Study note
PediatricsNewborn Care

Systemic examination findings in neonates

THE CONTEXT
Chest, cardiovascular, abdominal, and musculoskeletal findings help distinguish normal neonatal features from possible disease.

Chest and breathing

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The anteroposterior chest diameter is roughly equal to the transverse diameter.
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Nasal flare, grunting, fast breathing, and intercostal or subcostal retractions indicate respiratory distress.
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Possible causes include pneumonia, respiratory distress syndrome, delayed reabsorption of lung fluid causing transient tachypnea, and other cardiorespiratory conditions.
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Stridor indicates larger airway obstruction, whereas wheezing denotes small airway obstruction.
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Bowel sounds in the chest may indicate congenital diaphragmatic hernia.

Cardiovascular findings

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Abnormal heart sounds or murmurs may indicate congenital heart disease; affected neonates may have tachypnea, cyanosis, or both.
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Bilateral femoral artery pulsations may be absent in coarctation of the aorta.

Abdominal findings

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An unusually flat or scaphoid abdomen may be associated with congenital diaphragmatic hernia.
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Visible gastric or bowel patterns may indicate ileus or intestinal obstruction.
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In normal neonates, the liver may be palpable below the costal margin; the spleen tip and lower pole of the left kidney may also be palpable.

Musculoskeletal findings

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Common deformations result from adverse mechanical factors in utero. Most positional deformities are mild and resolve over time.
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