intro
hi my name is ayesha nd i am the student midwife. i have been asked to undertake the newborn infant physcial examination of your baby. The purpose of this is to do a detailed head tp toe check, specifically focusing babies eyes, heart, hips and genitilia. This can help us to arrange furhter follow up or treatment if required. this examination however does not detect all conditions. is it okay for me to proceed?
history
I would have read the mothers case ntoes before undertaking the examination. i want to be aware of any risk factors from her medical and family medical history as well as her pregnancy and labour. Fro example, I would want to know if the baby was breech position after 36 weeks as I would think about DDH. I also want to gain a hsitory from the paretns to reinstate what i have read on the notes.
considerations
i watn tto ensure privacy for the paretns as we may be talking about confidetnial infromation such as their medical history and findings from the examination. i want to esnru ea warm envionment to maintain baby’s temperature as they will be exposed for the examination. i want to ensure the room is well lit so taht i am able to see properly when examining. Im then going to make sure i have all my equipment prsent, that it is clean and working. before beginning the examination i want to make sure i have the paretns consent and then carry out hand hygeien as well as wearing my PPE. Throughout the examination i will communicate what it is im doing with the parenta and explain that i may need to be quiet when auscultating the heart. i watn to ensur ethe baby is calm throughout and allow time for feedign if baby is hungry.
Observation
Before touching the baby i want ot observe their overall appearacne. i am lokoing at their skin, colour, tone. also looking for any asymmetrical features suhc as their ears or facial palsy whcih could be from a forceps.
Scalp
Im then going to examine the scalp. im looking and feeling for any birth trauma suhc as caput or bruising, im checkign for the sutrue lines and fontanelles. caput succedaneum (subcutaneous oedema which crosses the suture lines) and cephalhaematoma (subperiosteal haemorrhage confined to the skull bones and does not cross suture lines) are benign findings and will resolve. These swellings should not increase in size significantly after birth and the baby should be observed for jaundice.
caput succedaneum
subcutaneous oedema which crosses the suture line. Benign finding and will resolve. these swellings should not increase in size significantly after birth and the baby should be observed for jaundice.
cephalhaematoma
subperiosteal haemorrhage confined to the skull bones and does not cross suture lines. benign finding and will resolve. These swellings should not increase in size significantly after birth and the baby should be observed for jaundice.
Head
Looking and feeling for head shape and size. im measurign the occiputal fronal circumferencce, whch should be 32-27cm for a term baby.
Face
im observing the babys face for symmetry, numbers and any bruising or swelling or unsual features. im checking for facial palsy and checkign that the top third of ear lobe are in line with the eyes. where they are lower set, thsi could be sign of trisomy 18.
eyes
im looking at both eyes at the same time to observe for symmetry, spacing, slant. im checlign that there are two eyes, and examining for epithantic folds which could be normal or indicate trisomy 21 if pther features were present.
nose
deviated septum, chroanal atresia, nasal flaring, cyanpotic nsoe when feeding
mouth
looking for any teeth. i want to check the palate by visual inspection using a light and digital insepction to feel the hard palate. i may feel a bifid uvula whcihd suggests a submucousal palate. i also want ot check that the suclking reflec is present.
