What is a neonatal examination?All babies born in the UK should have an examination within the first few days of life. This includes specific checks of the hips, heart, eyes and, for boys, the testes. The examination usually takes place within 72 hours of birth and again at 6-8 weeks of age.[1] Show
Initial post-delivery examinationA brief screening examination should be conducted checking the face, eyes, mouth, chest, abdomen, spine and limbs to exclude major abnormalities. A strong cry and a widespread pink blush over the face and body are good signs that all is well. Some children may be born with ambiguous genitalia. Ambiguous genitalia is a medical emergency and requires urgent assessment by a paediatrician. If you have sufficient clinical experience, an orogastric tube should be passed when the neonate's mother has suffered polyhydramnios. This excludes oesophageal atresia. The Apgar scoreThe Apgar score gives a reproducible, quantitative, semi-objective assessment of neonatal condition that is useful for assessing a baby's progress or deterioration immediately after delivery. It should be checked at one minute, at five minutes and, if needed, at ten minutes after birth.
Although UK practice still includes recording Apgar scores, it is not recommended that Apgar scoring be used to predict mortality or neurological outcome. Only a small proportion of babies with a very low Apgar score have significant neurodisability.[2] All personnel attending deliveries in the UK are trained in neonatal life support (NLS) and follow the Resuscitation Council UK recommended assessment, which includes checking for colour, tone, breathing and heart rate after drying the baby with a warm towel. This is a better way of assessing the baby’s condition and resuscitation needs rather than the Apgar score. Routine neonatal examinationParent(s) have the right to decline all or part of the newborn and infant examination (NIPE). The reason for declining the examination should be recorded. The examination is increasingly done by NIPE-trained midwives in many hospitals, with much lower numbers being done by paediatricians. The examination may be performed by a GP and primary care team following home births. The recommended recording of the examination is now electronic. A paper copy of the electronic record is printed and attached in the red book for the parent’s benefit. The National Institute for Health and Care Excellence (NICE) recommends that the aims of the examination should be fully explained to the parent(s) before it is conducted. NICE advises that the examination should be carried out within 72 hours of birth and incorporate:[3]
The examination is best conducted in a well-lit, warm, private room with the mother in attendance and able to see and help with what is being done. Suggested schema for screening neonatal examinationFirst wash your hands thoroughly to reduce the risk of cross-infection. Then:
Perform a systematic 'head to toes' examination
Record findings
Other neonatal screening testsSee the separate Newborn Screening article. Common abnormalities detected in the neonatal examination
Abnormalities that may indicate a significant underlying cause
What happens to a newborn immediately after birth?As quickly as possible, a new baby is placed in your arms. Often, the baby is placed skin-to-skin on your chest right after birth. Some babies will breastfeed right away. In the first hour or 2 after birth, most babies are in an alert, wide awake phase.
What are common findings in a newborn assessment?The routine newborn assessment should include an examination for size, macrocephaly or microcephaly, changes in skin color, signs of birth trauma, malformations, evidence of respiratory distress, level of arousal, posture, tone, presence of spontaneous movements, and symmetry of movements.
When examining a postpartum woman the nurse should immediately report?The nurse must report a PPH immediately and prepare for the insertion of a large-bore intravenous catheter, if one is not already present, and the administration of intravenous fluids and oxygen. In the case of an early PPH caused by damage to the birth canal, surgical repair is usually necessary.
Why is it important for a mother to see her newborn right after birth?Skin-to-skin contact improves physiologic stability for both mother and baby in the vulnerable period immediately after birth, increases maternal attachment behaviors, protects against the negative effects of maternal–infant separation, supports optimal infant brain development, and promotes initiation of the first ...
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