Examination of the Newborn

The newborn examination is carried out within 48 hours of birth, then again at 8 weeks (usually by the GP).

  • WIPE
    • Wash hands, introduce self (ideally mother should be present), check mother and baby details* and explain the examination/gain consent
      • * Check name, DOB, gestational age, birth weight (and centile), delivery type, feeding (and how will they feed)/urinating/bowel movements (any meconium passed?- black, sticky stool), any parental concerns (ask specifically about family problems with hips, congenital heart problems etc)
        • NB this can be done whilst washing your hands or whilst parent/you are undressing the baby
  • General inspection (Completely undress the baby down to nappy)
    • Note skin colour (any jaundice; any marks from birth, any obvious birthmarks); activity, posture, response
      • NB You will have to examine the baby’s back so best to leave general inspection of that until then- you may do this first or last.
  • Head
    • Measure and record head circumference
    • Palpate the fontanelles and sutures
      • Note any tense fontanelles (remember this may be normal when the baby is crying but is relatively rare at rest)
      • NB It may be easier to do this whilst examining the baby’s back
    • Assess facial appearance- eye position and ear position; any asymmetry
  • Eyes
    • If the baby has its eyes open, check the red reflex with an ophthalmoscope (congenital cataracts)
    • Look for any obvious signs of infection
  • Ears
    • Note size, shape, symmetry and whether they are set normal or low
    • Check the patency of the external auditory meatus
      • Note that formal hearing testing is offered later
  • Mouth
    • If possible, look into the mouth to look at the palate (any cleft?)
      • DO NOT use a tongue depressor; only use your finger (clean) and be gentle
    • With a clean finger, check the suckling reflex
  • Limbs
    • Feel the baby’s bones, checking symmetry
    • Count fingers and toes (looking for any abnormalities); check palmar creases; look for talipes (club foot)
    • Check the baby’s tone (this does not have to be a rigid examination of tone)
    • Check the clavicles (may be disturbed during birth and cause Erb’s palsy)
    • Check the hips using Ortolani and Barlow’s tests to check for any developmental dysplasia
    • Check if there is a grasp reflex in both hands
  • Chest
    • Look at the baby’s chest; check respiratory rate (normally 30-60bpm)
    • Listen to the heart sounds (normally 120-150bpm).  It can be difficult to hear any murmurs but you should try.
    • Also check the radial, brachial and femoral pulses (and any radio-femoral delay)
  • Abdomen
    • Palpate the abdomen and inspect the umbilical stump for any signs of infection
  • Groin/Genitals
    • Remove the baby’s nappy and inspect the genitals.  In male babies, check for both testicles (any undescended)
  • Back and Anus
    • With the baby on their front, inspect the back, particularly at the neck and the sacrum (look for any dimples)
    • Feel down the spine, checking for any curvature
    • Check the patency of the anus
    • As you are turning the baby back, it is good point to check the Moro reflex
      • With you holding/supporting the baby’s back (so the baby is lying on your arm face up); suddenly lower the baby and stop suddenly
        • the moro reflex is abduction and adduction of the arms, usually accompanied by crying (primitive startle reflex)

Remember also to carry out screening tests e.g. heel prick at 5-8 days; sweat test; formal hearing test etc.

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