Newborn Physical Assessment

Newborn Physical Assessment Parameters Normal Findings Respirations (count for 1 full minute) 30-60 breaths/minute Synchronization of chest and abdominal movements Diaphragmatic and abdominal breathing Transient tachypnea Apical Pulse (count for 1 full minute) 120-160 bpm (if asleep 100 bpm; if crying, up to 180 bpm) Temperature (rectal) Rectal 97.8-99*F (36.6-37.2*C); 98.8*F desired Axilla 97.5-99*F (36.4-37.2*C) Heavier neonates tend to have higher body temps Weight (lb/oz) 5# 8 oz – 8# 13 oz 2500-4000g Length (inches) 18-22 in (48-56 cm) Grows 3 in (10 cm) during first 3 months Alterations/Possible Causes Actual Findings (flag Tachypnea (pneumonia, RDS) Rapid, shallow breathing (hypermagnesemia due to large doses given to mothers with PIH) Expiratory grunting, subcostal and substernal retractions; flaring of nares (respiratory distress); apnea (cold stress, respiratory disorder) Weak pulse (decreased cardiac output) Bradycardia (severe asphyxia, arrhythmia) Tachycardia (over 160 bpm at rest) (infection, CNS problems, arrhythmia) Elevated temperature (room too warm, too much clothing or covers, dehydration, sepsis, brain damage) Subnormal temperature (brain stem involvement, cold, sepsis) Swings of more than 2F from one reading to next or subnormal temperature (infection) <6# (<2748 g) = SGA or preterm infant >9# (4050 g) = LGA or infants of diabetic mothers Less than 45 cm (congenital dwarf) Short/long bones proximally (achondroplasia) Short/long bones distally (Ellis- abnorms) Parameters Normal Findings Alterations/Possible Causes Van Creveld syndrome) Skin  Color Color consistent with genetic background Newborns of European descent: pink-tinged or ruddy color over face, trunk, extremities Newborns of African or Native American descent: pale pink with yellow or red tinge Newborns of Asian descent: pink or rosy red to yellow tinge Common variations: acrocyanosis, circumoral cyanosis, or harlequin color change Mottled when undressed Minor bruising over buttocks in breech presentation and over eyes and forehead in facial presentations  Texture Smooth, soft flexible; may have dry peeling hands and feet  Turgor Elastic, returns to normal shape after pinching  Lanugo A fine hair covering, decreases as gestational age increases. The amount of lanugo is Pallor of face, conjunctiva (anemia, hypothermia, anoxia) Beefy red (hypoglycemia, immature vasomotor reflexes, polycythemia) Meconium staining (fetal distress) Jaundice (hemolytic reaction from blood incompatibility within first 24 hours, sepsis) Cyanosis (choanal atresia, CNS damage or trauma, respiratory or cardiac problem, cold stress) Generalized cracked or peeling skin (SGA or postterm; blood incompatibility; metabolic, kidney dysfunction) Seborrheic-dermatitis (cradle cap) Absence of vernix (postmature) Yellow vernix (bilirubin staining) Maintains tent shape (dehydration) Actual Findings (flag abnorms) Parameters Normal Findings Alterations/Possible Causes Actual Findings (flag greatest at 28-30 weeks and then disappears, first from the face, then from the trunk and extremities  Rashes  Mongolian Spots  Vernix Caseosa Erythema toxicum (normal newborn rash): innocuous pink popular rash of unknown cause with superimposed vesicles; it appears within 24-48 hours after birth and resolves spontaneously within a few days If associated with other signs and symptoms, may be an indication of infection Macular areas of bluish-black or gray-blue pigmentation found on the dorsal area and the buttocks Common in newborns of Asian and African descent and other dark-skinned races Gradually fade during the first or second year of life A whitish cheeselike substance, covers the fetus while in utero and lubricates the skin of the newborn. The skin of the term or postterm newborn has less vernix and is frequently dry; peeling is common, especially on the hands and feet Reflexes  Blink Stimulated by flash of light; response is closure of eyelids Lack of blink response (damage to cranial nerve, CNS injury) abnorms) Parameters  Pupillary reflex  Moro/Startle  Rooting and sucking  Palmar grasp Normal Findings Alterations/Possible Causes Actual Findings (flag Stimulated by flash of light; response is constriction of pupil Lack of reflex (damage to cranial nerve, CNS injury) Response to sudden movement or loud noise should be one of symmetric extension and abduction of arms with fingers