Physical examination of newborn – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Physical examination of newborn
Physical examination
A physical examination is an evaluation of the body and its functions using inspection, palpation (feeling with the hands),percussion (tapping with the fingers), and auscultation (listening). Acom plete health assessment also includes gatheringinformation about a person’s medical history and 1 ifestyle, doing laboratory tests, and screening to
for disease.
Physical examination of newborn
A complete physical examination is an important part of newborn care. Each body system is carefully examined for signs of health and normal function. The nurse/midwife also looks for any signs of illness or birth defects.
Purposes of newborn examination
1. To understand the physical and wellbeing of child,
2. To detect disease in early stage.
3. To measure the health in future.
4. To determine the cause and effect of disease.
5. To determine the nature of treatment.
6. To ensure the safety from injury and infection.
7. To identify actual and potential health problems.
8. To detect congenital malformations.
Physical assessment of a newborn
Before performing physical examination, the first thing we need to know about the history.
Labor history:
Liquor color
Gestation.
Ruptured of membrane.
Then we need some preparation-
- Informed consent
- Wash hands
- Wash rooms
- Examination completed within 10-15 minutes
Then examination should be done in following steps
First step
1. Observation
- What does the baby look like?
- Flexed limbs.
- Movement.
- Floppy
- Skin well-nourished or meconium staining.
Top to toe examination
Before starting top to toe examination it is best to take the opportunity of a quiet baby to listen heart & lungs first. After auscultation of heart & lungs sound then perform the following examination.
1. Skin: To detect cyanosis, jaundice, pallor, plethora, lanugo hair, vernix, erythema toxicum, dryness, Mongolian spot, lacerations etc.
2. Head: Head should be examined for presence of caput succedaneum, cephalohematoma, molding, forceps marks, any asymmetry enencephalocele, closed suture, bulging fontanels etc.
3. Face: Examined for normal appearance & symmetry of eyes, ears & features during crying, paralysis, swelling & abnormal movements.
4. Eves: Checked for edema, discharge, sub-conjunctival hemorrhage, and color of sclera, congenital cataract, pupillary size & reflex, abnormal placement of eyes.
5. Nose: Nose is examined for patency, low nasal bridge, nasal discharge & flaring ete.
6. Ears: Examined for size & shape, sufficient cartilage & position, skin tags, preauricular sinus etc.
7. Mouth: Check for cleft lip, cleft palate, size of oral opening, natal teeth, tongue tie, blisters, oral infection etc.
8. Neck: Examined for mobility, fracture clavicle, swelling & stiffness, short neck, excessive skin folds & webbing.
9. Chest: Observed for abnormal shape & size, development of nipple & breast tissue should be checked to assess gestational age. Rate & rhythm of respiration, chest retraction & abnormal respiratory sound should be examined. Heart sound should be auscultate for rate, rhythm & abnormal sound.
10. Abdomen: Observed for the shape, distension & auscultation of bowel sound.
11. Umbilical cord should be observed for signs of infection, discharge, redness around insertion, presence of hernia or any congenital anomalies.
12. Genitalia:
- Female baby: To assess whether labia majora covers labia minora & clitoris. Vaginal white mucoid discharge may be found. Also observe the presence of vaginal & urethral orifices.
- Male baby: Full term male baby usually have both testes in scrotal sac & scrotum appears pigmented & markedly wrinkled with rugae, beside this also assess hypospadias, epispadias, phimosis, hydrocele, inguinal hernia.
13. Groin: Assess femoral pulsation, if there is any swelling during crying or palpation baby must be referred for urgent diagnosis.
14. Back: Checked for spinal abnormal, spinal curvature, tufts of hair or skin disruptions indicating spina bifida multa, meningocele & meningomyelocele also observed.
15. Buttocks: Observed for any mass. Perineal area should be examined for anal opening; anal fissures or any other abnormalities.
16. Hips: to detect congenital hip dislocation.
17. Extremities: Extremities are examined for fractures, range of motion & irregular position, polydactyl, syndactyly, club foot etc.
18. Neurological status: Important indicator of neurological development is protective reflex & primitive reflex.
19. Special senses: Neonate should be examined for special senses. The sense of touch is the most highly developed special sense & mostly observed on the lips, tongue, ear & forehead. Hearing occur after the first cry & the infant respond to sound with eye movements. Neonate can smell breast milk & ol search for nipple & mother. Neonates respond to tactile, visual & auditory stimulation, which need to be examined.
Examination the baby’s heart
1. Observation: heart rate, rhythm, quality of heart sounds, active precordium.sa
2. Position of heart: may be determined by auscultation.
3. Listen to the heart sounds carefully and for any added sounds or presence of murmur.
4. Palpate the pulses (femoral) & define whether it’s normal, weak or absent.
5. Check for perfusion.
6. Signs of congestive heart failure: gallop, tachycardia & abnormal pulses.
7. Suspected abnormalities require further examination (and often more expert opinion and investigation).
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