Examination Of The Newborn

Question 1

How would you begin and conduct your visit ?

Answer 1

Introduce yourself, state your name and role, explain what you’re going to do and again informed consent.

Question 2

What is the purpose of the daily newborn examination ?

Answer 2

Identify any deviations from normal, monitor neonatal wellbeing , monitor weight and support the parents.

Question 3

What would your initial observations be when entering the home ?

Answer 3

How the parents look, do they look tired, how are they holding Alfie, is the environment safe, what is Alfie wearing.

Give advice if necessary such as no hats indoors or reduce smoke exposure

Question 4

How would you prepare for examination of the newborn ?

Answer 4

Ensure the space is warm and has good lighting.

Wash hands following 5 moments 7 steps, ensure hands are warm and apply non sterile gloves.

Question 5

Observing the baby before undressing can reveal potential problems, how would you undertake general observations of the baby ?

Answer 5

Ask the parents about behaviours and sleep patterns, how much baby is feeding.

Ask how many wet and dirty nappies baby has had. We expect 5-6 wet nappies and 2 dirty nappies in 24 hours.

Ask the parents if they have any concerns

Can look out for good limb movement and respiratory rate (normal is between 30-40 per min.

Question 6

Explain how you would do the examination and why ?

Answer 6

Take baby’s temp ( normal between 36.5 and 37.5)

Take HR checking for rate rythm and regularity ( normal between 110- 160bpm

Take a systematic approach can do examination in cot or on lap.

Question 7

HEAD

Answer 7

checking for any signs of moulding, trauma, signs of caput.

Checking fontanelles and sutures for any indentation

Question 8

EYES

Answer 8

Making sure eyes are not bloodshot and that there’s no trauma

Checking there’s no discharge or signs of infection

Checking for signs of jaundice ( yellow tinge to the eyes)

Question 9

NOSE

Answer 9

Checking there’s no excessive nostril flaring or respiratory effort, check for any swelling

Question 10

MOUTH

Answer 10

Checking the whole mouth for signs of trauma, infection or any signs of thrush (creamy white patches on the tongue)

Question 11

NECK

Answer 11

Checking for any dried milk tucked in the creases

Question 12

SKIN

Answer 12

Checking for birth marks, checking baby has good peripheral perfusion and no signs of any circulation problems

Checking for any bruising, rashes or signs of jaundice.

Question 13

ARMS

Answer 13

Checking under the arm pits arms and fingers looking for any signed of poor hygiene, brushing, trauma.

Ensuring good limb movement

Question 14

ABDOMEN

Answer 14

Checking the cord for signs of separation or infection.

Making sure abdomen feels soft

Question 15

BUTTOCKS

Answer 15

Checking for any signs of nappy rash or thrush such as bright red rashes which are painful for baby

Question 16

LEGS AND FEET

Answer 16

Checking for good movement in the limbs and feet and signs of trauma or infection

Question 17

Newborn babies have higher levels of uric acid explain how this may be present and why ?

Answer 17

Normally presents as a red or orange powder formation in the nappy

This is normal

Reassure parents that the more baby feeds the more hydrated they will be and this should resolve

Question 18

Following examination what would your actions be ?

Answer 18

Wash and dry hands

Dispose of single use equipment and PPE

Discuss findings with parents and give any advice

Ensure parents have relevant contact numbers

Question 19

What would you document ?

Answer 19

DATE TIME AND SIGN

Plan next visit

Question 20

Summarise the roles and responsibilities of the midwife when performing examination of the newborn ?

Answer 20

Handle baby with safely and communicate well throughout examination with the parents.

Give parents opportunities to ask questions and share information.