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.
·
Maternal
reassurance.
·
Health
education; explaining common variations.
·
Detecting
asymptomatic problems, e.g. congenital heart disease, DDH.
·
Screening
for rare, but serious conditions.
·
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.
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
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