Examination of the newborn baby

1. Examination of the newborn baby

2. 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 2 EN-

3. Examination of the newborn baby Minimum prerequisites • 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 ! 3 EN-

4. Principles of examination • Assess • Ask, Check, Record • Look, Listen, Feel • Classify • Treat or advise 4 EN-

5. 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 5 EN-

6. Assess: Look for 6 EN-

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

8. Assess:Look for • Single umbilical artery • Simian crease • Dysmorphic features • Excessive drooling of saliva 8 EN-

9. Look for abnormal swelling Abnormality of limbs & spine Eyes, ears, umbilicus Observe Breathing rate / pattern Color Heart rate Activity- feeding , movements Assess: Look for 9 EN-

10. Assess:Listen for • Grunting, Cry, Heart sounds 10 EN-

11. 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 11 EN-

12. 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 12 EN-

13. Temperature • At birth-warmth, keep the baby in skin to skin contact with the mother 13 EN-

14. 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 14 EN-

15. 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 15 EN-

16. Examination within 24 hours • Assess • Ask, Check, Record • Look, Listen, Feel • Classify • Treat or advise 16 EN-

17. Examination at 24 hrs: Assess Ask • Breastfeeding • Activity of the baby • Any other problems* Check • Weigh the baby • Temperature Record • Passage of meconium up to 24 hrs and urine up to 48 hrs of life • is usually normal 17 EN-

18. 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 for 18 EN-

19. Assess: Listen for • Grunt • Cry • Auscultation of heart 19 EN-

20. Assess: Feel for • Femoral pulse • CRT • Temperature by touch • Descent of testis • Depth or extent of jaundice • Feel for abdomen • Confirm findings of inspection 20 EN-

21. Record 21 EN-

22. 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 22 EN-

23. Discharge from eyes , umbilicus Breathing difficulty Breast feeding- exclusivity and adequacy Jaundice Assess: Look for Listen for • Auscultation of heart 23 EN-

24. Assess: Feel for • Temperature by touch • Depth or extent of jaundice • Confirm findings of inspection, if any 24 EN-

25. Danger signs • Not feeding well • Less active than before • Fast breathing (>60/ min) • Moderate or severe chest in-drawing • Grunting • Convulsions 25 EN- 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

26. 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 26 EN-

27. 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 27 EN-

28. 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 28 EN-

29. 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 29 EN-

30. R E T R A C T I O N S 30 EN-

31. Caput succedaneum vs. cephalohematoma • Normal vs. Abnormal 31 EN-

32. The umbilicus: Which one is normal? • Normal vs. Abnormal 32 EN-

33. Umbilicus 33 EN-

34. Skin conditions: Which baby will you treat? • Normal vs. Abnormal 34 EN-

35. Skin pustules Locate ? 35 EN-

36. Skin A baby may have PUSTULES MOREthan10are aDANGER SIGN • Refer this baby urgently Lessthan10are alocal skin infection • Treat them immediately 36 EN-

37. 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. 37 EN-

38. The normal resting posture of a baby born breech 38 EN-

39. ABNORMAL position of arm and hand 39 EN-

40. Color of the baby • Normal vs. Abnormal 40 EN-

41. Color of the baby • Normal vs. Abnormal 41 EN-

42. 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? 42 EN-

43. 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? 43 EN-

44. 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