Overview
Clinical Frame
At the first newborn examination, the perineum often answers the most urgent question: is there a patent anal opening, and is it in the expected location?
At the first newborn examination, the perineum often answers the most urgent question: is there a patent anal opening, and is it in the expected location? Anorectal malformation (ARM) is a congenital defect in which the anus or distal rectum is absent, narrowed, misplaced, or connected to another structure through a fistula. The term *imperforate anus* describes only part of this spectrum. ARM occurs in approximately 1 in 4,000 live births in Canada. A newborn with no visible anus, a tense or enlarging abdomen, and green emesis is not simply a baby who is late passing stool. The combination suggests a structural obstruction until pediatric surgery has assessed the anatomy. The immediate nursing response is to protect the airway, withhold feeds when obstruction is suspected or NPO is ordered, avoid rectal instrumentation, and escalate promptly.