Clinical Examination

  • Avroy A. Fanaroff
  • Jonathan M. Fanaroff
  1. I.
    Normal physical findings
    1. A.
      Respiratory rate 40–60/min.
      1. 1.

        Irregular with pauses ≤5 s in REM sleep

      2. 2.

        Regular in non-REM sleep, rate 5–10 breaths/min slower than in REM sleep or when awake

      3. 3.

        Comfortable (no dyspnea)

      4. 4.

        No chest retractions (subcostal or intercostal)

      5. 5.

        No flaring of nostrils

      6. 6.

        No grunting

    2. B.
      Pulse rate 120–160 beats/min (but may go as low as 80 during sleep).
      1. 1.

        Sinus arrhythmia rare in the newborn.

      2. 2.
        Pulses easy to feel.
        1. a.

          Femoral pulses may be decreased in the first 48 h.

        2. b.

          Femoral pulses may be impalpable, reduced or delayed with coarctation of the aorta. In any infant with suspected heart disease, blood pressure should be measured in all four limbs. A difference of >15 mmHg between the upper (higher) and lower extremities is significant.

        3. c.

          Bounding pulses are characteristic of a patent ductus arteriosus.

      3. 3.
        Interpreting the heart rate is best done in conjunction with the respiratory rate and oxygen saturation.
        1. a.

          Episodes of...


Patent Ductus Arteriosus Esophageal Atresia Congenital Diaphragmatic Hernia Tension Pneumothorax Capillary Refill Time 
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Suggested Reading

  1. Arlettaz R, Archer N, Wilkinson AR. Natural history of innocent heart murmurs in newborn babies: controlled echocardiographic study. Arch Dis Child Fetal Neonatal Ed. 1998;78:F166–70.PubMedCrossRefGoogle Scholar
  2. Barrington K. Neonatal screening for life threatening congenital heart disease. BMJ. 2009;338:a2663.PubMedCrossRefGoogle Scholar
  3. Frommelt MA. Differential diagnosis and approach to a heart murmur in term infants. Pediatr Clin North Am. 2004;51:1023–32.PubMedCrossRefGoogle Scholar
  4. Greenough A, Greenall F. Observation of spontaneous respiratory interaction with artificial ventilation. Arch Dis Child. 1988;63:168–71.PubMedCrossRefGoogle Scholar
  5. Yi MS, Kimball TR, Tsevat J, Mrus JM, Kotagal UR. Evaluation of heart murmurs in children: cost-effectiveness and practical implications. J Pediatr. 2002;141:504–11.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of PediatricsRainbow Babies and Children’s HospitalClevelandUSA
  2. 2.Division of Neonatology, Department of PediatricsRainbow Babies & Children’s HospitalClevelandUSA

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