.
Check location, size, symmetry, shape and movement of the eyelids. Presence of secretions, edema, subconjunctival hemorrhage.
Observe the shape, size, location, patency and configuration. Nasal Congestion presence of secretions, sneezing. Presence of Milium.
Note location on the face, lips the color symmetry, configuration and movement, language, values and palpate the palate. Rate quantity and characteristics of the saliva. Rooting reflex.
Note the size, deployment: a line is drawn through the external outer edge of the eyes, which reaches the upper edge of the ear canal hearing abierto.He valued response to noise. Their alterations have been associated with urinary tract malformations especially. The eardrums are difficult to visualize and appear opaque.
Examine sternocleidomastoid and the movement and position of the head. The neck is relatively short and head seems to rest on the shoulders. Occasionally may present asymmetry with deviation to the side, which is more often a persistent fetal position with his head cocked (asincletismo).
Examine and feel the shape, breathing movements, evaluate the clavicles, rib cage which moves symmetrically with breathing. Rate the nipple size and number. Wet noises may be heard in the first hours postpartum. An asymmetrical or decreased breath sounds, should be suspected pathology. Heart: Heart rate under 90 and of 195 per minute should be considered. The apex is lateral to the midclavicular line in the third or fourth left intercostal space. They can often auscultated systolic ejection murmurs are transient. Every breath that persists beyond 24 hours or are accompanied by other symptoms should be studied.
On auscultation breath sounds should be clear.
Immediately after birth is something soft and scaphoid (depressed), to the extent that the bowel is filled with air, the abdomen begins to distend. The abdominal organs are easily palpable during this period. A marked and persistently depressed abdomen suggests diaphragmatic hernia. A distended abdomen may suggest organomegaly, ascites or bowel obstruction.
Examine and palpate the cord. Olfatee. Sniff. It is cylindrical, appears with slight protrusion and moves with respiration. It is important to tell the mother that is a protrusion of skin which slowly disappear. The belly starts to dry 1 or 2 hours after birth, darkens to the three days and sloughing between 7 and 10 days.
Note the first void to be sure that the urinary system is working properly. The urine should be light colored.
Sex should be clearly defined. Male: In term infants, with pendulous scrotum is the sac covering wrinkles, pigmented. The testicles should be lowered. Penis size is highly variable, the foreskin is attached to the glans and the meatus is small. In the preterm is less pigmented scrotum and testicles are not descended.
Female: By the end of the labia completely cover these minors and clitoris. The hymen can be seen and protuyente. During the first days after birth, may be seen normally a whitish discharge that sometimes mucosa contain blood. Occasionally, the labia minora can be fused to cover the vagina.
Year: must be permeable and have muscle tone anal sphincter.
Should abduct symmetrically; suspect congenital dislocation of hips if there is limitation to abduction or if you feel a ridge where the femur is directed backward and then abducted
Column should be evaluated to detect the possible presence of dimples, lumps, locks of hair, spinal curvature. The folds of the buttocks and the knee should be symmetrical.
Must be examined to detect possible presence of missing or additional palmar deformities and femoral pulses. In considering both femoral pulses should feel strong, no pulse can indicate contraction of the cord.