Comprehensive Neonatal Physical Examination

General Assessment and Vital Signs

The American Academy of Pediatrics recommends measuring and documenting vital signs including axillary temperature (36.5°C to 37.4°C), respiratory rate (<60 breaths per minute with no signs of distress), and heart rate (100-190 beats per minute when awake, as low as 70 beats per minute when sleeping) 1
Accurate anthropometric measurements including weight, length, and head circumference should be plotted on appropriate growth charts, as recommended by the World Health Organization 2
For premature infants (<36 weeks gestation), measurements should be corrected for gestational age for at least the first 24 months of life, according to the American Academy of Pediatrics 4

The American Academy of Pediatrics recommends palpating fontanelles for size, tension, and abnormalities 4
Eyes should be examined for red reflex, pupillary reactivity, conjunctivitis, and response to visual stimuli, as recommended by the American Academy of Pediatrics 4
Ears should be assessed for position, patency, and response to auditory stimuli, according to the American Academy of Pediatrics 4
The nose and mouth should be examined for patency, abnormalities, and evidence of respiratory distress, as recommended by the American Academy of Pediatrics 4
The neck should be evaluated for masses, abnormal movement, and mobility, according to the American Academy of Pediatrics 4

The American Heart Association recommends auscultating lungs for breath sounds, noting any abnormalities or signs of respiratory distress 5
A cardiac examination including heart rate, rhythm, and presence of murmurs should be performed, as recommended by the American Heart Association 5

The American Academy of Pediatrics recommends palpating the abdomen for masses, organomegaly, or tenderness 4
The umbilical cord should be examined for healing, number of vessels (two arteries and one vein), and signs of infection, according to the American Academy of Pediatrics 3
Fluid balance should be assessed and any bilious or repetitive vomiting documented, which may indicate pyloric stenosis or other gastrointestinal issues, as recommended by the European Society for Pediatric Gastroenterology 6

The American Academy of Pediatrics recommends examining genitalia for abnormalities, ambiguous features, or malformations 4
The first void should be observed if possible, or documented if already occurred, as recommended by the American Academy of Pediatrics 1

The American Academy of Pediatrics recommends assessing extremities for symmetry, range of motion, and deformities 4

The American Academy of Pediatrics recommends assessing muscle tone, posture, and symmetry of movement 4
Primitive reflexes including Moro, rooting, sucking, palmar and plantar grasp, stepping, and placing reflexes should be evaluated, as recommended by the American Academy of Pediatrics 4

The American Academy of Pediatrics recommends assessing for jaundice, which should be quantified with transcutaneous bilirubin or total serum bilirubin if present 3
Skin should be evaluated for signs of infection or poor perfusion, as recommended by the British Association of Dermatologists 6

For infants with jaundice, total and direct bilirubin levels should be measured, as recommended by the American Academy of Pediatrics 3
Newborn screening tests should be reviewed if available or plans made for completion, according to the American Academy of Pediatrics 1

The American Academy of Pediatrics recommends documenting successful feeding (breastfeeding or bottle-feeding) with proper coordination of sucking, swallowing, and breathing 1
Newborn metabolic, hearing, and pulse oximetry screenings should be completed per hospital protocol and state regulations, as recommended by the American Academy of Pediatrics 1
A source of continuing healthcare for follow-up after discharge should be identified, according to the American Academy of Pediatrics 1
Parents should be educated on signs of illness, feeding patterns, and when to seek medical attention, as recommended by the American Academy of Pediatrics 1