Neonatal Examination Flashcards
(10 cards)
Alfie baby, Stephanie Mum, James Dad
P1+0
SVB
3.65kg at birth
60 hours old
Day 3 exam
How would you begin and conduct your visit?
Hi I’m Chelsea, Student Midwife
Confirm Baby Alfie DOB/ address, correct child
No contraindications before starting / if Alfie unwell
Gain informed consent - discuss the examination (top to toe) and requires me to undress Alfie, is this okay?
What is the purpose of the daily newborn examination?
Assess the health of newborn, and monitor their wellbeing
Looking for deviations from the norm, and refer to appropriate person
Looking for signs of infection
Monitor weight gain in line with local guidelines
Supporting parents in their new role and their transition into parenthood, giving advice and answering questions
What would be your initial observations on entering the home?
Assessing the environment - too hot, too cold/ temperature, visitors, smoke exposure, pets/ safe with baby?
How do the parents look, and their general feelings? Anxious, tired, how are they handling Alfie. Home hygiene - Any concerns regarding these things.
Give appropriate support and advice regarding findings
What would you wish to discuss with Stephanie and James regarding baby Alfie?
• Behaviour – How has the baby been and how are you getting on at home?
• Sleep pattern
• Feeding
• Frequency of feeding.
• If formula feeding, discuss volume
• If breastfeeding, discuss frequency. Ask if baby is going to both breasts and does mum feel her breasts are emptying after each feed. Is Alfie coming off breast, settled between feeds/ active for them?
• Elimination – How many wet nappies? As he is 3 days old now we would expect to see between 5-6 wet nappies and 2-3 dirty (becoming heavier) a day.
• Change in stool – meconium at first now yellower/ lighter. Minimum of 2 per day at least the size of a £2 coin and changing in colour and consistency.
• We want to link the volume of urine and stools that he passes to effective feeding and make this link with the parents.
• Ask if they have any concerns and address them as we undergo the examination.
How would you prepare for the daily physical examination of the baby?
5 WHO moments and 7 Steps Hand hygiene, use hand gel if hands visibly clean
appropriate PPE - Apron and gloves
Find a safe surface to do examination
Make sure temperature is warm/ suitable to undress, not exposed for too long.
Ensure good lighting, windows are closed. Any animals/pets out of the room.
Gather equipment needed - stethoscope, thermometer, scales,
Observing the baby before fully undressing it can reveal several potential problems. How would you undertake the general observation?
Assess the baby’s colour and tone - alertness/sleeping /drowsy?
good perfusion - not yellow, grey or blue.
Overdressed or underdressed.
Looking for signs of jaundice in sclera. Or skin
Looking for good rhythm, rate and regularity of respiration rates (30-40 breaths per minute - 60 if in crying/ distress). Looking at chest movements are they symmetrical - no nasal flaring.
Safe sleeping - feet to foot of cot, blankets to chest, no bumpers or toys in cot that could cause suffocation.
No hat indoors if warm as potential to overheat.
Signs of vomitting, or possetting on baby’s mouth or neck.
If moving make sure all limbs are mobile, no concerns with movement.
Explain how you would perform the physical examination, explaining in detail what you would do and why?
• Examine the head – looking for any signs of moulding or trauma. Look visually at the whole head all the way round looking for signs of scarring or bruising. Any puncture sites from the birth or trauma from forceps/ventouse/ fetal scalp electrode.
• Looking for signs of cephal haematoma or capute (swelling or bleeding)
• Looking for any signs of indentation in the fontanelles – we don’t want the fontanelles to be expanded or extended in either the anterior fontanelle or the posterior.
• There may be some moulding which we will ensure the parents is completely normal.
• Make sure you can physically palpate each of the sutures and fontanelles.
• You are then looking into the eyes to make sure they’re symmetrical, the sclera is clear and not bloodshot. This could be trauma. Can reassure parents this is normal.
• Looking for any signs of discharge that could be a sign of infection, or yellowing signs of jaundice.
• Look at nose – no excessive effort respiratory effort. No swelling or distention to the nostrils.
• Look inside the mouth. Can use torch. Gently open mouth and visualise the tongue and roof of the mouth. Looking for signs of trauma or infection or any problems. Possibly signs of thrush.
• Might see some sucking blisters on the lips.
• Anything unusual we ask can ask questions about.
• Looking at the neck – Look at skin creases, are there any signs of infection. Any excoriation. Turn round and look at the back of the neck and head. Good opportunity to talk about hygiene. If baby has had any possetting that this has been washed thoroughly and dried.
• Looking at the babies skin – we know there are differences depending on ethnicity and ensuring the babies skin is perfused dependent on the ethnicity.
• Looking for birthmarks. Should already have been noted in documentation.
• Look at skin from top to toe. Ensure there is good peripheral perfusion. No signs of any challenges for his circulatory system.
• Check there is no cyanosis, skin isn’t blue , pale.
Tone is good, not floppy.
• Check for signs of jaundice – we might see this in the sclera, tongue or in the gums if baby is of a different ethnicity. Will test as appropriate if that is the case.
• Check for signs of rashes, spots, bruising or any signs of infection.
• We have looked at trunk, chest, legs, arms, hands, back of baby, spine – nothing untoward.
• Look at arms and under armpits, fingers – looking for signs of paronychia in each of his fingers, looking at the nails.
• Look at feet for infection, poor hygiene or signs of paronychia.
• Look at the umbilicus for signs of separation or any challenges of separation. No fouls odour or discharge or hot red skin - signs of infection.
Give advice to the parents around hygiene and keeping the area as clean and dry as they can. Cord should come off by 3rd week.
• Look at the buttocks and the groin. Bottom – clear view, lift legs up – look for signs of thrush or trauma, rashes or nappy problems.
Looking for good hygiene and give advice on what may be found. Changing the nappy if that is necessary.
• Do an axilla temperature. Between 36.5 - 37.5
- weigh baby in line with local guidelines, baby’s can lose 5-10% of weight in the first
• Throughout duration, you are using a systematic approach. Baby is handled gently and appropriately and communicated well with the parents. Also, not exposed him for too long.
Newborns babies have higher levels or uric acid which is a by product of nucleotide breakdown. Explain how this may present and what information you would provide to parents ?
Can look like red or orange dust or crystallization in nappy, it is not blood & completely normal / and can be cleared with good hydration and feeding - might need extra time at breast. Monitor.
Following the routine examination of the newborn what will your actions be?
What findings from the routine examination of the newborn would you document?
Redress the baby
• Discard of any single use equipment and PPE
• Rewash hands
• Discuss my findings with parents
• Make and discuss action plans on baby’s care
• Make any referrals if necessary
• Ongoing advice and support – ask them if they have any further questions
• Ensure they have all contact details required if they need to contact
regarding a concern
• DOCUMENT – Findings – what was discussed with parents, observations,
vital signs RR, HR, TEMP, baby’s general appearance, feeding, behaviour
patterns, elimination, tone, any deviations from the
normal/abnormalities found, babys weight and % loss/gain.
• Date Time and Sign
• Thank them and Say Goodbye
Summarise the role and responsibilities of the midwife when performing the routine examination of the newborn?
Look for deviations from the normal – early detection and
management of complications
• Assess and promote fetal wellbeing - using systematic approach (top to toe)
• Communicate well with parents – ask open questions and create a dialogue, provide opportunity for them to ask questions and answer compassionately. Give them
added support
• Rule out of any signs of infection
• Educate parents
• Provide support/advice and refer them to additional help
Do not expose baby for too long
• Refer problems if necessary
