Examination: Newborn Baby

Screening for abnormalities in the newborn. It should be performed within the first 24 hours of birth. It is an extensive examination that requires practice.

• Wash hands
• Expose the baby - naked
• Reposition baby lying down

• Weigh baby
• Measure
  1. Head to toe length
  2. Head circumference

• Heart Rate
• Respiratory Rate
• Temperature
• General appearance
• Colour, breathing pattern, tone

• Usually red, but may have blue colour at extremities, birthmarks or rashes
• Jaundice is pathological if seen in first day of life
• Erythema toxicum is benign. 50% children affected. Red lesions with yellow central papules are seen

• Sutures and fontanelles - palpate
• Size
• Shape
  • Caput – crosses suture lines, resolves in several days
  • Haematoma – never crosses suture lines, caused by a Subpereostial haemorrhage. 5% associated with underlying fractures
• Eyes
  • Discharge?
  • Appearance
  • Cataract
  • Assess for the red reflex with an ophthalmoscope
• Ears
  • Position
  • Skin tags
• Mouth
  • For a cleft palate
  • Symmetry
  • Size
• Neck
  • Palpate for thryoglossal cysts
  • Lymphadenopathy present in 33%

• Inspect
  • Pectus excavatum common and benign
  • Respiratory rate (should be 40-60 per minute)
• Palpate
  • Heart rate (should be 120-160 per minute)
  • For thrills
  • Femoral pulses
• Auscultate
  • Heart murmurs
  • Breath sounds

• Inspect
  • Shape
  • Size
  • Distended?
  • Herniae
  • Umbilical cord appearance
  • For an umbillical hernia – normal finding in neonates
  • Umbillicus – 3 vessels? (if only 1 artery, think of renal problems)
• Palpate for size of internal organs – should be able to feel 1-2cm liver

• Palpate for inguinal herniae
• Examine urethra position (?Hypospadias)
• Males: feel for testes in scrotum
• Female: assess if labia present (usually are swollen for first few weeks)
• Ensure anus is open

• Length – proportionate?
• Hands and feet

• For dislocation
  • Ortolani test: Flex hips and knees to 90 degress. Place thumbs on inner side of baby's knee, with index finger on greater trochanter. Adduct hips whilst applying forwards pressure. Can feel a click if dislocation occurs
  • Barlow test: Hips and knees flexed to 90 degrees, abduct the hip while applying backward pressure on the knee - you will feel a click if dislocation occurs

• Inspect and palpate spinal column. Are there any openings suggestive of spina bifida?

• Tone – pick up baby
  • Reflexes
  • Moro - startle newborn, so their legs and arms swing out and forward, with fingers outstretched
  • Rooting - baby turns mouth to face stimulus
  • Suckling - when nipple/object put into mouth, baby sucks

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