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


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

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

Assess skin
  • 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

Assess head and face
  • 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%
Assess torso
  • 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

Assess abdomen
  • 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

Assess genitals
  • 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

Assess limbs
  • Length – proportionate?
  • Hands and feet

Assess hips
  • 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

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

Assess nervous system
  • 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

  • Thank the mother and dress baby.

written by: celine_lakra, first posted on: 05/01/13, 10:37

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Comments:

rain_brain says...
It's very helpful
POSTED ON: 04/03/17, 03:51

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