It is particularly valuable for midwives and nurses undertaking examination of the Newborn modules, as well as a useful reference work for those already undertaking this role. It provides midwives and other practitioners involved in neonatal examination with a comprehensive guide to the holistic examination of the newborn infant. Examining the Newborn encourages the reader to see each mother and baby as unique, taking into account their experiences preconceptually, prenatally, and through birth.
Preface to the second edition
Newborn Screening: A Practical Guide (2nd Edition) takes newborn screening to a new level, using a family-centered approach to this important consultation. This text encourages all practitioners with responsibility for newborn screening to see each child as unique, an individual born into a complex community. Newborn Screening: A Practical Guide (2nd Edition) provides a comprehensive guide to holistic newborn screening.
Acknowledgements
Examination of the newborn: where are
- Cognitive
The quality of the examination was assessed using video recordings of 11 midwives and seven SHOs (a total of 39 examinations were recorded). These skills should be applied to all professionals who carry out the examination of the newborn, regardless of professional qualifications. Respondents in the study by McDonald (2008) also believed that training to examine the newborn should be integrated into current midwifery education.
In the beginning
Scenarios will be used to explore specific issues, focusing on the role of the practitioner undertaking the first examination of the newborn. Some of the issues facing new parents were considered along with the possible responses of the practitioner. Summary It is with appreciation of the preceding events, dilemmas and expectations that the practitioner examines the newborn baby.
Fetal development
Assessment of fetal well-being
It is therefore essential that the physician has a clear understanding of the events leading up to the examination of the newborn. It starts with an overview of prenatal care and the importance of the 'booking history'. This information is essential for the examination of the newborn and should therefore be read carefully by the doctor before seeing the baby.
It can be seen that previous knowledge of the prenatal history can enable the practitioner to improve the parents' experience of their baby's examination. It has been found to be highest at the beginning and towards the end of pregnancy and is common in 90% of women (Statham et al. 1997). An increased nuchal translucency measurement (depth of fluid at the back of the fetus's neck) is used as a marker in Down's syndrome screening.
Measurement of the fetal nasal bone has been suggested to improve the performance of first trimester screening for trisomy 21 (Kagan et al. 2009). It is important that the practitioner is aware of the recorded prenatal growth pattern in order to make an accurate diagnosis of the baby's health status at birth. If the baby was in a specific position before birth, this can have consequences for the examination of the newborn baby.
Summary There are a range of antenatal parameters that the practitioner examining the neonate must be aware of in order to be sensitive to the needs of the mother and her baby.
Risks to the fetus during childbirth
Prelabor Rupture of the Membranes Prelabor Rupture of the Membranes (PROM) is defined as the rupture of the fetal membranes before the onset of labor and occurs in about 10% of all pregnancies; 90% of these are at term (Alexander and Cox 1996). The practitioner examining the baby must consider all of the above when reading the woman's labor and delivery records to assess how this history may affect the newborn. The effects on the baby of the drugs commonly used in childbirth will be described in the following sections.
The doctor examining the baby can encourage the mother in the above situation by explaining that the baby's response is likely due to the pethidine she received during delivery and that it is therefore worth persevering. Therefore, the first newborn examination may be the first time the child is examined clinically, unless there is an indication. It is important for the practitioner to identify why the caesarean section was performed in order to perform a sensitive and effective examination of the baby.
According to a retrospective review of neonatal records of 904 cesarean deliveries (Smith et al. 1997), the incidence of clefts was 1.9%. Delay in delivery of the fetal shoulders is a serious complication of the second stage of labor. After the birth of the head, the umbilical cord is compressed between the woman's pelvis and the baby's body.
During your review of the mother's birth details, it is important to note the condition of the baby at birth so that you can anticipate potential questions from the parents.
Neonatal examination
It will take the practitioner systematically through the process and introduce the principles of neonatal screening. It will focus on the normal findings to be expected and also describe the abnormal findings that may be detected. It is through the prediction of the normal that deviations are detected and this is the philosophy of the examination described in this chapter.
