The aim is to screen for abnormality, and to see if the mother has any questions or difficulties with her baby. The following is a recommended routine before the baby leaves hospital or during the first week of life for home deliveries. Before the examination find out if the birth weight was normal. Was the birth and pregnancy normal? Is mother Rhesus ve? Find a quiet, warm, well-lit room. Enlist the mother's help. Explain your aims. Does she look angry or depressed? Listen if she talks. Examine systematically, eg from head to toes. Wash your hands meticulously before each examination.
The head
Circumference (50th centile=35cm) shape (odd shapes from a difficult labour soon resolve), fontanelles (tense if crying or intracranial pressure; sunken if dehydrated).
Eyes
Red reflex (absent in cataract and retinoblastoma); corneal opacities; conjunctivitis.
Ears
Shape; position. Are they low set (ie below eyes)? The tip of the nose, when pressed, is an indicator of jaundice in white children. Breathing out of the nose (shut the mouth) tests for choanal atresia. Ensure that oto-acoustic screening is done. Are follow-up brainstem evoked responses needed?
The complexion
Cyanosed, pale, jaundiced, or ruddy (polycythaemia)? Mouth: Look inside. Insert a finger is the palate intact? Is suck good?
Arms & hands
Single palmar creases (normal or Down's). Waiter's (porter's) tip sign of Erb's palsy of C5 & 6 trunks. Number of fingers. Clinodactyly (5th finger is curved towards the ring finger, eg in Down's).
The thorax
Watch respirations; note grunting and intercostal recession (respiratory distress). Palpate the precordium and apex beat. Listen to the heart and lungs. Inspect the vertebral column for neural tube defects.
The abdomen
Expect to feel the liver and spleen. Are there any other masses? Next inspect the umbilicus. Is it healthy? Surrounding flare suggests sepsis. Next, lift the skin to assess skin turgor. Inspect the genitalia and anus. Are the orifices patent? Ensure in the 1st 24 hours the baby passes urine (consider posterior urethral valves in boys if not) and stool (consider Hirschprung's, cystic fibrosis, hypothyroidism). Is the urinary meatus misplaced (hypospadias), and are both testes descended? The neonatal clitoris often looks rather large, but if very large, consider CAH, p 134. Bleeding PV may be a normal variant following maternal oestrogen withdrawal.
The lower limbs
Test for congenital dislocation of the hip (p 684). Avoid repeated tests as it hurts and may induce dislocation. Can you feel the femoral pulses (to exclude coarctation)? Note talipes. Are the toes: too many, too few, or too blue?
Buttocks/sacrum
Is there an anus? Are there mongolian spots? (blue and harmless). Tufts of hair ± dimples suggest bifida occulta? Any pilonidal sinus?
CNS
Assess posture and handle the baby. Intuition can be most helpful in deciding whether the baby is ill or well. Is he jittery (hypoxia/ischaemia, encephalopathy, hypoglycaemia, infection, hypocalcaemia)? There should be some degree of control of the head. Do the limbs move normally, and is the tone floppy or spastic? Are responses absent on one side (hemiplegia)? The Moro reflex rarely adds important information (and is uncomfortable for the baby). It is performed by sitting the baby at 45°, supporting the head. On momentarily removing the support the arms will abduct, the hands open and then the arms adduct. Stroke the palm to elicit a grasp reflex
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