Examination of the newborn: a systematic bedside assessment
Newborn examination confirms transition to extrauterine life, identifies congenital anomalies, detects birth injury and infection, assesses feeding and establishes a baseline for follow-up. It must be performed after immediate stabilisation, in a warm environment, with the baby observed before handling and the mother involved.
A sick newborn may deteriorate rapidly: check breathing, colour, tone, temperature, glucose and feeding before completing the full examination.
Preparation and sequence
- Hand hygiene, warm room, good light, clean equipment and consent.
- Confirm identity, sex, birth time, gestation, birth weight, Apgar, resuscitation, maternal illness, drugs, blood group and infection risks.
- Observe posture, tone, colour, breathing, cry, activity, feeding and interaction before disturbing the baby.
- Perform general examination, measurements, head-to-toe examination, systems review, hips, spine, genitalia and neurological assessment.
- Rewarm, support feeding and document findings with a plan for follow-up.
Measurements and vital signs
| Measure | Technique/interpretation |
|---|---|
| Weight | Calibrated scale, naked or dry nappy; classify low birth weight and plot against gestation |
| Length | Recumbent length board with two people where possible |
| Head circumference | Non-stretch tape above eyebrows and around occiput; repeat if abnormal |
| Temperature | Axillary measurement with validated device; hypothermia and fever are both significant |
| Respiratory rate | Count full minute when quiet; note grunting, nasal flaring, indrawing, pauses |
| Heart rate/perfusion | Count, assess femoral pulses, capillary refill, colour and blood pressure when indicated |
General inspection
Assess maturity, size, proportionality, posture, tone, spontaneous movement, cry and consolability. Look for dysmorphic features, birth trauma, bruising, petechiae, pallor, jaundice, cyanosis, oedema, rash, dehydration, congenital anomalies and signs of infection. Note whether the baby is alert and feeding or unusually sleepy, irritable or floppy.
Head and face
- Inspect scalp swelling: caput crosses sutures; cephalohaematoma is confined by sutures; subgaleal haemorrhage is diffuse, fluctuant and potentially rapidly fatal.
- Palpate sutures and fontanelles; tense fontanelle with illness may indicate raised intracranial pressure.
- Assess facial symmetry, eyes, red reflex, pupils, mouth, palate, tongue, suck, nostrils and ears.
- Look for choanal obstruction, cleft palate, micrognathia, macroglossia and cranial nerve abnormalities.
Chest and cardiovascular system
Inspect respiratory effort and symmetry. Auscultate both lungs for air entry, crackles, wheeze or asymmetry. Check precordium, apex, heart sounds, murmurs, femoral pulses, perfusion and signs of heart failure. A murmur may be transitional, but cyanosis, weak femoral pulses, poor feeding, tachypnoea or shock requires urgent evaluation for critical congenital heart disease.
Abdomen, cord and genitourinary system
Inspect distension, veins, hernias and cord vessels. Palpate liver, spleen, kidneys and masses. Bilious vomiting, absent bowel sounds, distension or failure to pass meconium suggests obstruction. Examine anus for patency. Inspect genitalia for sex-development variation, hypospadias, undescended testes, ambiguous genitalia and scrotal swelling; do not assign blame or make rushed assumptions.
Musculoskeletal and neurological examination
- Inspect limbs, digits, clubfoot, fractures, brachial-plexus injury and movement symmetry.
- Perform Ortolani and Barlow manoeuvres gently when trained; assess risk factors for developmental dysplasia.
- Inspect spine and sacrum for dimples, tufts, masses and curvature.
- Assess tone, alertness, posture and primitive reflexes: rooting, sucking, Moro, grasp and stepping.
- Observe cry, consolability and response to handling; asymmetry or persistent hypotonia needs evaluation.
Skin and jaundice
Describe colour and lesions, blanching, distribution and timing. Jaundice in the first 24 hours, rapidly rising jaundice, pale stools, dark urine, anaemia, lethargy or poor feeding is urgent. Transcutaneous or serum bilirubin should guide management according to age in hours, gestation and risk factors; visual inspection alone is unreliable.
Feeding assessment
Observe latch, suck–swallow–breathe coordination, fatigue, choking, vomiting, urine output and stool passage. Ask about skin-to-skin, time to first feed, colostrum, maternal medications and breast anatomy. Poor feeding is a non-specific but important sign of sepsis, hypoglycaemia, respiratory disease, neurological illness or congenital anomaly.
Documentation and discharge safety-net
Record gestation, measurements, vital signs, examination positives and negatives, prophylaxis/immunisation, feeding plan and follow-up. Teach caregivers to return for difficulty breathing, fever or coldness, jaundice spreading to palms/soles, convulsions, lethargy, poor feeding, repeated vomiting, abdominal distension, bleeding or reduced urine.
References
- SlideShare: Neonatal examination.
- WHO Essential Newborn Care and Pocket Book of Hospital Care for Children.
- Uganda newborn and neonatal-care protocols.
