The Baby Check

The Baby Check
Newborn and Infant Examination
• Newborn examination - undertaken no later than 72
hours after birth.
• The physical examination is repeated at approximately
6-8 weeks of age
• The examinations tailored to patients needs
– Must review relevant issues:
Family history
Mother's pregnancy, the birth
Antenatal screening outcomes
When baby 1st PU and BO
The baby's development, feeding patterns, weight, alertness and
general wellbeing
• Any aspects of their baby that might be worrying the parent
New born and Infant examination
• Top to toe examination
• Also involves 4 screening examination
– Eyes
– Heart
– Hips
– Testes
Newborn and Infant Examination
Appearance including colour, breathing, behaviour, activity and posture
Head (including fontanelles)
Eyes - opacities and red reflex
Neck and clavicles, limbs, hands, feet and digits; assess proportions and symmetry
effort, rate and lung sounds
position, heart rate, rhythm and sounds, murmurs and femoral pulse volume
face, nose, mouth including palate, ears, neck and general symmetry of head and facial features.
Measure and plot head circumference
shape and palpate to identify any organomegaly; also check condition of umbilical cord
Genitalia and anus
completeness and patency and undescended testes in males
note colour and texture as well as any birthmarks or rashes
Central nervous system
inspect and palpate bony structures and check integrity of the skin
observe tone, behaviour, movements and posture. Elicit newborn reflexes
symmetry of the limbs and skin folds (perform Barlow and Ortolani’s manoeuvres)
NICE Guideline CG37 - 2006
• About 200 children a year are born in the UK with
congenital cataract in one or both eyes
• Only one fifth of these 200 have a family history of
• Cataract is the largest treatable cause of visual loss in
childhood in the UK
• Associated risk factors include:
– low birth weight <1500g
– low gestational age <32 weeks
– family history of any eye disorder of childhood onset including
congenital cataract, glaucoma and retinoblastoma
– maternal infections during pregnancy e.g. Rubella,
toxoplasmosis, herpes simplex virus (HSV)
• Screen +ve
– The absence of any reflex suggests presence of a
congenital cataract
– A white reflex (leukocoria) is suggestive of tumour
of the eye (retinoblastoma)
– Other abnormal findings include:
• abnormalities of the iris
• small or absent eye
• +ve Results
• @ Newborn check
– Refer for expert consultation
– To be seen by 2 weeks of age
• @ 8 Week Check
– Refer for expert opinion
– To be seen by 11 weeks of age
Congenital cardiac defects are a leading cause of infant death
Critical or serious congenital cardiac malformations are found in
approximately 6-8 in 1,000 newborn babies
Associated risk factors include:
– family history of congenital heart disease
– maternal conditions such as diabetes, systemic lupus erythematosus
– exposure to rubella during the first trimester of pregnancy,
– Some medications taken during pregnancy e.g. Lithium
– Syndromes Down’s, Noonan’s and Marfan’s
• A proportion of major cardiac lesions may be identified during the
fetal anomaly scan
• Screen +ve findings
– Tachypnoea at rest
– Episodes of apnoea lasting longer than 20 seconds or associated with
colour change
– Increased work of breathing.
– Central cyanosis
– Visible pulsations over the precordium, heaves, thrills
– Presence of murmurs/extra heart sounds
significant murmurs are usually loud
heard over a wide area
have a harsh quality
associated with other abnormal findings
benign murmurs are typically short, soft, systolic, localised to the left sternal
border, have no added
– Absent or weak femoral pulses
• Response to +ve finding
• @ New born examination
– Discuss with appropriate expert
– Urgency will depend on circumstances
– Measure pre and post ductal arterial O2 sats
(pulse oximetry) within 4 hours
• @ 8 Week Check
– Discuss with appropriate expert at the time of the
Approximately 1-2 in 1000 babies have a hip problem that
requires treatment
• Major associated risk factors include:
– a first degree family history of hip problems in early life
– breech presentation at 36 weeks of pregnancy, irrespective of
presentation at delivery and mode of delivery
– breech delivery if earlier than 36 weeks
– Multiple births, if any of the above risk factors are present, all
babies should be referred for
• Undetected DDH or delayed treatment may result in
significant morbidity
• Early diagnosis and intervention improve health outcomes
and reduce the need for surgical intervention
• Screen +ve test
– Difference in leg length
– Knees at different levels when hips and knees are
bilaterally flexed
– Difficulty in abducting the hip to 90 degrees
– Palpable ‘clunk’ when undertaking either the
Ortolani or Barlow manoeuvres
• Response to +ve Screening test
• @ New born Exam
– Abnormal examination
• Refer for
– urgent ultrasound
– expert clinical consultation
– To be seen by 2 weeks of age
– Normal examination but has risk factors
• Refer for Uss Hip – completed by 6 weeks of age
• Cryptorchidism affects approximately 2-6% of male babies born at
• Associated risk factors include:
– a first degree family history (father or sibling) of cryptorchidism
– low birth weight
– small for gestational age or pre-term delivery
• Cryptorchidism is significant as it is associated with:
– a significant increase in the risk of testicular cancer (primarily
– reduced fertility when compared with descended testes
– May also be associated with other urogenital problems such as
hypospadias and testicular torsion
• Early diagnosis and intervention improves fertility and may aid
earlier identification of testicular cancer
• The absence of one or both testes in the scrotal sac is a screen
positive finding
• Bilateral undescended testes in the newborn may be
associated with an underlying endocrine disorders
• @ New Born Check
• If Bilateral undescended testes
– To be seen by a senior paediatrician within 24 hours of the
• If Unilateral undescended testis
– Review at 6-8 week examination
• @ 6-8 week check
• If Bilateral undescended testes
– To be seen by a senior paediatrician within 2 weeks
• If Persistent unilateral undescended testis
– GP to review between 24-30weeks of age
– Testis still absent -Refer to surgeon (Should be seen no later than 13
• NHS E-Learning module – Video + Reference

similar documents