Examination of The Newborn Baby

Examination of the newborn baby
Examination at birth
Aim
o
To describe and carry out an examination of a baby soon after birth To screen for malformations To observe smooth transition to extra uterine life An asses overall of babys condition
Objectives
o o
Teaching Aids: ENC
EN- 2
Examination of the newborn baby

Minimum prerequisites
o o o o o o
Mother & baby together Warm room, fresh clean sheet/clothes Thermometer Weighing scale Watch with seconds Stethoscope
Eyes see what the mind knows Skilled , knowledgeable health professional !
Teaching Aids: ENC EN- 3
Principles of examination
Assess

Ask, Check, Record Look, Listen, Feel
Classify Treat or advise

EN- 4
Teaching Aids: ENC
Examination at birth: Assess

Ask
o Antenatal details Antenatal visits TT, Iron-folate supplementation, HIV/Syphilis screening Exposure to teratogens, infections Poly or oligohydramnios o Postnatal details: Condition at birth; resuscitation, Single umbilical artery ,excessive drooling
Check
o Weigh the baby o Temperature
Record
Assess: Look for
Teaching Aids: ENC
EN- 6
Assess: Look for

Quick screening for malformations
Screen from top to bottom, midline, and back examination Orifice examination
Anal opening
Teaching Aids: ENC
EN- 7
Assess: Look for

Single umbilical artery Simian crease Dysmorphic features Excessive drooling of saliva
Teaching Aids: ENC
EN- 8
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
Grunting, Cry, Heart sounds

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
Teaching Aids: ENC
EN- 11
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 Calibrate daily Clean the scale pan between each weighing
EN- 12
Scale maintenance

Teaching Aids: ENC
Temperature
At birth-warmth, keep the baby in skin to skin contact with the mother
Teaching Aids: ENC
EN- 13
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 36.5C-37.5C
EN- 14
Teaching Aids: ENC
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
Teaching Aids: ENC
EN- 15
Examination within 24 hours
Assess

Ask, Check, Record Look, Listen, Feel
Classify Treat or advise
Teaching Aids: ENC
EN- 16
Examination at 24 hrs: Assess

Ask
o Breastfeeding o Activity of the baby o Any other problems*
Check
o Weigh the baby o Temperature
Record
Passage of meconium up to 24 hrs and urine up to 48 hrs of life is usually normal
Assess: Look for

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
Teaching Aids: ENC
EN- 18
Assess: Listen for

Grunt Cry Auscultation of heart
Teaching Aids: ENC
EN- 19
Assess: Feel for
Femoral pulse CRT Temperature by touch Descent of testis Depth or extent of jaundice Feel for abdomen Confirm findings of inspection
Teaching Aids: ENC
EN- 20
Record
Findings
Heart rate Respiratory rate Retractions Color Temperature Feeding Weight
Normal
Abnormal
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
Assess: Look for
Listen for
Discharge from eyes , umbilicus Breathing difficulty Breast feedingexclusivity and adequacy Jaundice
Auscultation of heart
Teaching Aids: ENC
EN- 23
Assess: Feel for
Temperature by touch Depth or extent of jaundice Confirm findings of inspection, if any
Teaching Aids: ENC
EN- 24
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
EN- 25
Teaching Aids: ENC
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
Teaching Aids: ENC
EN- 26
Normal: feeding behaviour
Positioning
o o o o
Head in line with body Well supported Abdomen touches the mother abdomen Turned to the mother Mouth wide open Lower lip everted Little areola visible Chin touches mother breast
Attachment
o o o o
Assessment of feeding adequacy

EN- 27
Teaching Aids: ENC
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 Have some mild chest in-drawing Periodically stop breathing for a few seconds
Small babies (<2.5 kg or born before 37 wks gestation) may:

Teaching Aids: ENC
EN- 29
R E T R A C T I O N
S
Caput succedaneum vs. cephalohematoma
Teaching Aids: ENC
Normal vs. Abnormal

EN- 31
The umbilicus: Which one is normal?
Teaching Aids: ENC
Normal vs. Abnormal

EN- 32
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 days No discharge LOCAL UMBILICAL INFECTION
RED
umbilicus or RED skin around the umbilicus
POSSIBLE SERIOUS INFECTION Umbilicus draining pus or Umbilical redness, swelling extending to skin
Teaching Aids: ENC
EN- 33
Skin conditions: Which baby will you treat?
Teaching Aids: ENC
Normal vs. Abnormal
EN- 34
Skin pustules
Teaching Aids: ENC
Locate ?
EN- 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 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.
Teaching Aids: ENC
EN- 37
The normal resting posture of a baby born breech
Teaching Aids: ENC
EN- 38
ABNORMAL position of arm and hand
Teaching Aids: ENC
EN- 39
Color of the baby
Teaching Aids: ENC
Normal vs. Abnormal

EN- 40
Color of the baby
Teaching Aids: ENC
Normal vs. Abnormal

EN- 41
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?
Teaching Aids: ENC
EN- 43
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

Examination of The Newborn Baby

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Examination of the newborn baby

Teaching Aids: ENC