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Examination of the newborn baby. Examination at birth. Aim 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. 2.

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examination at birth
Examination at birth

Aim

  • 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

2

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examination of the newborn baby1
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 !

3

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principles of examination
Principles of examination
  • Assess
    • Ask, Check, Record
    • Look, Listen, Feel
  • Classify
  • Treat or advise

4

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examination at birth assess
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

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assess look for1
Assess: Look for

Quick screening for malformations

  • Screen from top to bottom, midline, and back examination
  • Orifice examination
      • Anal opening

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assess look for2
Assess:Look for
  • Single umbilical artery
  • Simian crease
  • Dysmorphic features
  • Excessive drooling of saliva

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assess look for3
Look for abnormal swelling

Abnormality of limbs & spine

Eyes, ears, umbilicus

Observe

Breathing rate / pattern

Color

Heart rate

Activity- feeding , movements

Assess: Look for

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assess listen for
Assess:Listen for
  • Grunting, Cry, Heart sounds

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assess feel for
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

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weighing the baby
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

12

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temperature
Temperature
  • At birth-warmth, keep the baby in skin to skin contact with the mother

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temperature recording
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

14

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examination within 24 hours
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

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slide16

Examination within 24 hours

  • Assess
    • Ask, Check, Record
    • Look, Listen, Feel
  • Classify
  • Treat or advise

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examination at 24 hrs assess
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

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slide18
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

Assess: Look for

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slide19

Assess: Listen for

  • Grunt
  • Cry
  • Auscultation of heart

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slide20

Assess: Feel for

  • Femoral pulse
  • CRT
  • Temperature by touch
  • Descent of testis
  • Depth or extent of jaundice
  • Feel for abdomen
  • Confirm findings of inspection

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record
Record

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examination at discharge
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

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slide23
Discharge from eyes , umbilicus

Breathing difficulty

Breast feeding- exclusivity and adequacy

Jaundice

Assess: Look for Listen for

  • Auscultation of heart

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slide24

Assess: Feel for

  • Temperature by touch
  • Depth or extent of jaundice
  • Confirm findings of inspection, if any

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danger signs
Danger signs
  • Not feeding well
  • Less active than before
  • Fast breathing (>60/ min)
  • Moderate or severe chest in-drawing
  • Grunting
  • Convulsions

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Floppy or stiff

Temperature >37.50C or <35.50C

Umbilicus draining pus or umbilical redness extending to skin.

>10 skin pustules

Bleeding from umbil. Stump

examination on follow up
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

26

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normal feeding behaviour
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

27

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it is normal for a baby
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

28

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normal breathing
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

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slide30

R

E

T

R

A

C

T

I

O

N

S

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caput succedaneum vs cephalohematoma
Caput succedaneum vs. cephalohematoma
  • Normal vs. Abnormal

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the umbilicus which one is normal
The umbilicus: Which one is normal?
  • Normal vs. Abnormal

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skin pustules
Skin pustules

Locate ?

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slide36
Skin

A baby may have PUSTULES

MOREthan10are aDANGER SIGN

  • Refer this baby urgently

Lessthan10are alocal skin infection

  • Treat them immediately

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posture
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.

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color of the baby
Color of the baby
  • Normal vs. Abnormal

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color of the baby1
Color of the baby
  • Normal vs. Abnormal

41

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case scenario 1
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?

42

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case scenario 2
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?

43

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conclusion
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