Newborn neurologic examination.

This is the first article in a series describing the essentials of the pediatric neurologic examination. The series will address the neurologic examination at different developmental stages from the neonate to the teenage years. The goals of the article are to 1) describe the newborn examination and 2) briefly describe the most common neurologic problems seen in the newborn population. One of the most dreaded calls for the adult neurology resident is the consult from the neonatal intensive care unit (ICU). Faced with the morass of tubes and monitors underneath which lies a tiny infant, the resident is often paralyzed by the daunting task of trying to perform an examination. As one resident put it, “I could tell he was moving all fours, but that was it.” With keen observation and a systematic approach, one can obtain a detailed examination of the newborn. The intent of this article is not to be comprehensive, but to provide a simple approach to the examination and evaluation of the newborn. A summary of the neurological examination is provided in the figure. Further details can be found in the reference articles listed below.1,2 By being organized and having the right tools, one can perform as comprehensive an examination as in an adult. Tools for examination of the newborn are as follows: 1) bell, 2) ophthalmoscope, 3) reflex hammer, 4) cotton-tipped application, 5) measuring tape. Before proceeding to a discussion of the neurologic examination, two important aspects of the general physical examination should be noted. Keeping in mind that the neurologic system is derived from ectoderm, one should pay particular attention to the examination of the skin. Outgrowths such as encephaloceles, cutaneous lesions such as port-wine stains, and the presence of sacral dimples or sinuses should be sought as clues to underlying neurologic dysfunction. Additionally, head circumference should be measured with a tape measure. The normal term infant’s head circumference is 35 cm 2 cm and is a reflection of the underlying intracranial volume. Thus, it is a good way to monitor for intracranial masses and increased intracranial pressure. Additionally, macrocephaly and microcephaly can be indications of underlying metabolic, genetic, or infectious processes.