Medri Vodcast: Neonatology

Keep the baby upright and allow the soles of the feet to touch the surface of the table. Move the baby forward to accompany any stepping. Alternating stepping movements with both legs will occur. This response depends on arousal of the baby but it’s continuous absence can indicate paresis or be present in babies born by breech delivery.

With the baby in the supine position, turn the head to one side, holding the jaw over the shoulder. The arm and leg on the side to which the head is turned extend, while the opposite arm and leg flex. This response does not normally occur each time this maneuver is performed, and when it is elicted each time it is evoked it should be considered abnormal, at any age. It will persist beyond the time of expected disappearance in major cerebral damage.

The sucking reflex is common to all mammals and is linked with the rooting reflex and breastfeeding. It causes the child to instinctively suck at anything that touches the roof of their mouth. You can test this reflex with a pacifier, baby’s finger or your finger.

With the baby’s head positioned in the midline and hands held against the anterior chest, stroke with your finger the perioral skin at the corners of the baby’s mouth and the midline of the upper and lower lip. In response, the mouth will open and turn to the stimulated side. This response will also occur with stimulation of the infant’s cheek at some distance from the corners of the mouth. Absence of this reflex indicates severe generalized or central nervous system disease

Starting in the supine position, the baby is pulled by the arms to the sitting position. The head and the arms are observed during the maneuver. The arms should remain partially flexed at the elbow and the head may lag behind the trunk. When the baby is in the sitting position, the head should be able to come to the upright position for at least a few seconds before dropping forward or backward. Watch the sternocleidomastoid muscles which should bilaterally anticipate the pull to sit; the head flexes for a moment before head lag occurs.

Moro response can be produced in several different ways. Hold the baby in supine position, supporting the back and pelvis with one hand and arm and the head with the other hand, and allowing the head to drop several centimeters with a sudden, rapid, not too forceful movement. You can also invoke it by producing a sudden loud noise (for example striking the examining table with the palms of your hands on either side of the baby’s head), or by any other mechanical stimulation, as shown in the video. The normal baby throws out both arms quickly with symmetical abduction and spreads the fingers. This is often followed by jerky adduction of the arms as though the hands were reaching for an unseen security. An absent or incomplete Moro is seen in upper motor neuron lesions. An asymmetrical Moro response may be due to a previously unsuspected fracture of the clavicle or Erb’s palsy.

With the baby in the supine position, apply light pressure with the thumb to the sole of the foot producing flexion of the leg. The baby pushes back against the pressure, so the examiner gets the sensation that his thumb is drawing the limb out as by a magnet. The absence of the magnet reflex can indicate spinal cord damage.

Stimulate the palm of the baby’s hands and observe the reflex grasping of your finger. Stroke the sole of the foot, and the toes will flex and curl around your examining finger. Make sure that the response is not inhibited by unintended stimulation of the dorsal aspect of feet and hands. Persistence of the palmar grasp reflex beyond 6 months suggests cerebral dysfunction. It should be noted that babies normally hold their hands clenched during the first month of life. Persistence of the fisted hand beyond 2 months also suggests central nervous system damage.

Hold the baby horizontally and prone in one of your hands. Stimulate one side of the baby’s back approximately 1 cm from the midline along a paravertebral line extending from shoulder to the buttocks. This produces a curving of the trunk toward the stimulated side, with shoulders and pelvis moving in that direction. Pelvic response to stimulation of the back and flanks should be symmetrical. This reflex is absent in transverse spinal cord lesions or injuries.

Crawling reflex can be stimulated by placing the neonate prone on a flat surface. The neonate will attempt to crawl forward when the sole of his feet are touched. Voluntary crawling begins around 7 months.

The findings during the neurological examination in infancy, especially in the newborn period, differ markedly from those present in children and adults. There are number of specific reflex activities so called infantile automatisms, found in the normal newborn that disappear in early infancy. Reflexes are an involuntary muscle reactions to a certain type of stimulation and their absence in the neonate, or the persistence of some beyond their expected time of disappearance may indicate severe central nervous system dysfunctions.