General Clinical Assessment of Eyes, Ears, Nose, Mouth, Throat and Neck of a Newborn

Knowing the peculiarities of some body parts of the newborn ensure a very accurate clinical assessment to detect or differentiate between a healthy child and a sick one.

Usually the newborn keeps his eyes tightly closed. It is best to begin the examination of the eyes by observing the lids for edema, which is normally present for the first 2 days after delivery. A mongoloid slant, the lateral upward slope of the eyes with an inner epicanthal fold. may be indicative of Down's syndrome, The eyes should be observed for symmetry and for hypertelorism. The mean distance between the inner distance is 2cm, 3cm or more is considered ocular hypertelorism.

Tears usually does not appear until the first or second month of life. Purulent discharge from the eyes shortly after birth may signify Ophthalmic neuronum caused by gonorrhea, Chemical irritation or conjunctivitis may appear within 1 hours after instillation of silver nitrate but should last only 24 hours. The doctor carefully notes and records any discharge.

In order to visualize the surface structures of the eyes, the doctor holds the infant supine and gently lowers the head. The eyes will usually open, similar to the mechanism of dolls' eyes. The Sclera should be white and clear. The Cornea is examined for the presence at birth but is generally not elicited without brain or eye damage is suspected. The pupil usually responds to light by constricting. Absence of the pupillary reflex. particularly by 3 weeks of age, suggests blindness. A fixed, dilated or constricted pupil may indicate anoxia or brain damage.

A searching nystagmus is common after birth. Strabismus is a normal finding because of the lack of binocularity. The color of the iris is noted. Most light-skinned newborns have slate gray or dark blue eyes, whereas dark-skinned infants have brown eyes. Absence of color is characteristic of albinism. Although it is quite difficult to perform a funduscopic examination of the retina, a red reflex should be icedited. Absence of the red reflex may indicate the presence of retinal heamorrhages or congenital cataracts.

The ears are examined for position, structure, and auditory function. The pinna is often flattened, An otoscopic examination is ordinarily not performed because the canals are filled with vermix caseosa and amnioti fluid. making visualization of the drum difficult. Auditory sbility can be assessed by making a sharp, loud noise close to the infant's head. Normally the infant will respond with a startle reflex or twitching of the eyelids. Absence of any behavioral response to a sudden noise may indicate congenital deafness and should always be reported.

The nose is usually flatted after birth, and bruises are not uncommon. Patency of the nasal canals can be assessed by holding the hand over the infant's mouth and one canal and noting the passage of air through the unobstructed opening. If nasal patency is questionable, it should be reported because newborns are obligatory nostrils.

Thin white mucus is very common in the newborn, but a think, bloody nasal discharge without sneezing is very common in the newborn. Flaring of the nares is always noted because it is a serious sign of air hunger from respiratory distress.

Mouth and throat
The doctor inspects the mouth to identify existing structures. The palate is typically high-arched and somewhat narrow; a common finding is Epstein's pearls- small, white, epithelial cysts along both sides of the midline of the hard palate. They are insignificant and disappear in several weeks.

The frenulum of the upper lip is a band of think, pink tissue that lies under the inner surface of the upper lip and extends to the maxillary alveolar ridge. It usually disappears as the maxilla grows. It is particularly evident when the infant yawns or smiles. The sucking reflex is elicited by placing a nipple or tongue blade in the infant's mouth. The infant should exhibit a strong, vicious suck. The root reflex is obtained by stroking the cheek and aware the infant's response of turning towards the stimulated side and sucking.

It is difficult to examine the back of the throat. If the doctor attempts to depress the tongue, the infant objects with strong reflex protrusion of the tongue. Therefore, it is best to visualize the Uvula while the infant is crying and the chin is depressed. However, the Uvula may be retracted upward and backward during crying. Tonsillar tissue is generally not seen in the newborn.

The newborn's neck is short and covered with folds of tissue. Adequate assessment of the neck requires allowing the head to fall gently backward in hyper-extension while the back is supported in a slightly raised position. The doctor observes for range of motion, shape, and any abnormal masses.