Newborn Baby Examination Ellie Duckworth Stage 3 student,
University of Cambridge School of Clinical Medicine 2 nd May
2015
Slide 2
Newborn examination Newborn babies must be examined within 24
hours of birth Purpose of the examination: Detect congenital
anomalies not already detected at birth Check for potential
problems arising from maternal or familial disease Checked again at
6 weeks old (usually by GP)
Slide 3
Examination routine Usually described as examining top to toe
In reality, adapt the order of examination to when the baby is
settled or crying: Auscultation first (before removing rest of
clothing) Palate more visible when the baby is crying, or feel with
finger Sucking reflex can also help to calm the baby down Leave
most distressing parts until the end e.g. Moro reflex & hip
examination
Slide 4
History Key points in taking a history from the mum: Pregnancy
and mode of delivery Did they cry straight after birth? Any
problems with breathing? Family history Congenital heart disease
Hearing problems Hip dysplasia Has baby passed urine or meconium
yet? Any problems with breast/bottle feeding?
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General observations Undress down to the nappy Remember to look
at the babys back as well Skin Colour Skin lesions Respiratory
effort Spontaneous movements and posture symmetrical? Dysmorphic
features
Slide 6
Peripheral cyanosis Milia Mongolian Blue spot Erythema toxicum
(neonatal urticaria) www.nursingcrib.com Illustrated textbook of
paediatrics (Lissauer)
Slide 7
Head Measure head circumference Fontanelle Tense Raised ICP
Meningitis (late sign) Sunken Dehydration 3 rd fontanelle Downs
Check skull and facial bones for birth injuries
www.quickmedical.com
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www.abclawcenters.com
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Eyes Check red reflex with ophthalmoscope Lack of red reflex
Cataracts Retinoblastoma Ophthalmic infections Retinoblastoma
www.kellogg.umich.edu
Slide 10
Ears Shape and size Low set ears Downs Edwards Di George
Turners Noonan Patency of external auditory meatus Edwards Syndrome
Di George Syndrome www.gethelponline.org quizlet.com
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Mouth Colour of mucus membrane Palate High arched Marfans Cleft
lip/palate Tongue tie Sucking reflex Rooting reflex High arched
palate Cleft lip Tongue tie Rooting reflex www.mothering,.com
www.clapa.com newborns.stanford.edu beyondspine.com
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Arms & Hands Check neck, shoulders & clavicles for
traction birth injury Count fingers Shape of fingers clinodactyly
Palmar creases multiple or single Grasp reflex Single palmar crease
Clinodactyly Simianline.handresearch.com cai.md.chula.ac.th
Slide 13
Erbs Palsy Illustrated textbook of paediatrics (Lissauer)
shoulderdystociainfo.com
Slide 14
Legs & Feet Watch movement of each joint Check for talipes
equinovarus Count toes Shape of toes Babinski reflex Grasp reflex
Talipes equinovarus Babinski reflex wikipedia
hellomrdoctor.com
Slide 15
Peripheral pulses Brachial, radial & femoral Radio-femoral
delay Heart Apex beat Heaves or thrills Auscultation Lungs Watch
respiratory pattern, rate and depth Grunting, head nodding,
intercostal recession, stridor Auscultation
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Abdomen Abdominal girth and shape Omphalocoele/gastroschisis
Umbilical stump Infection (Omphalitis) Hernia Palpate for organs,
masses or hernia normal to be able to feel liver and/or spleen in
newborns External genitalia Undescended testes Inspect anus for
patency Omphalitis medscape.com
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Exomphalos/OmphalocoeleGastroschisis www.cdc.gov
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Back Check for skin lesions Palpate down the spine Looking for:
Spina bifida occulta Pilonidal sinus biology-forums.com
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Reflexes wikipedia Moro reflex
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Hips Checking for developmental dysplasia of the hip (DDH)
Illustrated textbook of paediatrics (Lissauer)
Slide 21
Guthrie test Blood sample (heel prick) taken on day 5-9 of life
In UK, all infants screened for: Phenylketonuria Hypothyroidism
Haemoglobinopathies Cystic fibrosis MCAD (medium-chain acyl-CoA
dehydrogenase Others e.g. Maple syrup urine disease www.mun.ca
namrata.co
Slide 22
Hearing screening Early detection and intervention of severe
hearing impairment Prevents delay in speech and language
development Evoked optoacoustic emission (EOEA) Earphone over the
ear to emit sound The sound evokes an echo/emission from the ear if
cochlear function is normal Automated auditory brainstem response
(AABR) If normal test not achieved Uses computer analysis of EEG
waveforms www.homerton.nhs.uk
Slide 23
Vitamin K Vitamin K deficiency can cause haemorrhagic disease
of the newborn Usually mild symptoms bruising, haematemesis,
melaena, prolonged bleeding around umbilical stump Can be severe
intracranial haemorrhage IM injection of vitamin K given to most
newborn infants in the UK immediately after birth Parents can
request oral vitamin K but this requires 3 doses over first month
of life to achieve adequate liver storage