extended; then return to normal relaxed flexion Infant lying on back: slightly raised head suddenly released; infant held horizontally, lowered quickly about 6 in, and stopped abruptly Fingers form a C Present at birth; disappears by 6 months of age Asymmetry of body response (fractured clavicle, injury to brachial plexus) Consistent absence (brain damage) Turns in direction of stimulus to cheek or mouth; opens mouth and begins to suck rhythmically when finger or nipple is inserted into mouth; difficult to elicit after feeding; disappears by 4-7 months of age Sucking is adequate for nutritional intake and meeting oral stimulation needs Disappears by 12 months Poor sucking or easily fatigable (preterm, breastfed infants of barbiturate-addicted mothers, possible cardiac problem) Absence of response (preterm, neurologic involvement, depressed newborns) Fingers grasp adult finger when palm is stimulated and held momentarily Lessens at 3-4 months of age Asymmetry of response (neurologic problems) Toes curl downward when sole of foot is stimulated Absent (defects of lower spinal abnorms) Parameters  Plantar grasp  Stepping  Babinski  Tonic neck/ Fencer  Prone crawl  Trunk incurvation Normal Findings Lessens by 8 months When held upright and one foot touching a flat surface, will step alternately Disappears at 4-5 months of age Fanning and extension of all toes when one side of sole is stroked from heel upward across ball of foot Disappears at about 12 months When head is turned to one side, extremities on same side extend and on opposite side flex This reflex may not be evident during early neonatal period Disappears at 3-4 months of age Response often more dominant in leg than in arm While on abdomen, neonate pushes up and tries to crawl Alterations/Possible Causes column) Asymmetry of stepping (neurologic abnormality) Absence of response (low spinal cord defects) Absent after 1 month of age or persistent asymmetry (cerebral lesion) Absence or variance of response (preterm, weak, or depressed newborns) Failure to rotate to stimulated side (neurologic damage) In prone position stroking of spine causes pelvis to turn to stimulated side Head  General appearance, movement, size Round, symmetric, and moves easily from left to right and up and down; soft and pliable Actual Findings (flag Asymmetric, flattened occiput on either side of the head (plagiocephaly) abnorms) Parameters Normal Findings Alterations/Possible Causes Actual Findings (flag Head held at angle (torticollis) Unable to move head side to side (neurologic trauma)  Circumference (centimeters) 32-37 cm (12.5-14.5 in) 1-2 cm greater than chest circumference  Molding  Fontanelles Extreme differences in size may be microencephaly (Cornelia de Lange syndrome, cytomegalic inclusion disease [CID], rubella, toxoplasmosis, chromosome abnormalities), hydrocephalus (meningomyelocele, achondroplasia), anencephaly (neural tube defect) Head is 3 cm or more larger than chest circumference (preterm, hydrocephalus) Shaping of the fetal head by overlapping of the cranial bones to facilitate movement through the birth canal during labor Breech and cesarean newborns’ heads are round and wellshaped Palpation of junction of cranial bones Anterior fontanelle: 3-4 cm long by 2-3 cm wide, diamond shaped; flat Posterior fontanelle: 1-2 cm at birth, triangle shaped; flat Overlapping of anterior fontanelle (malnourished or preterm newborn) Premature closure of sutures (craniostenosis) Late closure (hydrocephalus) abnorms) Parameters Normal Findings Slight pulsation Moderate bulging noted with crying, stooling, or pulsations with heartbeat  Cephalhematoma  Caput Succedaneum Moderate to severe pulsation (vascular problems) Bulging (increased intracranial pressure, meningitis) Sunken (dehydration) Collection of blood between cranial (usually parietal) bones and periosteal membrane Does not cross suture lines Does not increase in size with crying Appears between the first and second day Disappears after 2-3 weeks or may take months Collection of fluid, edematous swelling of the scalp Crosses suture lines Present at birth or shortly thereafter Reabsorbed within 12 hours or a few days after birth Face  General appearance Alterations/Possible Causes Symmetric movement of all facial features, normal hairline, eyebrows and eyelashes present Eyes at same level, nostrils equal size, cheeks full, and sucking pads present Lips equal on