Neonatal Examination

Question 1

When is this done?

Answer 1

At birth

6 weeks

Question 2

Equipment needed

Answer 2

Measuring tape
Ophthalmoscope
SATS probe
Full details of pregnancy and birth

Question 3

Observation

Answer 3

Colour: Pink/red, pale, jaundiced 
Any rash?
Behaviour and mood 
Movements 
Face: dysmorphism

Question 4

Head - what you look for and what you can find

Fontanelle
Measure ....?
Eyes 
Palate 
Ears 
Nose
Complexion 
Mouth

Answer 4

Feel fontanelle (bulging=raised intracranial pressure/ sunken?) and suturres

Measure circumference at widest point - looking for hydrocephalus and microcephaly

Check red reflex with opthalmoscope
Conjuctivitis

Feel inside top of mouth with little finger for cleft palate - also get sucking relfex

Shape
Check if they are low-set - below eye level
Tags or lumps
Check behind the ears
Ensure oto-acoustic screening has been done

Are they breathing out of the nose - shut the mouth and testing for choanal atresia

cyanosed, pale, jaundiced

Look inside - insert finger - is the palate intact
Is suck good

Question 5

Arms and hands

Answer 5

Single palmer creases - normal or trisomy 21
Does this baby look like the parents
Walter tip sign in Erbs palsy
Number of fingers
Clinodactyly - normal or trisomy 21
Check grasp reflex
Apply SATS probe on foot to check heart disease
Check for developmental dysplasia of the hips - are they dislocated
Check for clubbed foot i.e. internally rotated

Question 6

Chest and abdomen

Answer 6

Auscultate for air entry and murmurs
Palpate abdomen, including organomegaly
A palpable liver is normal
Note any discharge or erythema around the umbilicus

Question 7

Pelvis - what you’d look for and what they could indicate

Answer 7

Remove nappy
Palpate femoral pulses on both sides - absense may suggest coarcutation
CHeck genitatia are normal - feel testicles are descended in boys
Look for position of anus, ensuring it is not too far forward or is imperforate

Question 8

Back

Answer 8

Is spine straight
Marks at the base of spine - tuft of hair, meningocoele suggest spina bifida
Check for birthmarsk and skin lesions as new ones should bring some suspicion
Assess tone of baby when help up in ventral suspension
Moro reflex - drop back quickly and check for arm extension

Question 9

Things to ask about at 6 weeks

Answer 9

Feeding
Weight
Growth
Thriving - smiling