Examination of the newborn baby
‫الدكتور عبد المهدي عبد الرضا حسن‬
‫ جامعة بابل‬/ ‫كلية التمريض‬
Mental Health Nursing & PhD, pediatric
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
1
oTemperature
Record
Assess:
L o o k fo r
Assess:
L o o k fo r
Quick screening for malformations
Screen from top to bottom, midline, and back examination
 Orifice examination
 Anal opening
Assess:
L o o k fo r
 Single umbilical artery
 Simian crease
 Dysmorphic features
 Excessive drooling of saliva
Assess:
L o o k fo r
 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
2
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
3
Count respiratory
Chest retractions
rate
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
o
Head in line with body
o
Well supported
o
Abdomen touches the mother abdomen
o
Turned to the mother
Attachment
4
Mouth wide open
o
Lower lip everted
o
Little areola visible
o
Chin touches mother breast
Assessment of feeding adequacy
o
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
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
No
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.
5
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
6