both sides of midline Chin recedes when compared to other bones of face Eyes wide apart—ocular hypertelorism (Apert syndrome, cri-du-chat, Turner syndrome) Abnormal face (Down syndrome, cretinism, gargoylism) Abnormally small jaw— micrognathia (Pierre Robin syndrome, Treacher Collines syndrome) Inability to suck, grimace, and Actual Findings (flag abnorms) Parameters Normal Findings Makes facial grimaces Symmetric when resting/crying  Forceps or vacuum extractor marks  Milia Mouth  Function of facial, hypoglossal, glossopharyngealand vagus nerves  Palate (soft/hard) Reddened areas over the cheeks and jaws (forceps) Reddened/bruised suction marks on the vertex of the scalp (vacuum extractor) Usually disappear within 1-2 days Alterations/Possible Causes Actual Findings (flag close eyelids (cranial nerve injury) Asymmetry (paralysis of facial cranial nerve) Transient facial paralysis resulting from the forceps pressure is a rare complication Tiny white papules appearing on the face as a result of unopened sebaceous glands Disappear spontaneously within a few weeks Symmetry of movement and strength Presence of gag, swallowing, coordinated with sucking reflexes Adequate salivation Hard palate dome-shaped Uvula midline with symmetrical movement of soft palate Palate intact, sucks well when stimulated Epithelial (Epstein’s) pearls appear on mucosa Esophagus patent, some Mouth draws to one side (transient 7th cranial nerve paralysis due to pressue in utero or trauma during birth, congenital paralysis) Fishlike shape (Treacher Collins syndrome) Supressed or absent reflexes High-steepled palate (Treacher Collins syndrome), bivid uvula (congenital anomaly) Clefts in either hard or soft palate (polygenic disorder) Excessive drooling or bubbling (esophageal atresia) Lack of movement or abnorms) Parameters Ears Eyes Normal Findings asymmetric movement (neurologic damage) Tongue-tied Tongue deviations from midline (cranial nerve damage) White cheesy coating of tongue (thrush) Tongue with deep ridges Large tongue with short frenulum (cretinism, Down syndrome, other syndromes) Nodules, cysts, or sinus tracts in front of ear Adherent earlobes Low set ear placement (Down syndrome) No response to sound stimuli (deafness) Fails (refers) Algo hearing test unilaterally or bilaterally Presence of one or more risk factors Tongue  External ear Without lesions, cysts, or nodules Placement of pinnae parallel with eye canthi bilaterally  Hearing Attends to sounds; sudden or loud noise elicits Moro reflex Passes Algo hearing test bilaterally Absence of all hearing risk factors  General placement and appearance Bright and clear; even placement  Coordination Color Actual Findings (flag drooling common in newborn Tongue free moving in all directions, midline Tongue pink color, smooth to rough texture, non-coated Tongue proportional to mouth   Alterations/Possible Causes Slight nystagmus (involuntary cyclical eye movement) Concomitant strabismus Move in all directions Blue- or slate-blue gray Gross nystagmus (damage to third, fourth, and sixth cranial nerves) Constant and fixed strabismus abnorms) Parameters Normal Findings Brown color at birth in darkskinned infants  Eyelids Position: above pupils but within iris, no drooping Eyes on parallel plane Epicanthal folds in Asian and 20% of newborns of northern European descent  Movement Blink reflex in response to light stimulus Eyes open wide in dimly lighted room  Inspection  Cornea Edematous for first few days of life, resulting from birth and instillation of Erythromycin ointment (chemical conjunctivitis); no lumps or redness Clear Corneal reflex present (do not elicit) May appear bluish in newborn, then white; slightly brownish Alterations/Possible Causes Actual Findings (flag Lack of pigmentation (albinism) Brushfield spots may indicate Down syndrome (a light or white speckling of the outer 2/3 of the iris) Elevation or retraction of upper lid (hyperthyroidism) “Sunset sign” lid retraction and downward gaze (hydrocephalus), ptosis (congenital or paralysis of oculomotor muscle) Upward slant in non-Asians (Down syndrome, cri-du-chat syndrome) Blink absent (CNS injury) Purulent drainage (infection); infectious conjunctivitis (gonococcus, Chlamydia, staphylococcus, or gramnegative organisms) Marginal blepharitis (lid edges red, crusted, scaly) Ulceration (HSV); large cornea or corneas of unequal size (congenital glaucoma) Clouding, opacity