Examination of a neonate is a crucial part of obstetrics and neonatology. It helps to assess the neonate and detect any abnormality.
An examination is to be conducted:
- Soon after birth.
- After 24 hours.
- Before discharge.
Depending on the health of the infant, a frequent examination may be required.
Aim of examination of an infant at birth
- To screen for any malformation in the infant.
- To observe the smooth transition of the neonate from intrauterine to extrauterine life.
- To assess the overall health condition of the infant.
I. Examination at birth
Examination at birth or soon after birth is crucial.
Following steps can help as a guide during an infant examination.
- Antenatal details.
- Antenatal visits – Tetanus immunisation.
- Intake of iron, calcium and folic acid supplements.
- Human Immuno Deficiency virus (HIV)/Syphilis screening.
- Exposure to teratogens, infections during pregnancy and delivery.
- History of polyhydramnios or oligohydramnios.
- Postnatal details: Condition at birth; resuscitation, excessive drooling.
II. Examination of an infant
A detailed head to toe examination has to be performed.
Neonatal reflexes should be elicited as they are a part of the infant examination.
Proper asepsis should be maintained while examining a new-born infant.
Look for pallor, cyanosis or jaundice.
It is abnormal if the infant is less than 24 hours old; it signifies Rh incompatibility, sepsis or TORCH (Toxoplasmosis, rubella, cytomegaly and Herpes zoster) infection.
After 24 hours, if the infant develops jaundice, it can be physiological which disappears within 10 days.
It is seen in anaemia, shock or asphyxia.
It is a bluish discolouration of the skin and mucous membranes. It can be central or peripheral.
In central cyanosis, the tongue is involved and in peripheral cyanosis, the tips of fingers and toes are involved.
It is a white, cheesy substance present all over the skin of a baby at birth, which protects the skin of the fetus.
Vernix caseosa is composed of sebum, i.e. the secretion of the sebaceous glands and cells that have sloughed off the fetal skin.
Milia are benign, self-limiting lesions that manifest as tiny, white bumps on the forehead, nose, upper lip and cheeks of the newborn. They are enlarged sebaceous glands present on the chin, nose, forehead and disappear in a few days.
These present as small, red, benign areas with a yellow papule in the centre which disappear after a few weeks.
These are benign, bluish pigmentation on the lower back and buttocks, which these are commonly seen in Asian babies and disappear by the age of 2.
These are fine, small hairs seen on the face and neck of a neonate.
Note the following:
- Moulding: Temporary asymmetry of the skull resulting from the birth process.
- Caput succedaneum: It is diffuse, oedematous swelling of the soft tissues of the scalp, which extends across the suture lines and resolves in a few days.
- Cephal-haematoma: It is a collection of the blood between the pericranium and flat bone of the skull, seen 12-24 hours after delivery. It is sub-periosteal haemorrhage caused by birth and injury is limited by suture lines.
- Anterior and posterior fontanelles: Bulging fontanelles indicate increased intracranial pressure (meningitis or hydrocephalus). Depressed fontanelles indicate dehydration in an infant. Anterior fontanelle fuses by 18 months and posterior by 2-4 months.
- Cartilage of the ear and nose are prominent in a neonate.
- Face is smaller in relation to the head, cheeks are full due to sucking pads of fat.
- Facial nerve injury.
- Hypertelorism or low set ears, as in Down’s syndrome.
- Eyes: Congenital cataract, Sub-conjunctival haemorrhage.
Examine the oral cavity for the following:
-Epsteins pearls or epithelial pearls: These are dense, white spots, probably keratin containing cysts, present on the hard palate, caused during the development of the palate by entrapped epithelium. They do not require treatment because they resolve spontaneously during the first few weeks of life.
-Natal teeth: Teeth present at birth.
-Cleft lip and Palate.
One needs to rule out the following pathologies in the neck:
- Short neck – Turner’s syndrome.
- Neonatal goitre.
- Thyroglossal cyst.
- Sternomastoid haematoma.
Mastitis is common due to maternal oestrogen, slight discharge from the nipples may occur, with enlargement of the breast.
The liver and spleen are palpable in an infant.
Rule out for hernia (omphalocele) or imperforate anus. Meconium is passed by the infant in 24 hours.
Male: Testes are in the scrotum.
Female: Labia majora covers labia minora.
Look for Syndactyl, Polydactyl or Clubfoot. Clubfoot, also known as Congenital Talipes Equinovarus, is a congenital condition that affects newborn infants.
Meconium is the first stool passed by the baby, soon after birth within 24 hours.
A small amount of urine is frequently passed by the infant. The urine has low specific gravity and contains uric acid and urates which stains the napkin red.
III. Examination at the time of discharge
A thorough examination of the infant should be conducted at the time of discharge.
Following are the aims and objectives of the examination at the time of discharge.
- To ensure that the baby is normal and on exclusive breastfeeds.
- To screen that heart is normal.
- To ensure the baby has no significant jaundice or danger signs.
- To advise about next follow up and danger signs.
Growth assessment of the neonate
The following points help to assess the growth of an infant.
In the first 10 days, the weight decreases by 10 to 15% of birth weight. Then, there is a gain in weight of 20 to 30 grams per day. Weight doubles by 5 months and increases to three times, by 1 year.
It increases by 0.8 to 1 centimetre per week.
It increases by 0.5 to 0.8 centimetre per week.
Reference: A Concise Textbook of Obstetrics & Neonatology with Homoeopathic Therapeutics by Dr Trupti M Deorukhkar