Intrauterine growth restriction occurs when the baby's growth during pregnancy is poor compared with norms. Using this information, the newborn can be classified as average, large, or small for gestational age.Ī newborn is considered small for gestational age if birth weight is below the 10th percentile. Once the child's gestational age is established, weight, length, and head circumference should be plotted on a nomogram to determine percentiles. 5 A video depicting this examination is available at. 2 – 4 The new Ballard score ( ) was designed to assess a newborn's gestational age through a scoring system that combines physical characteristics with neuromuscular development. Table 1 shows the normal ranges for newborn vital signs at 40 weeks' gestation. A term newborn should have pink skin, rest symmetrically with the arms and legs in flexion, cry vigorously when stimulated, and move all extremities equally. Diagnostic echocardiography should be performed if screening results are positive.Ī detailed newborn examination should begin with general observation for normal and dysmorphic features. Routine screening for congenital heart disease via pulse oximetry is recommended before discharge at 24 hours of life or later. Recent data indicate that ultrasonography should be performed in newborns with isolated ear anomalies, such as preauricular pits or cup ears, only when they are associated with one or more of the following characteristics: other malformations or dysmorphic features, teratogenic exposures, a family history of deafness, or a maternal history of gestational diabetes. Hearing should be evaluated in all newborns before one month of age, but preferably before discharge, using the auditory brainstem response or the otoacoustic emissions test. Regardless of red reflex test results, all newborns with a family history of retinoblastoma, cataracts, glaucoma, or retinal abnormalities should be referred to an ophthalmologist who is experienced in the examination of children.
Screening for hypoglycemia should be performed in newborns who are large or small for gestational age, newborns of mothers with diabetes mellitus, and late preterm infants (34 to 36 6/7 weeks gestational age). SORT: KEY RECOMMENDATIONS FOR PRACTICE Clinical recommendation Part II focuses on assessing extremities, and neurologic function. Part I of this two-part article discusses the assessment of general health, head and neck, heart, and lungs. Pulse oximetry should be performed in a systematic fashion before discharge. Benign murmurs are often present in the first hours of life. Proper auscultation is crucial for evaluation of the broncho-pulmonary circulation with close observation for signs of respiratory distress, including tachypnea, nasal flaring, grunting, retractions, and cyanosis.
The neck should be examined for full range of motion because uncorrected torticollis can lead to plagiocephaly and ear misalignment. If ankyloglossia is detected, a frenotomy may be considered if it impacts breastfeeding. Renal ultrasonography should be performed only in patients with isolated ear anomalies, such as preauricular pits or cup ears, if they are accompanied by other malformations or significant family history. Newborns with low-set ears should be evaluated for a genetic condition. If the red reflex findings are abnormal or the patient has a family history of pertinent eye disorders, consultation with an ophthalmologist is warranted. The red reflex assessment is normal if there is symmetry in both eyes, without opacities, white spots, or dark spots.
Craniosynostosis is caused by premature fusion of the sutures, and 20% of children with this condition have a genetic mutation or syndrome. A Ballard score uses physical and neurologic characteristics to assess gestational age. A comprehensive newborn examination involves a systematic inspection.