of lens (cataract) abnorms) Parameters   Sclera Normal Findings color frequent in newborns of African descent Pupils equal in size, round, and react to light by accommodation Pupils Slight nystagmus in newborn who has not learned to focus Pupil light reflex demonstrated at birth or by 3 weeks of age   Conjunctiva Vision Chemical conjunctivitis Subconjunctival hemorrhage (hemorrhage on the sclera of a newborn’s eye usually caused by changes in vascular tension during birth) Palpebral conjunctiva (red but not hyperemic) 20/150 Tracks moving object to midline Fixed focus on objects at a distance of about 10-20 in; may be difficult to evaluate in newborn Prefers faces, geometric designs, and black/white to colors Presence of lashes (lashes may be absent in preterm newborns)  Lashes and lacrimal glands Alterations/Possible Causes Cry commonly tearless True blue sclera (osteogenesis imperfecta) Anisocoria—unequal pupils (CNS damage) Dilation or constriction (intracranial damage, retinoblastoma, glaucoma) Pupils nonreactive to light or accommodation (brain injury) Nystagmus (labyrinthine disturbance, CNS disorder) Pale color (anemia) Inflammation or edema (infection, blocked tear duct) Cataracts (congenital infection) No lashes on inner 2/3 of lid (Treacher Collins syndrome); bushy lashes (Cornelia de Lange syndrome) Actual Findings (flag abnorms) Parameters Normal Findings Alterations/Possible Causes Actual Findings (flag Excessive tearing (plugged lacrimal duct, natal narcotic withdrawal), glaucoma Nose May appear flattened as a result of birth process Small and narrow in midline, even placement in relationship to eyes and mouth Patent nares bilaterally (nose breathers) Sneezing common to clear nasal passages Responds to odors, may smell breast milk Continued flat or broad bridge of nose (Down syndrome) Low bridge of nose, beaklike nose (Apert syndrome, Treacher Collins syndrome), upturned (Cornelia de Lange syndrome) Blockage of nares (mucus and/or secretions), choanal atresia Flaring nares (respiratory distress) No response to stimulating odors Short, straight, creased with skin folds Posterior neck lacks loose extra folds of skin Abormally short neck (Turner syndrome) Arching or inability to flex neck (meningitis, congenital anomaly) Webbing of neck (Turner syndrome, Down syndrome, trisomy 18) Neck  Appearance Straight and intact  Clavicles Moro reflex elicitable Symmetric shoulders Chest Circumference: 32 cm, 1-2 cm Knot or lump on clavicle (fracture during difficult birth) Unilateral Moro reflex response on unaffected side (fracture of clavicle, brachial palsy, ErbDuchenne paralysis) Hypoplasia abnorms) Parameters  Circumference (centimeters) and appearance  Expansion and retraction  Auscultation Normal Findings less than head circ. Wider than it is long Normal shape without depressed or prominent sternum Lower end of sternum (xiphoid cartilage) may be protruding; is less apparent after several weeks Sternum 8 cm long Bilateral expansion No intercostals, subcostal, or supracostal retractions Breath sounds are louder in infants Chest and axilla clear on crying Bronchial breath sound (heard where trachea and bronchi closest to chest wall, above sternum and between scapulae): Bronchial sounds bilaterally Air entry clear Rales may indicate normal newborn atelectasis Cough reflex absent at birth, appears in 2 or more days Flat with symmetric nipples Alterations/Possible Causes Actual Findings (flag Funnel chest (congenital or associated with Marfan syndrome) Continued protrusion of xiphoid cartilage (Marfan syndrome, “pigeon chest”) Barrel chest Unequal chest expansion (pneumonia, pneumothorax, respiratory distress) Retractions (respiratory distress) See-saw respirations (respiratory distress) Decreased breath sounds (decreased respiratory activity, atelectasis, pneumothorax) Increased breath sounds (resolving pneumonia or in cesarean births) Adventitious or abnormal sounds (respiratory disease or distress) abnorms) Parameters  Breasts Normal Findings Breast tissue diameter 0.5 cm or more at term Distance between nipples 8 cm Breast engorgement occurs on third day of life; liquid discharge may be expressed in term newborns Nipples Heart Location: lies horizontally, with left border extending to left of midclavicle Regular rhythm and rate Determination of PMI (usually lateral to midclavicular line at 3rd or 4th intercostals space) Functional