Newborn Check

Reference

• Newborn Check - HNE PAthways

Birth History

• Pregnancy

• Birth

• Early neonatal period

• Check if the mother had 6/52 check

Screen for Adverse Childhood Experience (ACE)

• Physical, emotional, or sexual abuse

• Neglect

• Parent or carer substance abuse or mental health

• One or no parents

• Parental incarceration

• Intimate partner violence

• Housing instability

• Foster care

• For refugees consider trauma

Look for protective families

• Parenting training programs

• Family and community support

• Support programs for teenage pregnancy

• Mental health support

Family medical history

• Who the baby lives with

• Health issues in siblings, parents

  • Congenital cardiac

  • Hearing

  • Kidney

  • Hip

• Social support and psychosocial risk factors including D+A

Ask about

• Feeding

  • Breast or bottle

  • Timing, frequency and tolerance

  • Volume and concentration of formula

  • Plans for introduction of solid

• Nappies

  • Concerns about urine or stools

  • Can vary from one per nappy to once per week

• Vomit and posset

  • Possets

    • Effortless

    • Common and peak at 67% at 4 months

    • 50% of <3 months have at least 1 per day

    • 5% have at 12 months

    • In isolation, possets are not GORD

  • GORD

    • Pronounced irritability

    • REfusal to feed

    • Weight loss

    • Haematemesis

    • Chronic cough and wheeze

    • Apnoea

• Sleep

  • Sleep-wake cycle develops over 3 months, at first babies do not recognise night from day

  • Short sleep cycles and need time to learn how to transition between sleep and self settle

  • Newborns aged up to about 2 months wake for feed every 3 to 4 hour overnight

• Crying or settling

  • Most infants go through a stage of increased crying

  • Starts to increase at age 2 weeks, peaks at 2 months, then reduces at about 4 to 5 months

  • Usually worse in the afternoon or evening

  • An infant may draw up their legs as if in pain but there is no evidence that excessive crying is causes by intestinal problems or wind

  • The Period of Purple Crying

• Development

  • Age 4 weeks babies fix on faces and begin to startle at noise

  • AGe 4 to 8 weeks babies learn to smile, start to vocalise, fix and follow with their eyes and raise their head briefly when prone

Examination

• Assess infant - carer relationship

  • How carer describes their child

  • Tone of voice, affect, and facial exprssions

  • How satisfied with their role as carer

  • Observe interactions

  • Eye contact, touch

  • Ask how the carer interprets their babies unsettledness

• Observe

  • Looking at faces, smiliing, tracking faces

  • Syndromes

  • Tone of limbs, moving and symmetrical

  • Jaundice

• Measure

  • Length, Weight, BMI and HC

• Head

  • Common

    • Moulding (over riding of cranial bones is noth at birth and resolves day 5)

    • Scalp swelling

  • Normal

    • Caput succedaneum (resolves 48 hours)

    • Cephalhaematoma

      • Swelling limited by suture lines

      • Often associated with difficult births with forceps or vacuum

      • Can worsen over 48 hours and takes months to resolve

      • Increases risk of neonatal jaundice

  • Abnormal

    • Subgalael haemorrhage

      • Less common, requires careful monitoring and treatment post-birth, resolves over 2 t o3 weeks

      • Associated with difficult births and coagulopathy

      • Deep haematoma that crosses the midline

    • Encaephalocoele

      • Midline swelling

      • Increases in size and crying

      • May disrupt hair growth

    • Plagiocephaly

• Fontanelle

  • Size and position

  • Palpate - should be soft and pulsatile

  • Bulging can occur with crying or raised ICP

  • Anterioe closes around 18 months and generally not before 10 months

  • Posterior can close by 2 months and not alwasy felt

• Ears

  • Low Set

    • Pinna below medial canthus can be Trisomy 21

  • Microtia (small)

    • CHARGE syndrome

    • Hearing loss

  • Pre-auricular tags

    • May be linked to hearing loss and syndromes

• Nose

  • Check patency with stethoscope

• Mouth

  • Cleft lip and palate

  • Micrognathia

  • Bifid uvula

  • Tongue tie

  • Neonatal teeth

  • Suck blisters

  • Thrush

• Eyes

  • Discharge

  • Blocked tear ducts, sticky yellow non-purulent secretions form the nasolacrimal duct, common

  • Conjunctivitis, less common and can be chlamydia / gonorrhoea

  • Corneal light reflexes

  • White pupils (cataract)

  • Fiation and tracking

  • Cover response

  • Nystagmus

• Neck

  • Congenital torticollis

  • Webbed neck in Turner’s

  • Neck lumps

    • Cystica hygroma

    • Thyroglossal duct

    • Crachial cyst

    • SCM tumours

• Cardiovascular

  • Cyanosois

  • Consider puloximetry

  • Murmurs

  • Femoral pulses

• Skin

  • Jaundice

  • Rashes

  • Haemangiomas

  • Birthmarks

• Abdomen, umbilicus, anus

  • Observe shape of abdomen

  • Masses

  • Hernia

  • Patent anus

  • Umbilicus clean

• Genitalia

  • Ambiguous genitalia

  • Inguinal hernia

  • Testes

  • Hydrocele

  • Hypospadius

• MSK

  • Digits

  • Palms

  • Distal upper limb

  • Feet

  • Hips

• Neuro

  • Moro

  • Grasp

  • Suck

  • Rooting

  • Placing and stepping

Complete Blue Blood