Neonatal examination

This page concerns what needs to be done with every neonate and includes a neonatal exam and certain investigations.

Neonatal Examination

The Inter Gluteal Cleft will feature in the later part of your examination.

Examination of the newborn infant is usually just a set of tick boxes to make sure they're not ill.

The best way to examine the newborn infant is to go from head-to-toe (or toe-to-head - but head-to-toe makes more sense to me so just read this backwards if you want to learn it the other way).

Numbers

Birthweight, head circumference (plus centiles for both) and gestational age.

General

The three things to look for are colour - specifically jaundice (yellow) and cyanosis (blue); posture; and movement. Muscle tone should be assessed both by observation and when turning the baby over to examine the back

Top-half (above diaphragm)

Head

Fontanelles: you should not be able to see the anterior fontanelle but should be able to palpate it. It should be soft - tension indicates raised intracranial pressure. Look in the face for signs of any abnormal syndrome, specifically Down's syndrome. Inside the mouth, the tongue turning blue is a sign of central cyanosis and palpating the roof of the mouth will show whether the baby has a cleft palate.

Eyes

The sclera are yellow in jaundice. The red reflex should be elicited using an opthalmascope. This is to rule out cataracts or some other rare conditions of the eye.

Chest

Observe breathing, looking for signs respiratory distress. Auscultate the heart - normal rate is 110-150 bpm (85 bpm during sleep).

Bottom-half (below diaphragm)

Abdomen

Palpate the abdomen for masses. The liver usually extends 1-2cm below the costal margin (bottom of the ribs) and you can sometimes feel the tip of the spleen.

Pelvic Region

The genitalia and anus should be inspected to "make sure all the holes are the and in the right place". Or present and patent if you want to sound clever. In boys, the presence of testes in the scrotum should be confimred. The femoral pulses should be examined for signs of coarctation of the aorta

The hips should be examined for DDH. (This is really hard to describe - get a GP or paediatrician to show you.)

Back

Look at back and feel the spine all the way down to the bum crack. (The awesomely titled Inter-Gluteal Cleft!) Don't forget to examine muscle tone when you turn over the baby.