Initial Newborn Examination

Question 1

The initial newborn examination should occur…

Answer 1

in the first few hours following birth

allowing time for skin to skin and first feed

Question 2

any newborn examination should occur in an environment that is…

Answer 2

warm and has a good light source

Question 3

during baby’s assessment immediately following birth, all of the following should be reviewed:

Answer 3

the head (circumference and shape of face)
eyes
nose
mouth 
ears
neck
clavicles
arms
chest
abdomen
genitalia
legs
spine
skin
elimination
weight
length
reflexes (rooting, sucking, plamar grasp etc)

Question 4

initial newborn examination: the head

Answer 4

head size should be reviewed in relation to body

parents should be reassured any moulding will resolve itself after 48 hours

visible signs of trauma should be noted (e.g. FSE, amnihook)

suture lines and fontanelles should be palpated

occipitofrontal circumference should be measured (though will change over next few days)

should be symmetrical face shape

Question 5

(initial newborn examination) moderate facial asymmetry is associated with…

Answer 5

prolonged second stage
forceps delivery
macrosomia

if face appears unusual in appearance, parents faces should be studied before expressing concern

Question 6

(initial newborn examination) widely spaced suture lines are indicative of…

Answer 6

preterm babies - lack of moulding

hydrocephalus (build up of fluid in brain)

Question 7

(initial newborn examination) a large diamond shaped anterior fontanelle is indicative of what?

Answer 7

prematurity
hypothyroidism
hydrocephalus

Question 8

(initial newborn examination) a small diamond shaped anterior fontanelle is indicative of what?

Answer 8

microcephaly

smaller head due to improper development

Question 9

(initial newborn examination) what diameter is used to measure head circumference?

Answer 9

occipitofrontal circumference

Question 10

(initial newborn examination) normal head circumference should be between which measurement?

Answer 10

around 32-38 cm

Question 11

(initial newborn examination) if baby’s eyes are closed…

Answer 11

baby should be gently tipped backwards and raised upwards

Question 12

(initial newborn examination) what appearance of the eyes is considered abnormal?

Answer 12

heavily wide spaced or narrow spaced eyes

Question 13

what are epicanthic folds?

Answer 13

normal in certain ethnic groups, e.g. east, southeast, central asians

can also be associated with underlying syndromes, e.g. T21

Question 14

(initial newborn examination) cloudy cornea may suggest?

Answer 14

infection
more severe birth trauma (e.g. from forceps)
congenital glaucoma - can cause childhood blindness if not treated

Question 15

conjunctival haemorrhage:

Answer 15

usually acquired during second stage of labour, caused by pressure from birth

should resolve after a few days

Question 16

(initial newborn examination) if baby has substantial eye discharge…

Answer 16

if it is profuse or purulent, should be noted and swab taken for testing
indicative of infection

Question 17

(initial newborn examination) the width of the bridge of baby’s nose should be…

Answer 17

greater than 2.5cm

Question 18

(initial newborn examination) baby’s nostrils flaring is indicative of…

Answer 18

respiratory illness

Question 19

(initial newborn examination) asymmetrical lips may suggest…

Answer 19

facial Bell’s palsy

Question 20

a baby with an abnormally small mouth may indicate…

Answer 20

micrognathia

an abnormally small lower jaw

Question 21

(initial newborn examination) when looking into baby’s mouth, the following should be for:

Answer 21

an intact palate

length of frenulum

Question 22

(initial newborn examination) baby’s ears:

Answer 22

should spring back into position when moved forward gently

low set ears may be indicative of chromosomal abnormalities, e.g. T21

Question 23

(initial newborn examination) a webbed neck is suggestive of…

Answer 23

chromosomal abnormalities

e.g. Turner’s syndrome

Question 24

(initial newborn examination) skin folds at the back of the neck may suggest…

Answer 24

Down’s syndrome / Trisomy 21

Question 25

what may increase the risk of a fractured clavicle?

Answer 25

baby born in breech presentation that required manipulation

Question 26

polydactyly vs syndactyly:

Answer 26

P = presence of extra fingers or toes
S = webbing or fusing together of two or more fingers or toes

Question 27

what are palmer creases?

Answer 27

babies should have 3 creases across palm

a single crease may indicate down’s syndrome