1. Blackburn, Susan PhD, RN, FAAN

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This column is part of an ongoing series on selected Internet resources that are useful for clinical practice or teaching. The Web sites discussed in this column are resources for health assessment or management of several neonatal problems. These recommended Web sites include a newborn assessment findings' photo gallery, 2 examples of Web sites for congenital cardiac defects, the New Ballard Score Web site, and the BiliTool.


A gallery of newborn physical assessment findings can be found at http://newborns.stanford.eduRNMDEducation.html. This Web site is from Stanford University and includes photographs from a systemic head to examination of a newborn, including normal findings, common variations, and abnormal findings with explanatory paragraphs for each system. An index is included so the viewer can easily search for specific findings of interest. Normal heart and lung sounds at several locations on the chest in a newborn can also be heard on this Web site ( Another Web site that includes an opportunity to listen to heart sounds, although these are all from adults, is The Cardiac Exam: Auscultation from Case Western Reserve University School of Medicine at This Web site contains recordings of heart sounds including normal heart sounds, systolic and diastolic murmurs, and other abnormal findings. A similar although less extensive Web site, also with primarily adult heart sounds, is the Auscultation Assistant from University of California, Los Angeles (


Many Web sites provide information and resources about congenital heart defects for both patients/families and professionals. Two examples of these are the Web sites from the Children's Hospital Boston and Cincinnati Children's Hospital. The Children's Hospital Boston Cardiovascular Program Multimedia Library ( is a searchable library of resource for the major congenital cardiac problems. These resources include examples of electrocardiograms, echocardiograms, x-rays, pathology, cardiac catheterization images, and pathology findings. The Cincinnati Children's Hospital Heart Institute Encyclopedia can be found at This Web site is a resource for patients, families, and healthcare professionals, which includes flash diagrams of different defects (comparing blood flow in a heart with the specific defect with that of a normal heart), in addition to explanations about clinical findings, diagnostic tests and treatments (including diagrams of surgical procedures) for congenital heart defects, and other cardiac problems.


The New Ballard Score Web site ( was developed by Dr Jeanne L. Ballard and is an excellent resource on gestational age assessment, focusing on the items included on the New Ballard Score. Each of the physical findings and neuromuscular parameters and maneuvers in the assessment is described in detail in a monograph on the Web site. In addition, each parameter is illustrated by video clips showing characteristic findings for examination for each scoring option using infants across the gestational age range from very premature to postterm.


The BiliTool ( is an online tool based on the American Academy of Pediatrics guidelines for the management of hyperbilirubinemia in infants of 35 weeks' gestation or more.1 This tool is a reference aid designed to assist clinicians assess the risks for development of hyperbilirubinemia in newborns who meet this criteria (ie, 35 weeks' gestation or more) and not for more premature infants. The tool can be accessed online or downloaded for use on several devices as a Web application. The clinician enters the date and time of birth to closest hour, date and time of blood sampling to closest hour (from 18 to 168 hours), and the total bilirubin (in either mg/dL or [mu]mol/L) or the infant's age in hours and total bilirubin. The tool then calculates risk zone from nomogram2 and recommended management on the basis of American Academy of Pediatrics guidelines1 that the clinicians can use in conjunction with their assessment of the infant.


Susan Blackburn, PhD, RN, FAAN


Professor Department of Family and Child Nursing University of Washington, Seattle




1. American Academy of Pediatrics, Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316. [Context Link]


2. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103:6-14. [Context Link]