Newborn examination

Question 1

What and why?

Answer 1

• Within 1st week of life (within 24hrs)
• Rpt week 6-8 by GP
• Screening tool to identify any asymmtomatic problems
• Offers parental reassurance and health education

Question 2

Order of examination

Answer 2

1. Prepare
2. Head
3. Chest
4. Abdomen
5. Hips, Limbs and back
6. Reflexes
7. Conclude

Question 3

Pre-exam checklist

Answer 3

• Establish if baby has name - use this throughout
• Inspect baby and maternal notes (antenatal, birthing (APGAR), birth history - gestation and mode of delivery, take note of birthweight
• Go over history with parents
• Maternal PMH - antenatal scans and bloods, family history, social history (child protection?)
• Feeding - any concerns? issues? passed meconium? urine?

Question 4

Prepare and inspect stage

Answer 4

• Ensure baby is fully stripped, settled and assistance is ready (another HCP)
• Ideally complete exam while baby is quiet and settled, if baby becomes unsettled, come back and complete it - opportunistic
• Wash hands, intro and consent

Question 5

Inspect

Answer 5

• Top to toe
• General state
• Posture
• Movements
• Colour, skin marks - jaundice?
• Dysmorphic features

Question 6

Head

Answer 6

• Shape of head - obvious unusual?
• Measure and plot occipitofrontal circumference - biggest of 3 readings
• Palpate suture lines and fontanelles
• Look at eyes usuing ophtalmoscope try to illict red reflex - excludes con cataracts and retinoblastoma
• Nose and mouth - cleft lip/palate? Suck relfex - gloved finger inside babys mouth?
• Size positon and shape of ears, patent EAM?

Question 7

Chest

Answer 7

• Look at neck
• Feel clavicles to ensure there is no fracture which can occur during delivery
• Chest shape and movement
• Listen for heart sounds and murmurs
• Air entry bilaterally
• HR and RR
• Peripheral saturations - post ductally probe on foot

Question 8

Abdomen

Answer 8

• Inspect - shape, distension, movements with resp, observe umbilicus
• Palpate for masses and inguinal or umbilical hernias,
• Auscultate - bowel sounds
• Groin - femoral pulse (coarctation or critical aortic stenosis), hernia
• External genitalia - 2 testes?perineum and anus (position and patency)

Question 9

Hips, limbs and back

Answer 9

• Movement of all four limbs - symmetrical?
• Count digits on hands and feet
• Check palms for single palmar crease
• Grasp reflex by finger in palm
• Examine hips - dysplasia? Barlow (first) and then Ortolani test - if posiitve, f/u with USS around 6 weeks and ortho assessment
• Turn baby over - check spine, palpate spinous processes, check sacrum to exclude spina bifida

Question 10

Reflexes

Answer 10

• Assess tone while handling baby
• Moro reflex - symmetrical? - warn parents (startled look and the arms will fling out sideways with the palms up and the thumbs flexed)
• Others - stepping reflex (stepping motion when held upright)

Question 11

Conclude

Answer 11

• Plot length, weight, occipito-frontal circumference on WHO growth chart
• Ensure newborn is dressed again and comforted - offer to re-dress
• Thank parents
• Ensure f/u

Question 12

Barlow and ortolani test

Answer 12

• Done first
• BAR - we are going out
• Dislocates hip - popped out of acetabulum - if this is possible, positive test
• Ortolani - pop back in, confirms definitely dislocated, positive if palpable audible clunk is heard