II. Physiology

III. Exam: Breast and Xiphisternum

  1. Palpate for abnormality
  2. Inspection
    1. Unilateral absence or hypoplasia of pectoralis major
      1. Poland's Syndrome (Poland's Sequence)
    2. Chest Deformity
      1. Pectus Carinatum
      2. Pectus Excavatum
    3. Widely spaced nipples
      1. Turner's Syndrome
      2. Noonan Syndrome

IV. Exam: Respiratory

  1. See Respiratory Distress in the Newborn
  2. Brief periods apnea are normal in transition
  3. Evaluate for unequal breath sounds or unequal chest wall movement
    1. Pneumothorax
    2. Diaphragmatic Hernia
    3. Cystic malformation of the lung
  4. Observe for respiratory distress
    1. Tachypnea, grunting or Cyanosis
    2. Nasal flaring or intercostal retractions
    3. Consider causes (See Respiratory Distress in the Newborn)
      1. Respiratory Distress Syndrome in the Newborn
      2. Meconium Aspiration Syndrome
      3. Transient Tachypnea of the Newborn

V. Exam: Cardiovascular

  1. See Congenital Heart Disease
  2. Vitals (Normal Newborn)
    1. See Pediatric Vital Signs
    2. See Newborn Pulse Oximetry Screening for Congenital Heart Disease
    3. Pulse Oximetry screening for Congenital Heart Disease (prior to discharge at 24 hours)
  3. Appearance
    1. Cyanosis and Tachypnea frequently accompany Congenital Heart Disease
  4. Abnormal Pulses
    1. Diminished pulses in all extremities
      1. Diminished Cardiac Output (e.g. Aortic Stenosis)
      2. Peripheral Vasoconstriction
    2. Diminished femoral pulses
      1. Heart lesion dependent on ductus arteriosus (e.g. Aortic Coarctation)
    3. Bounding Pulses
      1. High Cardiac Output (e.g. Patent Ductus Arteriosus)
  5. Hypertension (See normal Blood Pressure above)
    1. See Hypertension in Infants
  6. Murmurs
    1. See Pediatric Murmur
    2. Pathologic murmur characteristics
      1. Holosystolic murmur, Diastolic Murmur or continuous murmur
      2. Harsh Heart Murmur or Grade 3 murmur or louder
    3. Newborn murmurs are often transient
      1. Tricuspid regurgitation
      2. Patent Ductus Arteriosus
  7. Altered position of precordial heart sounds
    1. Shifted right: Dextrocardia
  8. Gallup Rhythms
    1. Split S2
      1. Normal finding
    2. Split S2 is Absent
      1. Common with Cyanotic Congenital Heart Disease (Truncus Arteriosus, Hypoplastic Left Heart, pulmonic valve atresia)
      2. Results in high pulmonary vascular resistance

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