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Newborn Abdominal Exam
Aka: Newborn Abdominal Exam
- See Also
- Umbilicus
- Urachus
- Vomiting in Children
- Technique: Abdominal exam
- Perform abdominal exam with infants hips and knees flexed
- Hold knees up with non-dominant hand while palpating with the opposite hand
- Relaxes the newborn's Abdomen
- Palpate for masses
- Use flats of fingers (instead of finger tips)
- Infant liver is typically palpable just below the costal margin
- History: Vomiting
- See Vomiting in Children
- Differentiate spitting-up from Vomiting
- True Vomiting in young infants, expecially if forceful requires a thorough evaluation
- Vomiting Red Flags
- Bilious Emesis
- Malrotation, mid-gut Volvulus or Small Bowel Obstruction
- Projectile Emesis
- Pyloric Stenosis
- Abdominal Distention with bloody stools and Emesis
- Necrotizing Enterocolitis
- Intractable Vomiting with a benign Abdomen
- Brain mass
- Non-accidental Trauma
- Exam: Abdominal findings
- Linea Nigra
- Hyperpigmented vertical line from the Umbilicus to the Pubic Symphysis and resolves with time from maternal Hormone exposure
- ScaphoidAbdomen
- Suggests congenital Diaphragmatic Hernia
- Persistent Abdominal Distention or mass
- Generalized distention
- Consider Bowel Obstruction or Ascites
- Localized mass
- See Abdominal Mass in Newborns
- Renal Masses (50% of abdominal lesions)
- Wilms tumor
- Renal vein thrombosis
- Multicystic dysplastic Kidneys
- Hydronephrosis
- Non-Renal Masses
- Teratoma
- Ovarian Torsion
- Ovarian Cyst
- Neuroblastoma
- Gastric Duplication Cyst
- Abdominal wall defect
- Diastasis Recti abdominis
- Weak fascia at midline between the rectus Muscles, resolves spontaneously with time
- Umbilical Hernia
- Rarely incarcerated or strangulated in infants and spontaneously resolve by 3 years old in most cases
- Evisceration
- Gastroschisis (Intestines protrude through right abdominal wall without a sac)
- Omphalocele (Intestines protrude through the midline abdominal wall in a sac)
- Umbilicus
- See Umbilical Cord
- Observe for umbilical infection or bleeding
- Single Umbilical Artery
- Associated with renal anomalies, IUGR and prematurity
- Renal Ultrasound is no longer indicated in isolated cases
- Liver
- See Hepatomegaly in Newborns
- Usually palpable 2 cm below costal margin
- Kidneys
- Usually palpable
- Exam: Rectum and Anus findings
- Anus patent and not ectopic
- Imperforate anus
- Isolated or
- Associated with Trisomy 18 and Trisomy 21 or
- Associated with VACTERL
- Vertebral/vascular anomalies
- Anorectal anomalies
- Cardiac anomalies
- Transesophageal anomalies
- Radial/renal anomalies
- Limb anomalies
- Cutaneous Signs of Dysraphism
- Simple sacral dimples do not require additional evaluation
- Shallow sacral dimple <0.5 cm in diameter AND
- Within 2.5 cm from anal verge
- And no hairy patches or Hemangiomas
- Further evaluate sacral dimples that do not meet these criteria or other midline defects
- Ultrasound for Spinal Dysraphism by 3 months of age is typical but is controversial as it may not change management
- Chem (2012) J Neurosurg Pediatr 9(3): 274-9 [PubMed]
- Expect meconium passed within 24-48 hours of birth
- Consider Hirschprung's Disease if not present
- References
- Drapkin (2019) Am J Emerg Med 37(6):1153-9 +PMID:30952605 [PubMed]
- Lewis (2014) Am Fam Physician 90(5): 297-302 [PubMed]