NEONATAL NEUROLOGIC EXAMINATION

Here is an outline of the neonatal neurologic examination followed by a listing of some reflexes that might be of value in demonstrating intact neurologic function.

 

GENERAL OBSERVATION/BEHAVIOR

 

CRANIAL NERVES

CN II – responds to light

CN III/IV/VI – vestibulo-ocular reflexes intact to cardinal directions of gaze

CN V – rooting reflex intact

CN VII – facial symmetry during crying

CN VIII – responds to sound

CN IX/X/XII – normal sucking

CN XI – sternocleidomastoid movement noted

 

MOTOR

Tone normal in all 4 extremities, no hypotonia, no hypertonia. Spontaneously moves all extremities.

 

REFLEXES

Symmetrical reflexes knee, ankle, biceps, triceps

 

SENSATION

Responds to touch in all 4 limbs

 

 

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PRIMITIVE REFLEXES

Primitive reflexes can be used to evaluate motor function in the neonate.  These are listed below:

 

Fetal position – After 36 weeks the fetus assumes a flexed position.  If the neonate is moved to extension, it will pull back to flexion. This lessons with time and is most present the first 48 hours after birth

 

Pull to sitting -the child will spontaneously open the eyes when pulled to a sitting position (fpnotebook.com)

 

Walking reflex – stand the baby up and he or she will exhibit a walking reflex

 

Rooting reflex – scratch the cheek and the baby will root for a nipple

 

Suckling reflex – front of tongue latches on finger/nipple, back of tingue massages it, pharynx/esophagus pulls on the finger.

 

Fencing reflex – turn head to the side, that arm extends and the opposite arm flexes above the head

 

Moro startle reflex – an abrupt drop causes the arms to outstretch and flex forward.

 

Swimmer’s (Gallant)- hold baby prone, stroke spine on one side, that side will flex

 

Crawling reflex – place baby prone, will try to crawl briefly.

 

Rotation test – hold baby up, rotate to one side, baby will turn head to that side

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