Routine newborn examination

Dr Suresh Victor
Clinical Lecturer and Honorary Consultant
University of Manchester

Routine newborn examination

Purpose
Detection of congenital abnormalities
Identification of actual or potential neonatal problems
Advice / counselling for parents

Limitations
Relatively poor sensitivity and specificity for screening

Timing & number of examinations

Optimum time between 24 to 48 hours
No advantage from two examinations over a
single examination (pre hospital discharge)

Glazener CMA et al. BMJ 1999;318:627-31

Essential history & information

Dates

LMP / EDD / scans - best estimate of

gestation

Past obstetric history

Maternal medical history
Family history (general)
Family history (specific)

Antenatal screening
Blood group & antibodies
Rubella & VDRL / TPHA
Hepatitis B & HIV (if recorded)
AFP / triple test (if done)
Amniocentesis (if done)
Microbiological results (if done)

Antenatal scans
Booking (dates)
Chorionicity if twins
Detailed mid-trimester scan (if done)

Maternal history

Labour & delivery

Mode of delivery
Duration of labour, ruptured
membranes
Complications during labour
Condition at birth / resuscitation
Apgars
Cord gases (if done)
Risk factors for infection

General assessment of the baby

Well or unwell?
Respiratory & circulatory status
State of arousal / responsiveness
Feeding
Jaundice

Growth parameters
Weight, OFC +/- length
Centiles

Maturity / assessment of gestational age

Systematic physical examination

Systematic examination
Cardiovascular
Heart sounds
Pulses (FEMORALS)
Colour & perfusion
(Pulse oximetry?)

Respiratory
Respiratory pattern
Colour (Cyanosis)

Genitourinary
Masses & organomegaly
Umbilicus
Hernial orifices
Genitalia & anus
Mouth & palate

Neurological
Tone, movements & behaviour
Reflexes
Eyes (red reflexes)

Skin & integument

Rashes & markings

Joints & skeletal

Limbs, spine, sacrum, skull
Hips, ankles (talipes)

General assessment
Maturity, measurements & growth
Dysmorphic features

Infant well being

Feeding
Level of arousal
Passage of meconium
Urinary stream (particularly male infant)
Any concerns?

Screening for developmental hip

dysplasia
Universal screening introduced in UK 1969
Based on clinical examination
-

Barlow
Ortolani

National policy reviewed 1986, recommending:

-

Examine at birth and again prior to discharge

Repeat examination at 6 weeks
Continued surveillance until walking

Advice for parents

Health promotion
Infant feeding
Smoking
Reduction of SIDS risk
Sleeping position
Avoid over-heating
Smoking
Screening
Blood spots
Neonatal hearing screening
Other specific tests as appropriate
Immunisations
Questions
Promoting uptake