Infant Assessment Components at Birth

Principles

  • The exam should be thorough and systematic.
  • The approach should be flexible to accommodate the newborn’s behavior.
  • The midwife can use the newborn exam as an opportunity to model ways of interacting and handling the newborn.
  • Ideally, the exam is conducted in a way that maximizes parental involvement and opportunities for education about newborn appearance and care.
  • Remembering that the parents are experts on their baby’s behaviour and appearance, physical assessment should include a history from the parents.

Preparation

  • Conduct the exam in a warm place, free from drafts.
  • Keep baby warm throughout.
  • Ensure adequate lighting.

 

Components of the Initial Newborn Examination

1. General Assessment

  • Note gestational age
  • State of alertness, behavior
  • Muscle tone
  • Symmetry
  • Response to sound and movement
  • Temperature, apical rate and respirations (for one full minute)

2. Reflexes

  • Rooting reflex
  • Sucking reflex
  • Other neurodevelopmental reflexes such as Moro, Plantar, Babinski and Grasp
   

3. Skin

  • Colour
  • Rashes, lesions, petechiae
  • Birthmarks
  • Vernix
  • Lanugo
  • Peeling, dryness
  • Turgor
  • Skin tags

4. Measurements

  • Head circumference
  • Chest circumference ( optional)
  • Length
  • Weight
   

5. Head

  • Sutures
  • Fontanels
  • Bones of skull
  • Symmetry
  • Moulding
  • Caput
  • Cephalhematoma

6. Eyes

  • Colour of sclera
  • Pupil size, position and reactivity
  • Red reflex
  • Tracking and abnormal gaze
  • Spacing and shape of eyes
   

7. Ears

  • Position in relation to eyes
  • Presence of canals
  • Pinna recoil

8. Nose

  • Shape
  • Nares
   

9. Mouth

  • Hard and soft palate intact (palpate and visualize)
  • Lesions

10. Neck

  • Webbing
  • Masses
  • Nuchal thickening
   

11. Chest

  • Auscultate lungs, air entry
  • Symmetry during respirations
  • Signs and symptoms of abnormal respirations (e.g., grunting, or retractions)
  • Clavicles
  • Breasts

12. Heart

  • Auscultate heart sounds over the 5 areas of the heart: aortic, pulmonic, 3rd left interspace, tricuspid and mitral
  • Rate and regularity
   

13. Abdomen

  • Palpate the abdomen for liver, spleen, distention, masses and hernia
  • Observe the umbilical stump for bleeding or oozing
  • Count the number of vessels in the cord (optional - can also be done on the placenta)
  • Check femoral pulses comparing character bilaterally

14. Genitalia and Rectum

  • Patency of the rectum
  • Note if meconium and/or urine have been passed
  • Male Newborn
    • Palpate for presence of testes in scrotum or inguinal canal
    • Presence and placement of urethral meatus
    • Presence of hydrocele
  • Female Newborn
    • Presence of labia minora, labia majora and clitoris
    • Patency of vaginal opening
    • Note vaginal discharge
   

15. Arms and Hands

  • Symmetry, shape and size
  • Number of digits
  • Webbing
  • Palm creases

16. Hips, Legs and Feet

  • Assess hips for congenital dislocation
  • Legs and feet, noting symmetry, size, shape and creases
  • Number of toes
  • Webbing of toes
   

17. Spine

  • Alignment
  • Skin disruption, sinus, tufts of hair