Examination of the newborn baby

Examination at birth Aim Objectives 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 Teaching Aids: ENC EN- 2

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 ! Teaching Aids: ENC EN- 3

Principles of examination Assess Ask, Check, Record Look, Listen, Feel Classify Treat or advise Teaching Aids: ENC EN- 4

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 Teaching Aids: ENC EN- 5

Assess: Look for Teaching Aids: ENC EN- 6

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

Assess: Look for Single umbilical artery Simian crease Dysmorphic features Excessive drooling of saliva Teaching Aids: ENC EN- 8

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

Grunting, Cry, Heart sounds Assess: Listen for Grunting, Cry, Heart sounds Teaching Aids: ENC EN- 10

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 Teaching Aids: ENC EN- 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 Teaching Aids: ENC EN- 12

Temperature At birth-warmth, keep the baby in skin to skin contact with the mother Teaching Aids: ENC EN- 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 Teaching Aids: ENC EN- 14

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 Teaching Aids: ENC EN- 15

Examination within 24 hours Assess Ask, Check, Record Look, Listen, Feel Classify Treat or advise Teaching Aids: ENC EN- 16

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 Teaching Aids: ENC EN- 17

Assess: Look for 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 Teaching Aids: ENC EN- 18

Assess: Listen for Grunt Cry Auscultation of heart Teaching Aids: ENC 19

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

Record Findings Normal Abnormal Heart rate Respiratory rate Retractions Color Temperature Feeding Weight Teaching Aids: ENC EN- 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 Teaching Aids: ENC EN- 22

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

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

Danger signs Floppy or stiff Not feeding well Temperature >37.50C or <35.50C Umbilicus draining pus or umbilical redness extending to skin. >10 skin pustules Bleeding from umbil. Stump Not feeding well Less active than before Fast breathing (>60/ min) Moderate or severe chest in-drawing Grunting Convulsions Teaching Aids: ENC EN- 25

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 Teaching Aids: ENC EN- 26

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 Teaching Aids: ENC EN- 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 Teaching Aids: ENC EN- 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 Teaching Aids: ENC EN- 29

R E T A C I O N S Teaching Aids: ENC EN- 30

Caput succedaneum vs. cephalohematoma Normal vs. Abnormal Teaching Aids: ENC EN- 31

The umbilicus: Which one is normal? Normal vs. Abnormal Teaching Aids: ENC EN- 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 days No discharge LOCAL UMBILICAL INFECTION RED umbilicus or RED skin around the umbilicus POSSIBLE SERIOUS INFECTION Umbilicus draining pus or Umbilical redness, swelling extending to skin Teaching Aids: ENC EN- 33

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

Skin pustules Locate ? Teaching Aids: ENC EN- 35

Skin Refer this baby urgently Less than 10 are a local skin infection 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 immediately Teaching Aids: ENC EN- 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. Teaching Aids: ENC EN- 37

The normal resting posture of a baby born breech Teaching Aids: ENC EN- 38

ABNORMAL position of arm and hand Teaching Aids: ENC EN- 39

Color of the baby Normal vs. Abnormal Teaching Aids: ENC EN- 40

Color of the baby Normal vs. Abnormal Teaching Aids: ENC EN- 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? Teaching Aids: ENC EN- 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? Teaching Aids: ENC EN- 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