Newborn examination

Question 1

How do you start the examination?

Answer 1

Exposure of baby - nappy only

Ask mother a few questions

• When was baby born, how baby was born and gestation

Complications of pregnancy / birth

Feeding okay? (passing pee nad black poo?)

Congenital conditions in the family?

Any concerns?

Question 2

What are general observations for the baby?

Answer 2

Skin (jaundice, cyanosis, bruising)

Tone

Sleepiness/rousability

Nature of cry

Measurement weight and length

Check temperature

Question 3

What do you inspect in the head?

Answer 3

Size and shape

Head circumference

Fontanelles

The posterior fontanelle usually closes by age 1 or 2 months. It may already be closed at birth. The anterior fontanelle usually closes sometime between 9 months and 18 months.

Question 4

What do you inspect in the face?

Answer 4

General facial appearance/symmetry/dysmorphological features

Eyes - position, size, symmetry and shape - red reflex and pupillary reflex

Ears - position, size, symmetry and shape - patency of EAM

Mouth - palate and tongue tie

Question 5

How do you inspect upper limbs?

Answer 5

size, symmetry and shape, deformity and movement

Count fingers

Count palmar creases

Question 6

How do you perform cardiovascular examination of the baby?

Answer 6

Femoral, brachial and radial pulses

Radio radial delay

Radio femoral delay

Palpate precordium - heaves and thrills

Auscultate heart - neonatal stethoscope

Question 7

How do you perform respiratory examination of the baby?

Answer 7

LOOK - respiratory pattern and rate of breathing - laboured breathing (nasal breathing / intercostal indrawing

Listen (stridor and grunting)

Auscultate breath sounds and take a respiratory rate (normally 30-60)

Question 8

How do you perform abdominal examination?

Answer 8

Distension

Umbilicus - hernia / inefection

Palpate for organomegaly / masses - and for SPLEEN LIVER AND KIDNEYS

Question 9

How do you check genitalia and anus?

Answer 9

Check anus is patent

Palpate testes in boy - check if undescended

Might be worth checking for hypospadias as well?

Question 10

How do you check the back?

Answer 10

Skin for tufts of hair

Spinal symmetry and curvatures

Palpate spine

Question 11

How do you inspect the lower limbs?

Answer 11

Inspect size, shape symmetry, deformity and movement

Count toes

Barlow’s test

Ortolani’s test

Question 12

How do you check primitive reflexes?

Answer 12

Moro reflex

Grasp reflex

Suckling reflex

Absence suggests CNS pathology (unilateral absence of moro may occur due to brachial plexus pathology

Question 13

How would you conclude the examination

Answer 13

Update parents (any findings? need for review/follow up)
Hip USS if DDH is suspected?

Bloods?

Question 14

Marking Scheme

Answer 14