Newborn examination of the umbilicus, spine, genitalia, and limbs
THE CONTEXT
Examination of the cord, lower back, anal opening, genitalia, and limb movements can identify findings requiring further attention.
Umbilical cord and anal opening
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Inspect the number of umbilical cord vessels; the illustrated freshly cut cord contains two arteries and one vein.
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A single umbilical artery occurs in 0.7% of live births and may be associated with renal and gastrointestinal tract anomalies.
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Palpate the base of the umbilical cord for a hernia and check that the anal opening is intact.
Spine and lower back
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Palpate the spine with a finger to exclude spina bifida, masses, and abnormal curvature.
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A sinus or tuft of hair in the lumbosacral region may indicate an underlying neural tube defect.
Genital examination
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Examine the genital area for the urethral opening and clitoris. A hymenal tag is an innocuous finding.
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Examine penile size and curvature. Hypospadias involves a ventrally located urethral opening rather than the normal opening at the tip, with ventral incurvation called chordee and deficient foreskin.
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Circumcision should be postponed in newborns with hypospadias.
Other examination findings
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Accessory auricles and preauricular tags are common.
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Check that the limbs move fully and that there is no dislocation or asymmetry of movement.