Features of a healthy newborn

Question 1

What are the transitions to extra uterine?

Answer 1

airway
apgar score
onset of respiration
circulatory adaptation
thermal adaptation

Question 2

What is in the first examination of the newborn?

Answer 2

general appearance
colour
inspection of:
the head including fontanelles and suture
the face including eyes, ears, nose and mouth
the neck
the chest and abdomen
the spine
the genitalia
the anus
limbs with hands and feet
identification of birthmarks and birth injuries

Question 3

What do you look for in general appearance?

Answer 3

Normal term baby weight is around 3.5kg
average length is 50cm
most babies appear plump and have a prominent abdomen

Question 4

What would you expect with sleeping and waking?

Answer 4

from birth the baby appears alert for about 1 hour then relaxes and sleeps
sleeping and waking rhythms take time to settle
initially waking periods are related to hunger but within a week the waking periods last longer and meet the need for social interaction

Question 5

What do you expect with crying?

Answer 5

the cry of a baby distinguishes different needs and its the way they communicate
it is possible to identify which may be hunger, thirst, pain general discomfort
maternal anxiety and difficulties relating to crying can be improved with info and support from the midwife

Question 6

Describe the 2 sleep state

Answer 6

deep sleep- hard to awake, eyes closed, some jerky makeup

light sleep- drowsy; eyes closed, may be sucking

Question 7

describe the awake state

Answer 7

drowsy or semi dozing
quiet alert
active alert 
crying
be aware of feeding cues

Question 8

what should the eyes look like?

Answer 8

eyes should be visualised and check the lens is clear

Question 9

What should the nose look like?

Answer 9

babies are nasal breathers

the nose id often squashed in utero or it may not be completely patent

Question 10

What should the mouth look like?

Answer 10

A clean finger should be inserted to check cleft palates. tongue/ tongue tie, neonatal teeth. Lips and muscous membranes should be pink and well perfused

Question 11

what does babies vision be like?

Answer 11

babies are sensitive to bright lights they may frown or blink
can recognise a human face at a distance of 15-20cm
can establish
eye contact with the mother which establishes bonding
can track a moving object by 5 days and from 2 weeks can differentiate mothers face from a strangers
no tears are present in newborns therefore they can become infected easily

Question 12

What should ears look like?

Answer 12

inspected noting their size, shape, position, abnormalities for example skin tags or dimples
ear abnormalities can be associated with chromosomal anomalies and syndromes and should be reported to neonatal staff

Question 13

What should a new born babies hearing be like?

Answer 13

new born babies eyes turn towards sound
can discriminate between voices, giving preference to their mothers
neonatal screening is performed on all babies usually within 4-6 weeks to identify early and follow up any baby with hearing impairments

Question 14

What should a babies smell and taste be like?

Answer 14

babies will prefer the smell of milk to other things and will prefer breastmilk
turn away from unpleasant smells
nasal flaring can be indicative of respiratory destress sneezing can be common

Question 15

What should the chest and abdomen be like?

Answer 15

chest and abdomen movements should be in sync
respirations may still be irregular 30-40 bpm
auditory assessment of breathing
abdomen should be rounding
haemostasis of the umbilical cord is vital and secured by a plastic clamp

Question 16

What should the spine be like?

Answer 16

best examined by lying the baby face down with its abdomen and chest in the palm of one hand
The back should be visualised and palpated, Any abnormality of the skin, for example swelling, tuft if hair, birthmarks should be noted
any sacral dimple should be closed

Question 17

What should the genitalia and anus be like?

Answer 17

Should be examined carefully for completeness and patency
Check patency of anus and whether the baby has based meconium. usually within the first 24 hours of birth. should pass urine in the first 24 hours initially 20-30mls per day rising to 100-200ml daily as fluid intake increases.

Question 18

What should meconium be like?

Answer 18

soft, greenish black substance accumulated in the intestine from approx 16th week of intrauterine life consisting of epithelial cells, swallowed amniotic fluid, fatty acids and bile pigment .
First stool passed within 48 years. As food is digested, the stool changes colour to a greenish brown, indicating that the gI tract is patent
5th day onwards the stool becomes yellow

Question 19

How does meconium changes with breastfed babies?

Answer 19

soft, bright yellow, inoffensive stools. May pass five or more times a day as a lactation is establishing
After 3-4 weeks, may only pass one soft yellow stools every 2-3 days as there are few waste products from breastmilk

Question 20

How does meconium changes with formula fed babies?

Answer 20

Paler, more formed stools with slightly offensive odour

More regular stool when feeding is established, although constipation is more likely

Question 21

What should the limbs and digits be like?

Answer 21

note length and movement of limbs
digits should be counted and separated to ensure no webbing or extra digits
the axillae, elbows, groin should also be inspected for abnormalities
Feet and toes and checked for extra digits and any deformity such as talipes equinovarus

Question 22

What should a babies sense of touch be like?

Answer 22

Babies are sensitive to touch
skin to skin contact immersion in water
stroking, cuddling and rocking movements
grasp relex enhances bonding

Question 23

Why are length and weight measured?

Answer 23

to provide parameters against which future growth can be monitored

Question 24

Describe vitamin K

Answer 24

In the UK it is advised that all babies should be given vitamin K as free circulating vitamin K is low after birth and rises gradually after 3-4 days
Vitamin K deficiency bleeding (VKDB) is a bleeding tendency that results from a lack of vitamin K that leads to reduced clotting factors and resultant bleeding.
Vitamin K is poorly transferred through the placenta and naturally low in breastmilk

NICE guidelines recommends 1mg

Question 25

Reflexes

Answer 25

Moro
rooting
sucking and swallowing
grasp
walking and stepping
crawling
Babinski

Question 26

What happens following the check?

Answer 26

Explain finding to parents
documentation
record your findings in the baby’s case notes and any abnormalities are referred to the neonatal team

Question 27

Identification and security in clinical setting

Answer 27

Identify name tags x2
baby in the cot when travelling
security cameras
visitor restrictions
staff ID badges

Question 28

What is checked in the daily examination of the baby?

Answer 28

hospital or home
general appearance
colour
activity and tone
eyes
mouth
cord
skin' jaundice
feeding
urinary output
stools
sleeping pattern

Question 29

What body systems is activity, behaviour, cry and tone checking?

Answer 29

respiratory
cardiovascular
skeletal-muscular
neurological

Question 30

What body system is colour and temp assessing?

Answer 30

Respiratory
Cardiovascular and blood physiology
metabolic
immunological

Question 31

What body system is urinary output assessing?

Answer 31

renal

immunological

Question 32

What body system is feeding and stool assessing?

Answer 32

gastrointestinal

immunological

Question 33

What body system is skin integrity/ rashes/ spots assessing?

Answer 33

immunological

Question 34

skin care

Answer 34

vernix caseosa should be left to absorb as an antibacterial and anti-fungal skin barrier
skin is an important role in temp regulation, barrier to infection, balances electrolytes and stores fat
baby products along with exposure to urine or faeces could disrupt the protective barrier

Question 35

advice to parents

Answer 35

breastfeeding
nappy changes
bathing
reducing the risk of cot death/ SIDS
safety in the home
importance of seeking early medical advice if the baby becomes unwell

Question 36

When is the full systematic physical examination of the newborn offered?

Answer 36

with 6-72 hours after birth and again at 6-8 weeks of age

includes examination of the hips and listening for heart murmurs