Neonatology Book

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Newborn Neurologic Exam

Aka: Newborn Neurologic Exam
  1. See also
    1. Newborn Head and Neck Exam
    2. Craniosynostosis
    3. Head Circumference
    4. Fontanelle
    5. Dysraphism (Neural Tube Defect)
    6. Intraventricular Hemorrhage in Preterm Infants
  2. Exam: General
    1. Newborn Reflexes
      1. Primitive Stepping Reflex
      2. Rooting Reflex
      3. Moro Reflex (Startle Reflex)
      4. Babinski Reflex
        1. Upgoing toe until after 6 months of age
    2. Seizures
      1. See Neonatal Seizures
      2. Typically subtle in infants (e.g. lip smacking, repetitive movements)
    3. Posture
      1. Normally in Fetal Position with hands closed
      2. Hold infant in vertical suspension
        1. Hypotonia is this position is abnormal
    4. Alertness
      1. Awakened by uncovering or stimulating foot or cheek
    5. Level of activity
    6. Jitteriness
      1. Normal fine Tremor provoked when startled
      2. Consider electrolyte abnormality if severe (obtain Serum Glucose, Serum Magnesium, calcium)
      3. Consider Drug Withdrawal for infants of mothers on longterm medications of drugs (e.g. Methadone, SSRI)
    7. Benign neonatal sleep Myoclonus
      1. Myoclonic Jerks while sleeping (resolves when infants are awake)
      2. Presents at 2-4 weeks of life, and resolves by age 6 months
    8. Saccadic Intrusions
      1. When infants are tracking with their eyes, their eyes may make corrective jumps
        1. Small amplitude conjugate interruptions (not Nystagmus)
      2. Resolve over the first few months of life
      3. Differentiate from randomly wandering eye movements (may be a sign of blindness)
    9. Periodic breathing
      1. Common and normal in children
      2. Pauses in breathing up to 20 seconds are normal (unless associated bradycardi, mental status change, Skin Color change)
  3. Exam: Cranial Nerve Exam
    1. Pupil reflex
      1. Cranial Nerve II
    2. Doll's Eyes
      1. Cranial Nerve III
      2. Cranial Nerve IV
      3. Cranial Nerve VI
    3. Corneal, sucking, and Rooting Reflexes
      1. Cranial Nerve V
      2. Cranial Nerve VII
    4. Response to noise
      1. Cranial Nerve VIII
    5. Gag Reflex
      1. Cranial Nerve IX
      2. Cranial Nerve X
  4. References
    1. Drapkin (2019) Am J Emerg Med 37(6):1153-9 +PMID:30952605 [PubMed]
    2. Lewis (2014) Am Fam Physician 90(5): 297-302 [PubMed]

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