Paediatrics: Routine neonatal examination

Routine neonatal examination

Each baby must be examined at least once in the first week, usually on day 1 after birth. Such child health surveillance can be done by a hospital paediatrician, advanced neonatal nurse practitioner, general practitioner, or specially trained midwife/nurse.

Purpose

·  Maternal reassurance.

·  Health education; explaining common variations.

·  Detecting asymptomatic problems, e.g. congenital heart disease, DDH.

·  Screening for rare, but serious conditions.

Order of examination

·  Attending midwife: ask if there are any concerns or problems.

·  Mother: check patient notes for relevant details of the maternal medical history, family history, antenatal and obstetric history, and social history. Ask about feeding and whether baby has passed meconium/urine.

·  Baby: when baby is quiet (if needed use calming techniques like pacifiers, sucking a clean finger, examination after a feed) note:

·  general posture and movements;

·  skin colour;

·  listen to the heart and lungs;

·  examine the eyes for size, strabismus;

·  using an ophthalmoscope examine the eyes for bilateral red reflexes to exclude cataract or retinoblastoma.

The remaining examination should proceed as described in the box opposite.

Rest of routine neonatal examination

The baby should be completely undressed. Examination proceeds as follows in head to toe order:

·Cranium: measure maximum occipital-frontal circumference (normal 33–37cm at term), assess skull shape, fontanelle positions, tension, and size (anterior may be up to 4cm x 4cm, posterior 1cm)

·Face: assess any dysmorphism, nose, chin size. Inspect mouth. Visualize and palpate palate for possible clefts

·Ears: assess position, size, shape, and external meatus patency

·Neck: inspect and assess movements; palpate clavicles.

·Chest: assess shape, symmetry, nipple position, respiratory rate (normal 40–60/min), pattern, and effort. Palpate precordium and apex beat

·Abdomen: inspect shape and umbilical stump. Check for inguinal hernias. Palpate for masses, liver (normally palpable up to 2cm below costal margin), spleen (normally palpable up to 1cm), kidneys (normally palpable), bladder

·Genitalia:

o girls—inspect (N.B. the clitoris and labia are normally large)

o boys—assess size, shape, position of urinary meatus; palpate for descended testes (N.B. retractile testes are normal)

·Palpate the femoral pulses (absence or weakness may indicate aortic arch abnormalities)

·Anus: assess position and patency

·Spine: inspect for deformity and sacral naevi/dimple/pit/hair patch/ lipoma/pigmentation (may indicate underlying abnormality);

·Limbs: assess symmetry, shape, passive and active movements, digit number and shape. Assess palmar creases. Examine hips for DDH

·CNS: in addition to evaluation of above: assess tone during handling, pulling baby to sitting position by holding wrists, and ventral suspension (baby should be able to hold head almost horizontally), check moro reflex (symmetrical?)

·  Finally, check that urine and meconium were passed within the first 24hr