Newborn Baby Assessment

Baby check at birth and 6 weeks 

Check notes and get equipment ready:  

Measuring tape.

Ophthalmoscope

Sats probe.

In notes, look at full details of pregnancy and birth, including Apgar scores at 1 and 5 minutes.

Observation:

Colour: pink/red, pale, jaundiced.

Any rash? Erythema toxicum is a self-limiting rash of red papules and vesicles, surrounded by red blotches which sometimes give a halo appearance. Usually occurs between 2 days and 2 weeks.

Behaviour and mood.

Movements.

Face: dysmorphism?

Head:

Feel fontanelle (bulging? sunken?) and sutures. Note that posterior fontanelle closes at 1-2 months, and anterior at 7-19 months.

Measure circumference at widest point; take the highest of 3 measurements. Looking for hydrocephalus and microcephaly.

Eyes: check red reflex with ophthalmoscope.

Feel inside top of mouth with little finger for cleft palate. Also gives you the sucking reflex.

Inspect ears to see if they are low-set (below eye level), have any tags or lumps, and check behind the ears.

Chest and abdomen:

Auscultate for air entry and murmurs.

Palpate abdomen, including for organomegaly. Palpable liver is normal.

Note any discharge or erythema around the umbilicus. Not so worrying if it's on the cord.

Pelvis:

Remove nappy.

Palpate for femoral pulses on both sides. Helps to hold leg straight. Absence may suggest coarctation.

Check genitalia are normal. Feel testicles are descended in boys.

Look for position of anus, ensuring it is not too far forward or is imperforate.

Limbs:

Check hands for single palmar crease, and count digits.

Check for grasp reflex by placing finger in palm.

Apply sats probe to foot ('post-ductal') to check for heart disease. ≥97% is fine. If 95-96%, measure right hand sats ('pre-ductal'), and if difference ≤3%, no action needed. If sats <95% or hand-foot difference ≥3%, investigate further.

Check for developmental dysplasia of the hips. Are they dislocatable – can push them posteriorly – or dislocated – can bring them back in anteriorly?

Check for clubbed foot i.e. internally rotated.

Turn the baby over, either in cot or lift them up:

Check spine is straight. Marks at base of spine – e.g. tuft of hair, meningocele – suggests spina bifida.

Important to check everywhere for birthmarks and skin lesions (and document them), as 'new' bruises at a later stage may lead to child protection concerns.

Assess tone of baby when held up in ventral suspension i.e. hand under abdomen, baby facing down.

Moro reflex: drop back quickly, checking for arm extension.

Things to ask about at 6 weeks:

Feeding

Weight

Growth

Thriving: smiling.

Paediatric screening test

Process:

Heel prick on the 5th day.

Results are reported in 6-8 weeks then stored for 5 years.

Not 100% sensitive, but pretty high for most, especially sickle cell.

Diseases:

Checks for 9 diseases, CH2A2M2PS: Cystic fibrosis, Hypothyroidism, Homocystinuria, glutaric Acidaemia type 1, isovaleric Acidaemia, MCADD, Maple syrup urine disease, PKU, Sickle cell.

PKU is an autosomal recessive phenoxyalanine hydroxylase deficiency, leading to an inability to breakdown the amino acid phenoxyalanine. High levels can be neurotoxic and cause cognitive impairment, so it should be eliminated from the diet.

MCADD is an autosomal recessive enzyme deficiency leading to difficulty in breaking down fats. Presents with hypoglycemic episodes, often during illnesses. Modify diet to reduce risk of cognitive impairment.

Universal newborn hearing screening

Carried out in the first few weeks.

Otoacoustic emission test → if not passed, audiological brainstem response test.

Abnormalities found in 1/500.