1. The Baby Check

2. Newborn and Infant Examination
Newborn examination - undertaken no later than 72 hours after birth.
The physical examination is repeated at approximately 6-8 weeks of age 
The examinations tailored to patients needs
Must review relevant issues:
Family history
Mother's pregnancy, the birth
Antenatal screening outcomes
When baby 1st PU and BO
The baby's development, feeding patterns, weight, alertness and general wellbeing
Any aspects of their baby that might be worrying the parent

3. New born and Infant examination
Top to toe examination
Also involves 4 screening examination
Eyes
Heart
Hips
Testes

4. Newborn and Infant Examination
Appearance including colour, breathing, behaviour, activity and posture
Head (including fontanelles)
face, nose, mouth including palate, ears, neck and general symmetry of head and facial features.
Measure and plot head circumference
Eyes - opacities and red reflex
Neck and clavicles, limbs, hands, feet and digits; assess proportions and symmetry
Heart
position, heart rate, rhythm and sounds, murmurs and femoral pulse volume
Lungs
effort, rate and lung sounds
Abdomen
shape and palpate to identify any organomegaly; also check condition of umbilical cord
Genitalia and anus
completeness and patency and undescended testes in males
Spine
inspect and palpate bony structures and check integrity of the skin
Skin
note colour and texture as well as any birthmarks or rashes
Central nervous system
observe tone, behaviour, movements and posture. Elicit newborn reflexes
Hips
symmetry of the limbs and skin folds (perform Barlow and Ortolani’s manoeuvres)
NICE Guideline CG

5. Screening Examinations

6. Eyes
About 200 children a year are born in the UK with congenital cataract in one or both eyes
Only one fifth of these 200 have a family history of cataracts
Cataract is the largest treatable cause of visual loss in childhood in the UK
Associated risk factors include:
low birth weight <1500g
low gestational age <32 weeks
family history of any eye disorder of childhood onset including congenital cataract, glaucoma and retinoblastoma
maternal infections during pregnancy e.g. Rubella, toxoplasmosis, herpes simplex virus (HSV)

7. Eyes
Screen +ve
The absence of any reflex suggests presence of a congenital cataract
A white reflex (leukocoria) is suggestive of tumour of the eye (retinoblastoma)
Other abnormal findings include:
abnormalities of the iris
small or absent eye

8. Eyes +ve Results @ Newborn check @ 8 Week Check
Refer for expert consultation
To be seen by 2 weeks of age
@ 8 Week Check
Refer for expert opinion
To be seen by 11 weeks of age

9. Heart Congenital cardiac defects are a leading cause of infant death
Critical or serious congenital cardiac malformations are found in
approximately 6-8 in 1,000 newborn babies
Associated risk factors include:
family history of congenital heart disease
maternal conditions such as diabetes, systemic lupus erythematosus (SLE)
exposure to rubella during the first trimester of pregnancy,
Some medications taken during pregnancy e.g. Lithium
Syndromes Down’s, Noonan’s and Marfan’s
A proportion of major cardiac lesions may be identified during the fetal anomaly scan

10. Heart Screen +ve findings Tachypnoea at rest
Episodes of apnoea lasting longer than 20 seconds or associated with colour change
Increased work of breathing.
Central cyanosis
Visible pulsations over the precordium, heaves, thrills
Presence of murmurs/extra heart sounds
significant murmurs are usually loud
heard over a wide area
have a harsh quality
associated with other abnormal findings
benign murmurs are typically short, soft, systolic, localised to the left sternal border, have no added
Absent or weak femoral pulses

11. Heart Response to +ve finding @ New born examination @ 8 Week Check
Discuss with appropriate expert
Urgency will depend on circumstances
Measure pre and post ductal arterial O2 sats (pulse oximetry) within 4 hours
@ 8 Week Check
Discuss with appropriate expert at the time of the examination

12. Hips
Approximately 1-2 in 1000 babies have a hip problem that requires treatment
Major associated risk factors include:
a first degree family history of hip problems in early life
breech presentation at 36 weeks of pregnancy, irrespective of presentation at delivery and mode of delivery
breech delivery if earlier than 36 weeks
Multiple births, if any of the above risk factors are present, all babies should be referred for
Undetected DDH or delayed treatment may result in significant morbidity
Early diagnosis and intervention improve health outcomes and reduce the need for surgical intervention

13. Hips Screen +ve test Difference in leg length
Knees at different levels when hips and knees are bilaterally flexed
Difficulty in abducting the hip to 90 degrees
Palpable ‘clunk’ when undertaking either the Ortolani or Barlow manoeuvres

14. Hips Response to +ve Screening test @ New born Exam
Abnormal examination
Refer for
urgent ultrasound
expert clinical consultation
To be seen by 2 weeks of age
Normal examination but has risk factors
Refer for Uss Hip – completed by 6 weeks of age

15. Testes
Cryptorchidism affects approximately 2-6% of male babies born at Term
Associated risk factors include:
a first degree family history (father or sibling) of cryptorchidism
low birth weight
small for gestational age or pre-term delivery
Cryptorchidism is significant as it is associated with:
a significant increase in the risk of testicular cancer (primarily seminoma)
reduced fertility when compared with descended testes
May also be associated with other urogenital problems such as hypospadias and testicular torsion
Early diagnosis and intervention improves fertility and may aid earlier identification of testicular cancer

16. Testes
The absence of one or both testes in the scrotal sac is a screen positive finding
Bilateral undescended testes in the newborn may be associated with an underlying endocrine disorders

17. Testes @ New Born Check If Bilateral undescended testes
To be seen by a senior paediatrician within 24 hours of the examination
If Unilateral undescended testis
Review at 6-8 week examination
@ 6-8 week check
To be seen by a senior paediatrician within 2 weeks
If Persistent unilateral undescended testis
GP to review between 24-30weeks of age
Testis still absent -Refer to surgeon (Should be seen no later than 13 months)

18. References NHS E-Learning module – Video + Reference sheets