pediatrics
Physical Examination of the Newborn
Cardiorespiratory System
(See also Overview of Congenital Cardiovascular Anomalies .) The heart and lungs are evaluated when the infant is quiet. The clinician should identify where the heart sounds are loudest to exclude dextrocardia. Heart rate (normal: 100 to 160 beats/minute) and rhythm are checked. Rhythm should be regular, although an irregular rhythm from premature atrial or ventricular contractions is not uncommon. A murmur heard in the first 24 hours is most commonly caused by a Patent Ductus Arteriosus (PDA) . Daily heart examination confirms the disappearance of this murmur, usually within 3 days. Femoral pulses are checked and compared with brachial pulses. A weak or delayed femoral pulse suggests Coarctation of the Aorta or other left ventricular outflow tract obstruction. Central cyanosis suggests congenital heart disease, pulmonary disease, or The respiratory system is evaluated by counting respirations over a full minute because breathing in neonates is irregular; normal rate is 40 to 60 breaths/minute. The chest wall should be examined for symmetry, and lung sounds should be equal throughout. Grunting, nasal flaring, and retractions are signs of Overview of Perinatal Respiratory Disorders . 