Examination of the newborn baby

Examination of the newborn baby

Examination at birth

Aimo To describe and carry out an examination of a

baby soon after birth

Objectiveso To screen for malformations o To observe smooth transition to extra uterine lifeo An asses overall of baby’s condition

EN-Teaching Aids: ENC 2

Examination of the newborn baby

Minimum prerequisiteso Mother & baby togethero Warm room, fresh clean sheet/clotheso Thermometer o Weighing scaleo Watch with secondso Stethoscope

Eyes see what the mind knowsSkilled , knowledgeable health professional !


Principles of examination

Assess Ask, Check, Record Look, Listen, Feel

Classify

Treat or advise


Examination at birth: Assess

Ask o Antenatal details Antenatal visits – TT, Iron-folate supplementation,

HIV/Syphilis screeningExposure to teratogens, infectionsPoly or oligohydramnios

o Postnatal details: Condition at birth; resuscitation, Single umbilical artery ,excessive drooling

Checko Weigh the babyo Temperature

Record


Assess: Look forLook for



Quick screening for malformationsQuick screening for malformationsScreen from top to bottom, midline, and back

examination

Orifice examination Anal opening



Single umbilical artery

Simian crease

Dysmorphic features

Excessive drooling of saliva



Look for abnormal swelling

Abnormality of limbs & spine

Eyes, ears, umbilicus

ObserveBreathing rate / pattern

Color

Heart rate

Activity- feeding , movements


Assess: Listen forListen for

Grunting, Cry, Heart sounds


Any abnormal swelling:

Caput, cephalhematoma Palpable femoral pulses Dislocation of hip Capillary refill time ( CRT) Confirm the findings of inspection Palpate the abdomen Feel for testes in male baby

Assess: Feel forFeel for


Weighing the baby

Prepare the scale: cover the pan with a clean cloth/autoclaved paper; ensure the scale reads zero

Preparing and weighing the baby Remove all clothing Wait till the baby stops moving Weigh naked Read and record Return the baby to the mother

Scale maintenance Calibrate daily Clean the scale pan between each

weighing


Temperature At birth-warmth, keep the baby in skin to

skin contact with the mother


Temperature recording

Hands and feet should be checked for warmth with the back of the hand to see if the baby is in cold stress

Temperature measurement Use clean thermometer Hold vertically in the axilla for 3 minute Read and record Normal 36.5ºC-37.5ºC


Examination within 24 hours

Objective To describe and carry out an examination of a baby

within 24 hours of birth

AimTo ensure that malformations are detectedTo ensure establishment of breast feeding ;

maintenance of temperature ;classify baby as normal or abnormal


Assess Ask, Check, Record Look, Listen, Feel

Classify Treat or advise


Examination within 24 hours

Examination at 24 hrs: Assess

Ask o Breastfeeding o Activity of the babyo Any other problems*

Checko Weigh the babyo Temperature

Record


•Passage of meconium up to 24 hrs and urine up to 48 hrs of life is usually normal

Color Skin Discharge from

eyes, umbilicus Count respiratory

rate Chest retractions

Abnormal swelling scalp

Abnormality of limbs fingers , back

Weight For breast feeding

Position Attachment

Assess: Look Look for for


Grunt Cry Auscultation of heart

Assess: Listen Listen for for


Femoral pulse CRT Temperature by touch Descent of testis Depth or extent of jaundice Feel for abdomen Confirm findings of inspection

Assess: Feel Feel for for


Record

Findings Normal Abnormal

Heart rate

Respiratory rate

Retractions

Color

Temperature

Feeding

Weight


Examination at discharge

Aim

To ensure that baby is normal on exclusive breast feeds

Objective

To screen that heart is normal

To ensure baby has no significant jaundice or danger signs

Tell about follow up and danger signs


Discharge from eyes , umbilicus

Breathing difficulty Breast feeding-

exclusivity and adequacy

Jaundice

Assess: Look Look for for Listen for

Auscultation of heart


Temperature by touch Depth or extent of jaundice Confirm findings of inspection, if any

Assess: Feel Feel for for


Danger signs


Not feeding well Less active than before Fast breathing (>60/

min) Moderate or severe

chest in-drawing Grunting Convulsions

Floppy or stiff Temperature >37.50C or

<35.50C Umbilicus draining pus

or umbilical redness extending to skin.

>10 skin pustules Bleeding from umbil.

Stump

Examination on follow-up

AimTo ensure that baby is growing well on exclusive breast

feeds & give immunization as per national policy

Objective

To record the anthropometry weight , head circumference

To ensure baby has no malformations like – cardiac murmurs


Normal: feeding behaviour

Positioningo Head in line with bodyo Well supportedo Abdomen touches the

mother abdomeno Turned to the mother

Attachmento Mouth wide openo Lower lip evertedo Little areola visibleo Chin touches mother breast

Assessment of feeding adequacy


It is NORMAL for a baby

To pass urine six or more times a day after day 2 To pass six to eight watery stools (small volume) in

24 hrs Female baby may have some vaginal bleeding for a

few days during the first week after birth. It is not a sign of a problem.

Loses weight and regains by 7-10 days


Normal breathing

30 to 60 breaths per minute No chest in-drawing, no grunting on breathing out When assessing breathing:

Count number of breaths for a full minute Babies may breathe irregularly for short periods of time

Small babies (<2.5 kg or born before 37 wks gestation) may: Have some mild chest in-drawing Periodically stop breathing for a few seconds


RREETTRRAACCTTIIOONNSS


Caput succedaneum vs. cephalohematoma

Normal vs. Abnormal


The umbilicus: Which one is normal?

Normal vs. Abnormal


Umbilicus

The NORMAL umbilicus is:Bluish-white in colour on day 1. It then begins to dry and shrink and If falls off after 7 to 10 daysNo discharge

LOCAL UMBILICAL INFECTIONRED umbilicus or RED skin around the umbilicus

POSSIBLE SERIOUS INFECTIONUmbilicus draining pus or Umbilical redness, swelling extending to skin


Skin conditions: Which baby will you treat?

Normal vs. Abnormal EN-Teaching Aids: ENC 34

Skin pustules

Locate ? EN-Teaching Aids: ENC 35

Skin A baby may have PUSTULES

MORE than 10 are a DANGER SIGN Refer this baby urgently

Less than 10 are a local skin infection

Treat them immediatelyEN-Teaching Aids: ENC 36

Posture

The normal resting posture of a term newborn baby: loosely clenched fists flexed arms, hips, and knees

Small babies (less than 2.5 kg at birth or born before 37 weeks gestation)

the limbs may be extended Babies born in the breech position may have fully

flexed hips and knees; the feet the mouth; and legs may even reach near the mouth.


The normal resting posture of a baby born breech


ABNORMAL position of arm and hand


Color of the baby


Color of the baby


Case scenario 1

Baby of Archana was born to a Primigravida mother at term, baby is now 20 hours of age noticed to have yellowness of face and trunk.

What is the problem?

What action you will take?


Case scenario 2

Baby of Radhika was born with weight of 1.5kg. Baby weighs 1.3 kg today on day 2.

What are your concerns?

What action you will take?


Conclusion

All newborn babies must be examined at Birth 24 hrs Before discharge and Follow-up

A systematic approach consisting of ‘Ask, Check, Look, Listen, Feel’ should be followed at each assessment

Documents

Examination of the newborn baby