Download - Examination of the newborn baby
Examination of the newborn baby
Examination at birth
Aimo To describe and carry out an examination of a
baby soon after birth
Objectiveso To screen for malformations o To observe smooth transition to extra uterine lifeo An asses overall of baby’s condition
EN-Teaching Aids: ENC 2
Examination of the newborn baby
Minimum prerequisiteso Mother & baby togethero Warm room, fresh clean sheet/clotheso Thermometer o Weighing scaleo Watch with secondso Stethoscope
Eyes see what the mind knowsSkilled , knowledgeable health professional !
EN-Teaching Aids: ENC 3
Principles of examination
Assess Ask, Check, Record Look, Listen, Feel
Classify
Treat or advise
EN-Teaching Aids: ENC 4
Examination at birth: Assess
Ask o Antenatal details Antenatal visits – TT, Iron-folate supplementation,
HIV/Syphilis screeningExposure to teratogens, infectionsPoly or oligohydramnios
o Postnatal details: Condition at birth; resuscitation, Single umbilical artery ,excessive drooling
Checko Weigh the babyo Temperature
Record
EN-Teaching Aids: ENC 5
Assess: Look forLook for
EN-Teaching Aids: ENC 6
Assess: Look forLook for
Quick screening for malformationsQuick screening for malformationsScreen from top to bottom, midline, and back
examination
Orifice examination Anal opening
EN-Teaching Aids: ENC 7
Assess: Look forLook for
Single umbilical artery
Simian crease
Dysmorphic features
Excessive drooling of saliva
EN-Teaching Aids: ENC 8
Assess: Look forLook for
Look for abnormal swelling
Abnormality of limbs & spine
Eyes, ears, umbilicus
ObserveBreathing rate / pattern
Color
Heart rate
Activity- feeding , movements
EN-Teaching Aids: ENC 9
Assess: Listen forListen for
Grunting, Cry, Heart sounds
EN-Teaching Aids: ENC 10
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
Assess: Feel forFeel for
EN-Teaching Aids: ENC 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
Scale maintenance Calibrate daily Clean the scale pan between each
weighing
EN-Teaching Aids: ENC 12
Temperature At birth-warmth, keep the baby in skin to
skin contact with the mother
EN-Teaching Aids: ENC 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 36.5ºC-37.5ºC
EN-Teaching Aids: ENC 14
Examination within 24 hours
Objective To describe and carry out an examination of a baby
within 24 hours of birth
AimTo ensure that malformations are detectedTo ensure establishment of breast feeding ;
maintenance of temperature ;classify baby as normal or abnormal
EN-Teaching Aids: ENC 15
Assess Ask, Check, Record Look, Listen, Feel
Classify Treat or advise
EN-Teaching Aids: ENC 16
Examination within 24 hours
Examination at 24 hrs: Assess
Ask o Breastfeeding o Activity of the babyo Any other problems*
Checko Weigh the babyo Temperature
Record
EN-Teaching Aids: ENC 17
•Passage of meconium up to 24 hrs and urine up to 48 hrs of life is usually normal
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
Assess: Look Look for for
EN-Teaching Aids: ENC 18
Grunt Cry Auscultation of heart
Assess: Listen Listen for for
EN-Teaching Aids: ENC 19
Femoral pulse CRT Temperature by touch Descent of testis Depth or extent of jaundice Feel for abdomen Confirm findings of inspection
Assess: Feel Feel for for
EN-Teaching Aids: ENC 20
Record
Findings Normal Abnormal
Heart rate
Respiratory rate
Retractions
Color
Temperature
Feeding
Weight
EN-Teaching Aids: ENC 21
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
EN-Teaching Aids: ENC 22
Discharge from eyes , umbilicus
Breathing difficulty Breast feeding-
exclusivity and adequacy
Jaundice
Assess: Look Look for for Listen for
Auscultation of heart
EN-Teaching Aids: ENC 23
Temperature by touch Depth or extent of jaundice Confirm findings of inspection, if any
Assess: Feel Feel for for
EN-Teaching Aids: ENC 24
Danger signs
EN-Teaching Aids: ENC 25
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
Examination on follow-up
AimTo 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
EN-Teaching Aids: ENC 26
Normal: feeding behaviour
Positioningo Head in line with bodyo Well supportedo Abdomen touches the
mother abdomeno Turned to the mother
Attachmento Mouth wide openo Lower lip evertedo Little areola visibleo Chin touches mother breast
Assessment of feeding adequacy
EN-Teaching Aids: ENC 27
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
EN-Teaching Aids: ENC 28
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 (<2.5 kg or born before 37 wks gestation) may: Have some mild chest in-drawing Periodically stop breathing for a few seconds
EN-Teaching Aids: ENC 29
RREETTRRAACCTTIIOONNSS
EN-Teaching Aids: ENC 30
Caput succedaneum vs. cephalohematoma
Normal vs. Abnormal
EN-Teaching Aids: ENC 31
The umbilicus: Which one is normal?
Normal vs. Abnormal
EN-Teaching Aids: ENC 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 daysNo discharge
LOCAL UMBILICAL INFECTIONRED umbilicus or RED skin around the umbilicus
POSSIBLE SERIOUS INFECTIONUmbilicus draining pus or Umbilical redness, swelling extending to skin
EN-Teaching Aids: ENC 33
Skin conditions: Which baby will you treat?
Normal vs. Abnormal EN-Teaching Aids: ENC 34
Skin pustules
Locate ? EN-Teaching Aids: ENC 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 immediatelyEN-Teaching Aids: ENC 36
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.
EN-Teaching Aids: ENC 37
The normal resting posture of a baby born breech
EN-Teaching Aids: ENC 38
ABNORMAL position of arm and hand
EN-Teaching Aids: ENC 39
Color of the baby
Normal vs. Abnormal EN-Teaching Aids: ENC 40
Color of the baby
Normal vs. Abnormal EN-Teaching Aids: ENC 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?
EN-Teaching Aids: ENC 42
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?
EN-Teaching Aids: ENC 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