Neonatal Exam

As part of our Patient, Physician and Society (PPS) course this block, we’re required to attend several “special sessions” at hospitals around the Texas Medical Center. Today I had my neonatal session at Ben Taub and was absolutely blown away by how wonderful the world of neonatology is. Plus… who doesn’t love babies?!

My group of five colleagues had an incredible attending who walked us through the basic things physicians need to assess on a newborn. Our baby was a 36 hour old male and incredibly cooperative… once he was fed. I guess I can relate to that. 😀

We started by carefully observing the baby’s general appearance. Are there signs of bruising? Do his movements look symmetric, or does he favor one side? Does he have ten little fingers and ten little toes? Are there two umbilical arteries and a single umbilical vein in the umbilical cord? Initially, a significant part of our time went into just looking at the baby without making physical contact. The attending proceeded to explain common findings we may observe in the future which are usually normal (mild jaundice and Mongolian spots to name a couple).

Then we pulled out our stethoscopes (finally got to use the pediatric side, but it was still too big), and listened to the baby’s heart and respirations. I knew the baby’s heart rate would be well over 100 bpm, but foolishly I tried to listen for a stable “lub-dub” rhythm with a delay between cycles. I placed the stethoscope firmly on his chest and heard “noise.” After a few seconds, I realized that noise was actually his heart. After a few more seconds, I could make out the rapid “lub-dub” cycles. And listening to the baby’s lungs (from each axilla, since that’s where the lobes of each respective lung tend to meet) while he cried allowed me to hear every… possible… lung sound… in a few short seconds. 😯 Incredible!

We did some nifty neuro exams too! To examine the red reflex, we dimmed the lights causing the baby to open his eyes. In neonates, a white-ish reflection could be indicative of cataracts or retinoblastoma, but our baby boy was just fine! 🙂 We examined some of the primitive reflexes which disappear with the maturation of a baby’s nervous system – the famous reflex we’ve studied but have rarely seen in adults (since it’s pathological in adults but normal in neonates) is the Babinski plantar reflex. Lo and behold, it was positive! I also tested his suckling reflex (which was awfully strong) with a gloved hand as I examined the integrity of his palate looking for any clefts. 🙂

We looked for bilateral descension of the testes, fusion of the scrotal sacs, patency of the anus, any signs of neural tube defects, etc. This baby was absolutely perfect!!

Overall, this was an incredible experience. It’s so nice to get out of the mundane cycle of reading through PowerPoint lectures and see how our skills can be applied to actual, living entities. I’m really looking forward to tomorrow’s session at Texas Children’s Hospital where we’ll learn how to properly conduct a pediatric examination.

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