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irregularities. The lungs should expand equally without retractions between the ribs or any crowing, labored respiration. The abdomen is usually protuberant. Although sometimes the edge of the liver or spleen can be felt on careful palpation, there should be no masses or hard tumors in the abdomen. The umbilical cord has three blood vessels—two arteries and a vein. These are best seen when the cord is clamped and cut before drying has occurred.
Careful examination of the genitalia to determine sex and, in case of males the presence of descended testes, is important. Usually there is no difficulty in urination. This spontaneously occurs within minutes to hours after birth. The need for circumcision in male babies remains a subject of controversy among pediatricians. However some decided benefits have been recently demonstrated, especially the lowered risk of urinary infection. Many parents still prefer this minor surgical procedure for hygienic reasons or for continuity of appearance among the male offspring. If so, this should be deferred for several days to allow the newborn to equilibrate from his birth experience and establish the pattern of breast feeding. The Biblical recommendation of circumcising a baby on the eighth day has value from a medical standpoint, in that the clotting ability of blood is usually restored to normal by that day, with the synthesis of Vitamin K in the intestinal tract. Most newborns by the eighth day will have little difficulty with hemorrhage. Aseptic surgical precautions are needed if a circumcision is performed, to prevent infection, The examination of the extremities includes more than counting the fingers and toes. Creases in the thighs should be symmetrical, and leg length should be equal. The hips should be able to rotate outward and inward equally, without a “clicking” sound or obvious asymmetry. Some inward turning of the ankles may be seen, because of the intrauterine position. But any unusual clubfoot deformity should be brought to the attention of a physician.