Examination of the newborn baby
الدكتور عبد المهدي عبد الرضا حسن
كلية التمريض / جامعة بابل
PhD, pediatricMental Health Nursing
Examination at birth
Aim
oTo describe and carry out an examination of a baby soon after birth
Objectives
oTo screen for malformations
oTo observe smooth transition to extra uterine life
oAn asses overall of baby’s condition
Examination of the newborn baby
Minimum prerequisites
oMother & baby together
oWarm room, fresh clean sheet/clothes
oThermometer
oWeighing scale
oWatch with seconds
oStethoscope
Principles of examination
Assess
Ask, Check, Record
Look, Listen, Feel
Classify
Treat or advise
Examination at birth: Assess
Ask
oAntenatal details
Antenatal visits – TT, Iron-folate supplementation, HIV/Syphilis screening
Exposure to teratogens, infections
Poly or oligohydramnios
oPostnatal details: Condition at birth; resuscitation, Single umbilical artery ,excessive drooling
Check
oWeigh the baby
oTemperature
Record
Assess: Look for
Assess: Look for
Quick screening for malformations
Screen from top to bottom, midline, and back examination
Orifice examination
Anal opening
Assess: Look for
Single umbilical artery
Simian crease
Dysmorphic features
Excessive drooling of saliva
Assess: Look for
Look for abnormal swelling
Abnormality of limbs & spine
Eyes, ears, umbilicus
Observe
Breathing rate / pattern
Color
Heart rate
Activity- feeding , movements
Assess: Listen for
Assess: Feel for
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
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
Aim
To ensure that malformations are detected
To 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 at 24 hrs: Assess
Ask
oBreastfeeding
oActivity of the baby
oAny other problems*
Check
oWeigh the baby
oTemperature
Record
Color
Skin
Discharge from eyes, umbilicus
Count respiratory rate
Chest retractions
Grunt
Cry
Auscultation of heart
Femoral pulse
CRT
Temperature by touch
Descent of testis
Depth or extent of jaundice
Feel for abdomen
Confirm findings of inspection
Record
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
Temperature by touch
Depth or extent of jaundice
Confirm findings of inspection, if any
Danger signs
Examination on follow-up
Aim
To 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
Positioning
oHead in line with body
oWell supported
oAbdomen touches the mother abdomen
oTurned to the mother
Attachment
oMouth wide open
oLower lip everted
oLittle areola visible
oChin 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
Caput succedaneum vs. cephalohematoma
The umbilicus: Which one is normal?
Umbilicus
Skin conditions: Which baby will you treat?
Skin pustules
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 immediately
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
1