pediatrics
Physical Examination of the Newborn
Abdomen and Pelvis
The abdomen should be round and symmetric. A scaphoid abdomen may indicate a Diaphragmatic Hernia , allowing the intestine to migrate through it to the chest cavity in utero; pulmonary hypoplasia and postnatal respiratory distress may result. An asymmetric abdomen suggests an abdominal mass. The splenic edge is palpable in about 30% of newborns. Splenomegaly (splenic edge palpable > 2 cm below the left costal margin) suggests congenital infection or hemolytic anemia. The kidneys may be palpable with deep palpation; the left is more easily palpated than the right. Large kidneys may indicate obstruction, tumor, or cystic disease. The liver is normally palpable 1 to 2 cm below the costal margin. An Classification of Abdominal Hernias , due to a weakness of the umbilical ring musculature, is common but rarely significant. The presence of a normally placed, patent anus should be confirmed. In boys, the penis should be examined for Hypospadias or In term girls, the labia are prominent. Mucoid vaginal and serosanguineous secretions (pseudomenses) are normal; they result from exposure to maternal hormones in utero and withdrawal at birth. A small tag of hymenal tissue at the posterior fourchette, believed to be due to maternal hormonal stimulation, is sometimes present but disappears over a few weeks. Ambiguous genitals (intersex) may indicate several uncommon disorders (eg, Overview of Congenital Adrenal Hyperplasia ; 5-alpha-reductase deficiency; 