Newborn Examination Flashcards
What is the role of the newborn examination?
The newborn examination is used as a screening tool to pick up abnormalities in the newborn baby. Without this examination, babies could go home with an extra digit, a heart murmur or spina bifida. It is the point at which referrals are sent to specialities that may need to follow-up the baby, for example, urology follow-up for hypospadias.
When is the newborn examination performed?
The examination is performed within the first 72 hours after birth. It is repeated at 6 – 8 weeks by their GP.
Briefly describe the principles underlying the newborn examination
Wash your hands before and afterwards, and minimise the risk of introducing infection to the baby. Explain, reassure and keep the parents involved. Keep the baby warm and comfortable during the examination.
Every part of the body needs to be examined, so they need to be adequately exposed to allow a full examination of the skin. Start at the top of the head and work down to the toes.
Have a systematic approach, but be opportunistic. For example, if the baby has their eyes open it is a good opportunity to check the red reflex, and if they are settled it may be a good time to listen to the heart and breath sounds.
Prior to conducting the newborn examination, what questions should be asked?
Before starting it is worth asking the parents if they have noticed any issues and specifically asking:
- Has the baby passed meconium?
- Is the baby feeding ok?
- Is there a family history of congenital heart, eye or hips problems?
Briefly describe the role of measuring oxygen saturations in the newborn examination
Babies should have their pre-ductal and post-ductal oxygen saturations checked. This measures the oxygen level before and after the ductus arteriosus. Normal saturations are 96% or above. There should not be more than a 2% difference between the pre-ductal and post-ductal saturations. Abnormal saturations require further investigation and potentially admission to the neonatal unit.
Briefly describe the ductus arteriosus and its importance
The ductus arteriosus is located along the arch of the aorta and connects the aorta with the pulmonary artery. It normally stops functioning within 1-3 days of birth. It allows blood from the deoxygenated right sided circulation before the lungs to mix with the oxygenated left sided circulation after the lungs.
Certain congenital heart conditions are duct-dependent, meaning they rely on the mixing of blood across the ductus arteriosus. When the ductus arteriosus closes there can be a rapid deterioration in symptoms. These duct-dependent conditions may be picked up by measuring the difference in pre-ductal and post-ductal saturations.
Where are pre- and post- ductal saturations measured?
Pre-ductal saturations are measured in the baby’s right hand. The right hand receives blood from the right subclavian artery, a branch of the brachiocephalic artery, which branches from the aorta before the ductus arteriosus.
Post-ductal saturations are measured in either foot. The feet receive blood traveling from the descending aorta, which occurs after the ductus arteriosus.
What is assessed in the general appearance in the newborn examiantion?
- Colour (pink is good)
- Tone
- Cry
What is assessed with the head in the newborn examination?
Head
- General appearance
- Size, shape, dysmorphology, caput succedaneum, cephalohaematoma and any facial injury
- Head circumference
- Known as the occipital frontal circumference (OCP)
- Anterior and posterior fontanelles
- Sutures
- Overlapping sutures are common and usually resolve as the baby grows
- Ears
- Skin tags, low set ears and asymmetry
- Eyes
- Slight squints are normal, epicanthic folds can indicate Down’s and purulent discharge could indicate infection
- Red reflex using an ophthalmoscope
- Check for symmetry
- It is often more pale in darker skinned babies
- It is absent with congenital cataracts and retinoblastoma
- Mouth
- Cleft lip or tongue tie
- Put your little finger in their mouth to check the suckling reflect and feel the palate all the way back, checking for a cleft palate
What is assessed with the shoulders and arms in the newborn examiantion?
- Shoulder symmetry
- Check for a clavicle fracture
- Arm movements
- Check for an Erbs palsy
- Brachial pulses
- Radial pulses
- Palmar creases
- A single palmar crease is associated with Down’s but can be normal
- Digits
- Check the number of digits and if the fingers are straight or curved (clinodactyly)
- Use a sats probe on the right wrist for a pre-ductal reading
What is assesssed with the chest in the newborn examination?
- Oxygen saturations in the right wrist and a feet: 95% and above is normal
- Observe breathing
- Look for respiration distress, symmetry and listen for stridor
- Heart sounds
- Listen for murmurs, heart sounds, heart rate and identify which side the heart is on heart
- Breath sounds
- Listen for symmetry, good air entry and added sounds
What is assessed with the abdomen in the newborn examination?
- Observe the shape
- A concave abdomen may indicate diaphragmatic hernia with abdominal contents in the chest
- Umbilical stump
- Look for discharge, infection and a periumbilical hernia
- Palpate for organomegaly, hernias or masses
What is assessed with the gentitals in the newborn examination?
- Observe for the sex, ambiguity and any obvious abnormalities
- Palpate testes and scrotum
- Check both are present and descended, check for hernias or hydroceles
- Inspect the penis for hypospadias, epispadias and urination
- Inspect the anus to check if it is patent
- Ask about meconium and whether the baby has opened the bowel
What is assessed with the legs in the newborn examination?
- Observe the legs and hips for equal movements, skin creases, tone and talipes
- Barlows and Ortolani manoeuvres
- Check for clunking, clicking and dislocation of the hips
- Count the toes
What is assessed with the back in the newborn examination?
Inspect and palpate the spine: look for curvature, spina bifida and a pilonidal sinus.
