Newborn Period And Infancy

The neurologic screening examination of all newborns should include assessment of mental status, gross and fine motor function, tone, cry, deep tendon reflexes, and primitive reflexes. More detailed examination of cranial nerve function, sensory function, and less common primitive reflexes are indicated if you suspect any abnormalities from the history or screening. The neurologic examination can reveal extensive disease but will not pinpoint specific functional deficits or minute lesions.

Assess the mental status of newborns by observing many of the newborn activities discussed on pp. 644-645 ("What newborns can do"). Make sure you test the newborn during alert periods, and, if possible, return at a later time if the baby is transiently too drowsy.

Assess the motor tone of newborns and infants, first by carefully watching their position at rest and testing their resistance to passive movement.

Persistent irritability in the newborn may be a sign of neurologic insult, or may reflect a variety of metabolic, infectious, or other constitutional abnormalities, or environmental conditions such as drug withdrawal.

Then assess tone as you move each major joint through its range of motion, noting any spasticity or flaccidity. Hold the baby in your hands, as shown

Newborns with hypotonia often lie in a frog-leg position, with arms below, to determine if the tone is normal, increased, or decreased. Either increased or decreased tone may indicate intracranial disease, although such disease is usually accompanied by a number of other signs.

flexed and hands near the ears. Hypotonia can be caused by a variety of central nervous system abnormalities and disorders of the motor unit.

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