murmurs No thrills Horizontal groove at diaphragm shows flaring of rib cage to mild degree Abdomen  Circumference and appearance No documented norms for circumference Cylindrical with some protrusion, appears large in relation to pelvis, some laxness of abdominal muscles No cyanosis, few vessels seen Auscultation of abdomen results in soft bowel sounds heard shortly after birth every 10-30 seconds Diastasis recti—common in infants of African descent Alterations/Possible Causes Actual Findings (flag Lack of breast tissue (preterm or SGA) Discharge Enlargement Breast abscesses Supernumerary nipples Dark-colored nipples Arrhythmia (anoxia), tachycardia, bradycardia Malpositioning (enlargement, abnormal placement, pneumothorax, dextrocardia, diaphragmatic hernia) Location of murmurs (possible congenital cardiac anomaly Marked rib flaring (vitamin D deficiency) Inadequacy of respiratory movement Distension, shiny abdomen with engorged vessels (gastrointestinal abnormalities, infection, congenital megacolon) Scaphoid abdominal appearance (diaphragmatic hernia) Increased or decreased peristalsis (duodenal stenosis, small bowel obstruction) Bowel sounds in chest (diaphragmatic hernia) Absence of bowel sounds Localized flank bulging (enlarged kidneys, ascites, or absent abdominal muscles) abnorms) Parameters  Umbilicus Normal Findings No protrusion of umbilicus (protrusion of umbilicus common in infants of African descent) Bluish-white color Cutis navel (umbilical cord projects), granulation tissue present in navel Two arteries and one vein apparent Begins drying 1-2 hours after birth No bleeding Alterations/Possible Causes Actual Findings (flag Umbilical hernia Patent urachus (congenital malformation) Omphalocele Gastroschisis Redness or exudates around cord (infection) Yellow discoloration (hemolytic disease, meconium staining) Single umbilical artery (congenital anomalies) Discharge or oozing of blood from the cord Absent or diminished femoral pulses (coarctation of aorta) Palpable, equal, bilateral Inguinal hernia  Femoral pulses No bulges along inguinal area No inguinal lymph nodes felt  Inguinal area Extremities and Trunk  General Short and generally flexed, extremities move symmetrically through range of motion but lack full extension All joints move spontaneously; good muscle tone, of flexor type, birth to 2 months Unilateral or absence of movement (spinal cord involvement) Fetal position continued or limp (anoxia, CNS problems, hypoglycemia) Spasticity when infant begins using extensors (cerebral palsy, lack of muscle tone, “floppy baby” syndrome) abnorms) Parameters  Arms Normal Findings Equal in length Bilateral movement Flexed when quiet Normal number of fingers  Hands Normal palmar creases Normal size hands Nails present and extend beyond fingertips in term newborn  Spine C-shaped spine Flat and straight when prone Slight lumbar lordosis Easily flexed and intact when palpated At least half of back devoid of lanugo Full-term infant in ventral suspension should hold head at 45-degree angle, back straight Alterations/Possible Causes Actual Findings (flag Hypotonia (Down syndrome) Brachial palsy (difficult birth) Erb-Duchenne paralysis Muscle weakness, fractured clavicle Absence of limb or change of size (phocomelia, amelia) Polydactyly (Ellis-Van Creveld syndrome) Syndactyly—one limb (developmental anomaly) Syndactyly—both limbs (genetic component) Simian line on palm (Down syndrome) Short fingers and broad hand (Hurler syndrome) Cyanosis and clubbing (cardiac anomalies) Nails long or yellow stained (postterm) Spina bifida occulta (nevus pilosus) Dermal sinus Myelomeningocele Head lag, limp, floppy trunk (neurologic problems) abnorms) Parameters  Hips Normal Findings No sign of instability (Ortolani’s maneuver) Hips abduct to more than 60 degrees Symmetric inguinal and buttock creases Legs equal in length Legs shorter than arms at birth  Legs  Feet Jaundice  Physiologic  Pathologic Foot is in straight line Positional clubfoot—based on position in utero Fat pads and creases on soles of feet Talipes planus (flat feet) normal under 3 years of age Normal number of toes A harmless condition caused by the normal reduction of RBC’s, occurring 24-48 or more hours after birth, peaking at the 3rd-5th day in term infants, and disappearing between the 7th10th day During the first week of life, bilirubin should not exceed 13 mg/dL Assessed by blanching skin (ie. forehead, nose, sternum) and/or color of sclera Alterations/Possible Causes Actual Findings (flag Sensation of abnormal movement, jerk, or snap of hip dislocation Asymmetry of inguinal and buttock creases (dislocated hips) Shortened leg (dislocated hips) Lack of leg movement (fractures, spinal defects) Talipes equinovarus (true clubfoot) Incomplete sole creases in first 24 hours of life (premature) A potentially serious condition caused by a pathologic condition (ie. ABO or Rh incompatibility) abnorms) Parameters Bowel Movements Normal Findings Meconium (thick, tarry, black or dark green) passed within 824 hours Transitional stools (thinner brown to green) passed for the next day or two Fecal Urine Genitalia  Male Penis Breast-fed (yellow gold, soft, or mushy) Formula-fed (pale yellow, formed, and pasty) Urine clear, pale yellow, inoffensive mild odor First void within first 24 hours First 2 days postnatally, voids 2-6 times/day, then 5-25 times/day after the first 48 hours Following the first void, urine frequently appears cloudy (due to mucus content) Occasionally, pink stains (“brick dust spots”) appear in the urine caused by urates (innocuous) Gender clearly delineated Slender in appearance, about 2.5 cm long, 1 cm wide at birth Normal urinary orifice, urethral meatus at tip of penis Noninflamed urethral opening Foreskin adheres to glans Uncircumcised foreskin tight for 2-3 months Alterations/Possible Causes Actual Findings (flag Clinically seen at birth or within the first 24 hours of postnatal life No bowel movement by 48 hours Hard pellet-like stool (constipation) No void by 24 hours Micropenis (congenital anomaly) Meatal atresia Hypospadias (urethral meatus located on the ventral surface of the penis), epispadias (urethral meatus located on the dorsal surface of the penis) Urethritis (infection) Ulceration of meatal opening abnorms) Parameters Normal Findings Circumcised—without redness, bleeding, or edema Erectile tissue present Scrotum Skin loose and hanging or tight and small; extensive rugae and normal size Normal skin color Scrotal discoloration common in breech Alterations/Possible Causes (infection, inflammation) Phimosis—if still tight after 3 months Large scrotum containing fluid (hydrocele) Red, shiny scrotal skin (orchitis) Minimal rugae, small scrotum Descended by birth; not consistently found in scrotum Testes size 1.5-2cm at birth Testes  Female Mons Clitoris Gender clearly delineated Normal skin color, area pigmented in dark-skinned infants Labia majora cover labia minora in term and postterm newborns; symmetric size appropriate for gestational age Normally large in newborn Edema and bruising in breech birth Urinary meatus and vaginal orifice visible (0.5 cm circumference) Vaginal tag or hymenal tag disappears in a few weeks Discharge; smegma under labia Actual Findings (flag Undescended testes (cryptorchidism) Enlarged testes (tumor) Small testes (Klinefelter syndrome or adrenal hyperplasia) Hematoma, lesions (trauma) Labia minora prominent Hypertrophy (hemaphroditism) Inflammation; erythema and discharge (urethritis) Congenital absence of vagina abnorms) Parameters Vagina Buttock and Anus Cry Laboratory Data  Hematocrit  Hemoglobin  WBC (total)  Blood glucose  Bilirubin  Blood type/Rh  Direct Coombs (DAT)  PKU Normal Findings Alterations/Possible Causes Bloody or mucoid discharge (pseudomenstruation) Foul-smelling discharge (infection) Excessive vaginal bleeding (blood coagulation defect) Buttocks symmetric Anus patent AEB passage of meconium within 24-48 hours after birth No fissures, tears, or skin tags Strong and lusty Moderate tone and pitch Cries vary in length from 3-7 minutes after consoling measures are used Pilonidal dimple Imperforate anus, rectal atresia (congenital gastrointestinal defect) Fissures High pitched, shrill (neurologic disorder, hypoglycemia) Weak or absent (CNS disorder, laryngeal problem) 43%-63% 14-20 g/dL (cord blood) 10,000-30,000/mm3 45-96 mg/dL <6 mg/dL (serum) A,B, AB, O with Rh + or – Determines the presence of maternal Rh positive antibodies in fetal cord blood Blood test to screen for a metabolic disease caused by an autosomal recessive inborn error in the metabolism of the amino acid phenylalanine Feeding  Type Breast Formula with Iron  Frequency and amount On demand Actual Findings (flag abnorms) Parameters Normal Findings Alterations/Possible Causes Actual Findings (flag abnorms)