Examination Of The Newborn

Question 1

Define the neonatal period

Answer 1

Birth to 28 days

Question 2

What are the aims of initial birth examination?

Answer 2

Immediate assessment to assess adjustment from intrauterine to extrauterine life using Apgar scoring system

Complete physical examination to confirm normality and detect deviations from the norm

Reassure the parents that their baby appears normal

Question 3

When should the initial examination take place?

Answer 3

Within the first 72 hours, however to encourage the initiation of breast feeding, separation of mother and baby should be avoided in first hour after birth (NICE), should be performed soon after, in presence of parents

Question 4

Role of midwife

Answer 4

Have knowledge of woman’s antenatal and intrapartum history

Question 5

Procedure

Answer 5

Examination is explained to the parents and informed consent gained
Wash and dry hands, minimise infection risk to baby - gloves worn
Ensure good lighting and good access to baby, in presence of parents
Check baby is warm, maintain temperature and only uncover part of baby being examined
Examine methodically and systematically, beginning with head and face, then neck and clavicles, arms, hands, chest, and abdomen, finally genitalia, legs, feet, spine
Colour tone and activity noted throughout
Passage of urine and meconium
Others obs = head circ, length and weight
Baby dressed/identification ensured
Discuss findings with parents
Document and act accordingly (NMC)

Question 6

The head…

Answer 6

Gently palpate the skull, sutures and anterior and posterior fontanelles, normally open and soft
Skull bones may overlap slightly due to moulding
Caput succedaneum is a swelling caused by pressure during birth and may be visible (swelling may cross suture line)
Cephalhaematoma = bleeding below the skull bone (periosteum), resulting in swelling (does not cross suture line), resolves spontaneously 6-8 weeks
Head circumference measured midway between hairline and eyebrows an d the occupital prominence (back of head) - avg = 34-35cm recorded + plotted
Ears positioned at level of an extended line from inner to outer canthus, cartilage well-developed in term baby

Question 7

The face…

Answer 7

Symmetrical, two eyes, inner and outer canthi should be level, eye opening is called the palpebral fissure and the distance in between inner canthus of the eyes should be length of one palpebral fissure, eyes clear, may be bruised and oedematous due to birth trauma, conjunctival haemorrhage may be seen

Nose vertically in midline, nostrils patent

Colour of lips and membranes pink, check lips tongue and frenulum intact - check for tongue tie

Hard and soft palette intact, sucking and gag reflexes noted

Check roof of mouth intact with pen torch

Question 8

The skin…

Answer 8

Clear, soft & elastic
Vernix caseosa
Centrally pink - check lips
Acrocyanosis, hands and feet slightly blue (cyanosed) usually resolves after 24 hours
Any other cyanosis other than acrocyanosis or jaundice in the first few hours of birth always needs referral/escalation to senior medical review and investigation

Question 9

Posture and movement…

Answer 9

Attitude of flexion, limbs equal in length, 5 separated fingers and toes, nails formed and creases on hand palm and soles of feet, all libs symmetrical when move and good muscle tone, feet should be straight, in neutral position with good range of movements, normal reflexes

Question 10

The chest and abdomen…

Answer 10

Chest equal and breast and nippy tissue developed in a term baby, clavicles observed and palpated for fractures (during birth), normal respirations 40-60bpm, HR 110-160bpm (NICE), temp taken in axilla using thermometer, temp = 36.5-37.5

Question 11

Genetalia…

Answer 11

Male: check normal urethral opening and passage of urine, both testes descended in normal scrotal sac

Female: normal appearance with labia majors slightly oedematous, signs of vaginal skin tags or over large clitoris

Position and patience of anus confirmed, even after meconium

Normally passes meconium and urine within 24 hours

Question 12

The spine…

Answer 12

Spine flat and vertebral column straight, skin clear - no sacral dimples, tufts of hair, blue spots = normal in some ethnic groups

Question 13

Role and responsibility

Answer 13

Being able to competently assess the baby at birth, using Apgar score, understanding the significance of the score (NICE)

Undertaking birth examination thoroughly and competently referring as necessary (NMC)

Contemporaneous record keeping (NMC)

Question 14

When should APGAR score be recorded?

Answer 14

1 and 5 minutes after birth (NICE)

Question 15

What is the APGAR score for?

Answer 15

To assess condition of baby at birth, baby is given a score for each sign which are added together to give a score out of 10 @ 1 5 + 10 minutes

Question 16

If baby is born in poor condition (APGAR less than 5) then what actions should be taken?

Answer 16

Record time to regular breathing

Take cord blood gasses

Record Apgar at intervals until condition stable (NICE)

Question 17

What signs are we looking for for APGAR?

Answer 17

Heart rate
Respiration rate
Reflexes
Muscle tone 
Colour