Examination of the newborn

Question 1

What should you do in the introduction?

Answer 1

Introduce self, check patient details, explain procedure, gain consent, wash hands
Encourage parents to voice concerns and ask questions
Ask parents to undress the child

Question 2

What questions should you ask?

Answer 2

Ask about the pregnancy (date/time, complications, delivery, birthweight, gestational age)
Ask about risk factors for neonatal infection
Family history of congenital problems
Newborn feeding, passing meconium
Any concerns?

Question 3

What should you examine on general inspection?

Answer 3

Colour, posture, tone (gently move limbs/inspect when picked up)
Inspect skin

Question 4

What examinations should you perform on the head?

Answer 4

Measure head circumference
Inspect head and cranial sutures
Palpate anterior fontanelle

Question 5

What examinations should you perform on the head and neck (including eyes and ears, mouth)

Answer 5

General inspection of face, eyes, ears, neck
Inspect sclera by retracting the lower eyelid
Red reflex
Inspect palate (use torch)

Question 6

What examinations should you perform on the upper limbs?

Answer 6

Inspect limbs, fingers, palms
Test grip
Palpate brachial pulses (good time for RR)

Question 7

What examinations should you perform on the chest?

Answer 7

Inspect
Auscultate lungs
Auscultate heart

Question 8

What examinations should you perform on the abdomen?

Answer 8

Inspect

Palpate for liver, spleen, kidneys, bladder

Question 9

What examinations should you perform on the genitalia?

Answer 9

Inspect genitalia and anus

Question 10

What examinations should you perform on the lower limbs?

Answer 10

Inspection
Palpate femoral pulses
Muscle tone
Oedema

Question 11

What examinations should you perform on the hips?

Answer 11

Barlow's= Adduct hip whilst pressing down on hip and knee
Ortolani's= Flex hips and knees to 90 degrees. Abduct hips whilst placing anterior pressure on greater trochanter

Question 12

Back and spine?

Answer 12

Inspect

Question 13

What reflexes should you test?

Answer 13

Palmar grasp- place object in palm and stroke
Rooting- touch cheek
Stepping- Touch soles on flat surface
Moro- Tilt them backwards while supported

Question 14

How do you weight and measure them?

Answer 14

Using baby scales, zero with a soft warm blanket on them

Use a special measuring cradle, with feet held in neutral position

Question 15

What does the APGAR score stand for?

Answer 15

Appearance (pale, blue, pink)
Pulse (Absent, below 100, above 100)
Grimace (Absent, grimace, cry)
Activity (Limp, tone, normal)
Respiration (Absent, irregular, regular)

Question 16

What parts of the body do you inspect? What are the extra tests?

Answer 16

Inspect: General, head, skin, face, eyes, ears, palate, neck, upper limbs, chest, abdomen, genitalia, lower limbs, back and spine
Special tests:
1) Tone- gently move legs
2) Head- measure circumference and palpate fontanelle
3) Eyes- inspect sclera, red reflex
4) Palate- use finger and torch to view
5) Upper limb- test grip, palpate brachial pulse
6) Chest- Auscultate lungs and heart
7) Abdomen- Palpate for liver, spleen, kidneys, bladder
8) Lower limbs- Palpate femoral pulses
9) Hips- Barlow’s and Ortalani’s tests
10) Reflexes
11) Weigh and measure