Physical Examination of a Premature Infant
A Step-by-Step Guide
A thorough examination of a premature infant should take between three to seven minutes. This detailed approach ensures that all critical aspects of the baby’s health are assessed, providing reassurance and identifying any issues that may need further attention.
Preparation and Initial Observation
1. Hand Hygiene
Before starting the examination, it is essential to wash your hands thoroughly to prevent any risk of infection.
2. Initial Visual Assessment
Conduct a cursory visual examination to check for any immediate signs of distress, respiratory difficulties, or gross abnormalities. This step involves:
- Observing the infant’s overall condition: Look for signs of distress or discomfort.
- Evaluating respiratory effort: Check for any signs of labored breathing, such as retractions or nasal flaring.
- Checking skin color: Ensure the infant is not cyanotic or pale.
Detailed Examination Steps
1. Face and Skull Examination
- Face: Check the ears, nose, and mouth for any gross abnormalities. Ensure there are no cleft lips or other visible deformities.
- Cranium: Feel the anterior and posterior fontanelle and check for any ridges along the sutures, indicating cranial synostosis.
2. Neck and Mouth
- Neck: Check for any masses or abnormalities.
- Mouth: Insert a finger to check for a cleft palate and assess the baby’s sucking capabilities. Confirm that the baby has a vigorous suck.
3. Abdomen Examination
- Lower Abdomen: Palpate to check for splenic enlargement, typically felt in the antirexillary line.
- Kidneys and Hernias: Feel for any kidney enlargement or hernia masses.
- Liver: Start low and work upwards to check for liver enlargement. Ensure the liver edge is smooth and not enlarged.
- Bladder: Ensure there is no bladder enlargement or masses.
4. Heart and Lungs
Listen to the heart starting at the base and moving down the left sternal border to the apex. Check for:
- Heart rate and rhythm.
- Presence of murmurs.
- Split heart sounds.
- Rumbles or gallops.
- Lungs: Listen to both sides of the chest and back, ensuring equal air entry and no signs of respiratory distress. Percuss the chest to check for any differences in sound that might indicate underlying issues.
5. Back Examination
- Sacral Area: Check for sacral dimples, hair tufts, or other abnormalities.
- Spine: Palpate along the spine to ensure there are no deformities or masses.
6. Diaper Area and Groin
- Female Infants: Check for abnormalities in the vaginal orifice and clitoral enlargement.
- Male Infants: Check for inguinal hernias and palpate the spermatic cord for thickening, indicating a potential hernia.
- Femoral Pulses: Ensure femoral pulses are present and symmetrical.
Neurological and Musculoskeletal Examination
1. Tone and Reflexes
- Tone: Evaluate the baby’s tone by checking for resistance to passive movement and spontaneous activity. Assess clonus and other reflexes.
- Hips: Examine the hips by pressing down on the knees to check for dislocation or clicks. Look for asymmetry in the gluteal folds, which might indicate hip dysplasia.
2. Neurological Reflexes
- Rooting Reflex: Check for the rooting reflex by pressing the palms and observing if the baby turns their head to the midline.
- Muscle Tone: Lift the baby’s head to demonstrate muscle tone and show the parents the infant’s strength.
Ophthalmologic Examination
- Red Reflex: Perform a quick ophthalmologic examination to check for a normal red reflex. Seek assistance from a nurse if needed to keep the eyes open.