Examination of the newborn baby



Examination of the newborn baby

الدكتور عبد المهدي عبد الرضا حسن

كلية التمريض / جامعة بابل

PhD, pediatric & Mental Health Nursing

Examination at birth

Aim

To describe and carry out an examination of a baby soon after birth

Objectives

To screen for malformations

To observe smooth transition to extra uterine life

An asses overall of baby’s condition

Examination of the newborn baby

Minimum prerequisites

Mother & baby together

Warm room, fresh clean sheet/clothes

Thermometer

Weighing scale

Watch with seconds

Stethoscope

Principles of examination

Assess

Ask, Check, Record

Look, Listen, Feel

Classify

Treat or advise

Examination at birth: Assess

Ask

Antenatal details

Antenatal visits – TT, Iron-folate supplementation, HIV/Syphilis screening

Exposure to teratogens, infections

Poly or oligohydramnios

Postnatal details: Condition at birth; resuscitation, Single umbilical artery ,excessive drooling

Check

Weigh the baby

Temperature

Record

Assess:

Look for

Assess:

Look for

Quick screening for malformations

Screen from top to bottom, midline, and back examination

Orifice examination

Anal opening

Assess:

Look for

Single umbilical artery

Simian crease

Dysmorphic features

Excessive drooling of saliva

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

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

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

Breastfeeding

Activity of the baby

Any other problems*

Check

Weigh the baby

Temperature

Record

Color

Skin

Discharge from eyes, umbilicus

Count respiratory rate

Chest retractions

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

Head in line with body

Well supported

Abdomen touches the mother abdomen

Turned to the mother

Attachment

Mouth wide open

Lower lip everted

Little areola visible

Chin touches mother breast

Assessment of feeding adequacy

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

Small babies ( ................
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