NEONATAL EXAMINATION

Question 1

What equipment is required for a neonatal examination?

Answer 1

Neonatal stethoscope

Ophthalmoscope

Neonatal sats monitor

Question 2

You have been asked to perform a neonatal examination on a baby that was born last night. The mother comes into the room carrying her baby. How should you start the examination?

Answer 2

Introduce yourself

Gain consent

Check mothers and babies names

Congratulate the mother on the birth

Question 3

Having introduced yourself, gained consent and washed your hands, how would you proceed with examining a neonate?

Answer 3

Expose - you will need to strip the baby down to his or her nappy. You may want to ask the mother to do this.

Question 4

What questions do you want to ask the mother before examining her newborn?

Answer 4

How was the birth?

Was he/she born vaginally or by caesarean section?

Were forceps or a ventouse used?

Did your baby need any help after birth with breathing?

How are you feeding your baby? Breast or bottle?

If breast, how is it going/baby latching ok, etc?

If bottle, which milk are you giving your baby/is baby taking bottles ok, etc?

Are there any conditions that run in you or dad’s family e.g. congenital heart problems?

Has anyone in your family (especially females) had problems with their hips at birth?

Has your baby passed its sticky black stool yet?

Question 5

On general inspection of a newborn in a neonatal examination what might you observe?

Answer 5

Does it look and behave “normally”, i.e. colour e.g. jaundice, activity and posture.

Is there any obvious bruising or marks from birth?

Strawberry naevi

Stork marks

Mongolian blue spot.

Symmetry of face

Remember to turn the baby over and inspect its back too.

Question 6

Having generally inspected a newborn as part of a neonatal examination, what would you do next?

Answer 6

Feel the fontanelles - they should be soft. Are they sunken or bulging?

Question 7

Having assessed the fontanelles as part of a neonatal examination, what would you do next?

Answer 7

Measure the circumference of the baby’s head

Question 8

Having assessed the fontanelles and measured the circumference of the baby’s head, what do yo then do as part of the neonatal examination?

Answer 8

If the baby has its eyes open check the red reflex using the ophthalmoscope

Question 9

What might an absent red reflex in a neonate suggest?

Answer 9

Congenital cataract

Retinoblastoma

Question 10

Having checked for a newborn’s red reflex as part of a neonatal examination, what would you do next?

Answer 10

Assess the limbs:

Clavicles (these can be injured during birth if shoulder dystocia occurs)

Both arms (e.g. Erb’s palsy) down to legs and feet.

Open up the baby’s hand and look at the palm for normal palmar creases, count the fingers on each hand.

Look at the feet, is there any signs of a sandal gap or talipes and count the toes on each foot.

Question 11

Having checked a newborn’s fontanelles, red reflex and limbs what would you then do as part of a neonatal examination?

Answer 11

Auscultate the heart and lungs

Question 12

What is the normal heart rate of a neonate?

Answer 12

120-150

Question 13

As well as rate, what else might you be looking for when you auscultate the heart of a neonate?

Answer 13

Murmurs and where they radiate too

Question 14

What is the normal respiratory rate of a newborn?

Answer 14

30 - 60

Question 15

As the resp rate, what else might you be looking for when you auscultate the lungs of a neonate?

Answer 15

Additional sounds such as stridor or grunting

Question 16

What would you specifically look for on the abdomen of a neonate when examining for the first time?

Answer 16

Umbilical stump/clamp to ensure no signs of infection.

Question 17

What would you specifically look for on the back of a neonate when examining them for the first time?

Answer 17

Sacral dimpling - neural tube defect

Question 18

Having assessed the baby’s head, limbs, abdomen and back, what must you then assess?

Answer 18

Undo the baby’s nappy to look for any obvious genital abnormalities.

It its a male you should palpate both the testes and make a note if you can’t.

Question 19

You are performing a neonatal examination and have undone the baby’s nappy and examined the external genitalia. What should then do before doing up the nappy?

Answer 19

Test the hips for developmental dysplasia of the hips using Barlow and then Ortolani test.

Question 20

How is Barlow test for development dysplasia of the hip performed?

Answer 20

Flex knees and hips to 90˚

Line up legs in parallel to each other in line with shoulders

Apply backward pressure to each knee in turn.

A subluxable hip is suspected on the basis of palpable partial or complete displacement using your finger.

Question 21

Having performed Barlow’s test for developmental dysplasia of the hip, why do we then perform Ortolani’s test?

Answer 21

Used to confirm Barlow findings to check that hip is actually dislocated

Question 22

How do you perform Ortolani manoeuvre?

Answer 22

Flex knee and hips to 90˚

Line up legs in parallel to each other in line with shoulders

Abduct hip whilst applying anterior pressure on the thigh to relocated the hip.

A relocating hip will be felt with your finger on the joint.

Question 23

What are the primitive reflexes that you could look for when assessing a neonate?

Answer 23

Moro - remember to explain to mum before performing this

Sucking

Grasping

Walking/stepping

Rooting reflex

Babinski sign

Question 24

How do you finish off a neonatal examination?

Answer 24

Note everything in the red book

Thank the mother

Offer to redress the baby