Newborn examination

Question 1

Questions to ask before?

Answer 1

Antenatal - any abnormalities on antenatal scans or screening and complications?

Delivery - mode, gestation, complications? - were they breech?

Risk factors for infection - history of Group B strep, intrapartum sepsis

FH - of any congenital heart defects, hip problems, congenital cataracts or eye problems

Weight of the baby? How feeding?

Passed meconium?

Question 2

Approach to examination

Answer 2

General inspection
Head
Eyes and ears
Mouth
Neck
Shoulders, arm and hands 
Heart and chest
Abdomen
Genitalia and anus
Hips, legs and feet

Question 3

General inspection and examination

Answer 3

Colour - jaundice, cyanosis
Assess tone
Moro reflex (do with tone)

Question 4

Head

Answer 4

Inspect and feel fontanelles
Inspect for any swellings - do these cross suture lines?
Measure head circumference

Face:
Inspect the features of the face - any abnormal?
Assess rooting reflex

Question 5

Eyes and ears

Answer 5

Eyes:
- Look for red reflex in both eyes

Ears:

• Assess whether they are normally set
• Assess patency

Question 6

Mouth

Answer 6

Look for cyanosis
Look for cleft lip/palate
Suckling reflex

Question 7

Shoulders, arm and hands

Answer 7

shoulder - assess for clavicle fracture

Arm - any erb’s palsy? Brachial pulse

Hands - 10 fingers, single palmar crease? webbed fingers?

Question 8

Heart and chest

Answer 8

Heart:

• Feel apex beat
• Auscultate the heart for rate and any murmurs

Chest:

• Count RR
• Signs of respiratory distress
• Auscultate the chest?
• Listen for abnormal breathing sounds e.g. grunting, stridor

Question 9

Abdomen

Answer 9

Palpate for masses - any hernias?

Check umbilical stump (2 arteries and a vein, any infection?)

Question 10

Genitalia and anus

Answer 10

Ask consent again
Male - check for hypospadias, testes descended
Female - ensure labia aren’t fused

Palpate for any inguinal hernias and palpate femoral pulse

Anus - check patency

Question 11

Hips, legs and feet

Answer 11

Hips - Barlow’s and Ortolani’s tests

Legs - femoral pulse if not done already, any malformations (valgus, varus)
- Also can check stepping reflex

Feet:

• Sandal gap?
• 10 toes?
• Talipes? (club foot)