It is important to anticipate and gather the equipment needed during the examination and ensure that it is clean (refer to local infection control guidelines) and in good working order. If the baby has to leave the bed to look for equipment, this may cause a previously content baby to become restless, hungry, or in need of comfort, and the examination may have to be postponed. Very few parents will refuse to have their baby examined; However, the practitioner should always obtain parental consent before doing this (for further discussion on this topic, see Chapter 8).
Ideally, a parent will be present during the assessment so that information and advice can be exchanged if necessary.
This technique can be useful for examining the chest (percussion note is hyper-resonant in the presence of pneumothorax) and abdomen. Successful examination of heart sounds with the baby partially clothed does not preclude further examination when the baby is undressed. Eyes The practitioner should be familiar with the normal anatomy of the eye before examination (Figure 6.2).
Look at their size, their position (including the separation distance), the features surrounding them (epicanthic folds, eyelids and eyebrows) and the slope of the palpebral fissures (Figure 6.3). Low pulmonary blood flow results from obstruction of the blood leaving the right side of the heart (right outflow obstruction). The first heart sound (best heard at the apex) represents the closing of the mitral and tricuspid valves.
The procedure should be repeated centrally, such as the left lobe of the liver. The rooting reflex can be elicited by gently stroking the skin of the baby's cheek. The plantar grasping reflex is elicited by touching the sole of the infant's foot with the little toe.
The baby is then carefully stretched and the movable rod is raised to touch the plane of the baby's foot.
Always make sure you have used the correct percentile chart for the baby's gender and feeding method and be aware that alternative centile charts exist for conditions such as Turner syndrome and Down syndrome, even if your hospital or practice, these may not be in stock as standard.
Completing the records for the parent(s) provides another opportunity to reassure the parents that all is well with the study. The documentation should also include completing the relevant computer-based registration and contact forms in accordance with the trust policy. The next chapter considers the identification of abnormal findings and how the practitioner examining the newborn infant should deal with such findings.
List the five areas of the chest wall that must be listened to to rule out a murmur. Now identify strategies to reduce the impact of such distractions in the hospital, the baby's home, or the community clinic/children's center. A possible solution may be to negotiate a mutual agreement with your colleagues to transfer calls until the investigation is completed and documented.).
Find out what information is available to new and expectant parents where you provide newborn screening. In what format(s) is it available (eg print, online, DVD) and is it available in different languages relevant to the population. A digital toolkit for the physical examination of newborns and infants aged 6 to 8 weeks, prepared for the UK National Screening Board.
Abnormal findings and congenital
Port wine stain (Table 5) Port wine stain in the arrangement of the first branch of the trigeminal (third cranial) nerve may be associated with vascular malformation of the meninges and cerebral cortex on the same side. It is usually associated with a shallow orbit, so for cosmetic reasons and for a normal eye examination, the child should be referred to an ophthalmologist. The infant should be carefully examined to confirm that testicles are present in each half and that the rest of the genitalia are normal.
If ballooning of the foreskin occurs during urination, the baby should be discussed with a surgeon. Spinal deformity This can be the result of a hemivertebra or abnormal growth of the spine. The baby is usually pink, but over time develops cyanosis, which may worsen due to spasm of the pulmonary infundibulum.
There may be a loud pulmonary second sound due to the pulmonary hypertension that develops as a result of the congestion. It can occur in the membranous part of the septum or in the muscular part. The baby should be referred to a cardiologist to confirm the diagnosis and arrangements should be made for early correction of the defect.
The infant requires urgent referral to a pediatric surgeon for further investigation and repair of the lesion. Examine the baby carefully, paying particular attention to the appearance and size of the genitals and other abnormalities. The anomaly can be diagnosed in utero, but after birth the diagnosis can be confirmed by X-ray of the bones.
