New Born Examination

(Baby Check)

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Rationale

-  Check of successful transition

-  Screen for abnormalities

-  Establish baseline weight, length & head circumference

-  Address concerns

 

Features

-  Performed at

-  +/- birth (briefly)

-  Within 1st 24hrs

-  Repeated in 1st week

-  Recommended to R/V at 3, 6 & 12 months of age

-  10-20% infants have anomaly

-  1-1.5% significant

-  3+ minor abnorm --> likely major

-  3% infants some kind of birth trauma

-  Document in baby book

 

Preparation

-  Check baby book: APGARs, weight, feeding, vitals, passage of meconium & urine

-  Infant quietly alert

-  Parents present

-  Warm room, well lit

 

General Inspection

-  Check chart

-  Weight, length, head circumference

-  Passage of meconium/urine

-  Vitals: temp, RR, HR

-  Pink tongue & mucus membranes

-  Normal to have slightly bluish peripheries

-  Color

-  Pink, pale

-  Jaundice

-  Cyanosis

-  Dysmorphisms

-  Activity, posture & tone

-  Distress

 

Head

-  Cephalohaematoma (does not extend over suture lines)

-  Caput succedaneum

-  Lacerations: assisted vaginal delivery

-  Fontanelles

-  Anterior closes 18 months

-  Posterior closes 3-4 months

-  Soft: normal

-  Bulging: hydrocephalus

-  Depressed: dehydration

-  Sutures

-  Overlapping: craniosyntosies, moulding

-  Brachycehpaly: Downs

-  Eyes

-  Often performed last

-  Haematoma

-  Jaundice

-  Red reflex

-  Leukocoria: colomboma, retinoblastoma, congenital cataracts

-  Can reposition baby to elicit eye opening

-  Ears

-  Symmetry

-  Canthal height: Downs

-  Preauricular ear tags/pits

-  Nose

-  Wide nasal bridge: Downs

-  Nasal flaring: respiratory distress

-  Mouth

-  Cleft palatte

-  Hare lip

-  +/- sucking reflex

-  Tongue tie

-  Natal teeth

-  Rannulae (cysts under tongue)

-  Neck

-  Cystic hygroma

 

Upper Limb

-  Check bilateral clavicles for fractures: shoulder dystocia, birth trauma

-  Symetrical limb movements

-  Axilla for rash

-  Brachial pulses

-  Hand

-  Fingers: syndactyly, polydactyly

-  Simian crease: Downs

 

Chest

-  Chest

-  RR = 40-60 & irregular = N

-  Pectus excavatum/carinatum

-  Respiratory distress: recession, accessory muscles, tracheal tug

-  Accessory nipples

-  Palpate

-  PMI: apex beat

-  Palpate for supraclavicular thrill

-  Auscultate

-  Listen for murmurs

-  Exclude dextrocardia

 

Abdomen

-  Abdo

-  Scaphoid abdomen: congenital diaphragmatic hernia

-  Hernia: gastroschesis, oophalocoele

-  Umbilical stump: infection

-  Palpate

-  RIF to RUQ: hepatomegaly or ptosis

-  RIF to epigastrium: caudate lobe hepatomegaly

-  RIF to LUQ: splenomegaly

-  Percussion

-  Tympany: obstruction

-  Femoral pulses: coarctation of aorta

-  Genital exam

-  Ambiguious genitalia

-  Vagina

-   Imperforate hymen

-  Penis

-   Patent urethra

-   Hypospadius (ventral urethral meatus)

-   Epispadius (dorsal urethral meatus)

-  Scrotum/testicles

-   Present bilaterally: cryptorchidism

-   Hydrocoele

-   Inguinal hernia

 

Lower Limb

-  Hip Exam (Ortolanis & Barlows): DDH

-  Toes & feet

-  Talipes

-  Dorsal foot oedema: Turners

 

Back

-  Turn infant on back

-  +/- posterior fontanelle

-  Posterior hairline

-  Spinous processes

-  Spina bifida

-  Scoliosis, kyphosis

-  Natal cleft

-  Sinus: normal if floor covered in skin, if not ?spina bidifa occulta

-  Patent anus

-  Passed meconium

-  Imperforate anus

-  Hairy patch/naevus

-  Moros reflex

 

 

 

References

 

Australian Resuscitation Council: Guideline 13.3: Assessment of the Newborn Infant