Because of in utero positioning, facial asymmetry may be present. Facial nerve palsy should be suspected when there is asymmetry of the nasolabial folds and the creases around the eyes when the baby cries. The eyes should open symmetrically. Pupils should be equal and react to light, and the fundi should be visualized. If a red reflex is obtained on ophthalmoscopic examination, lenticular opacities can be excluded.
Scleral hemorrhages are common.
The ear canals should be patent and the tympanic membranes visible. Although inexpensive portable devices can test the newborn's hearing, their reliability and validity have not been demonstrated for general screening purposes. The infant's ability to suck should also be evaluated. Ten percent of all newborns have anomalies or findings that require close monitoring during the first few days of life, including abnormal shape, size, or position of the kidneys or other organs. Normally, the liver is felt 1 to 2 cm below the costal margin, and the spleen tip is easily palpated.