Physical Examination or Assessment of Unwell Newborn or Neonate

Physical Examination or Assessment of Unwell Newborn or Neonate

Examination of Unwell Newborn or Neonate:

The initial assessment of an unwell child includes the paediatric assessment triangle: appearance, breathing and circulation to skin; primary survey that focuses on basic life support, patient assessment and immediate management; secondary survey with a detailed history of the event and physical examination; and ongoing assessment. Medical practitioners and their clinic staff must be prepared to undertake initial emergency management of a seriously ill child, and they must have the equipment and supplies available to carry out that management effectively.

You can read: How to Assess a High Risk Newborn or Neonate?

Examination of Unwell Newborn or Neonate:

a. Assessment of the skin of a newborn:

The skin of all babies to be examined for the followings –

1. Pallor (pale, mottled appearance indicating poor perfusion).
2. Plethora (beetroot colour indicating excess of circulating red blood cells).
3. Cyanosis: central cyanosis always requires immediate attention.
4. Jaundice: early jaundice is abnormal.
5. Skin rashes such as milia, miliaria, mongolian blue spots and bruising and erythema toxicum.

Infectious lesions e.g. Thrush, herpes simplex virus, umbilical sepsis, bullous impetigo.

b. Abnormal body temperature of a newborn:

The normal body temperature range for term infants is 36.5-37c rectally (core temperature). Abnormal body temperature includes –

1. Hypothermia:

A core temperature below 36c is term as hypothermia which can indicate respiratory distress, hypoglycemia and sepsis.

2. Hyperthermia:

An axillary temperature above 37.5 c is considered hyperthermia the usual hyperthermia is due to overheating of the environment but it can also be a sign of sepsis, brain injury or drug therapy.

c. Assess respiratory system of a newborn:

Respiration to be counted by watching the lower chest and abdomen rise and fall for a full minute. Rate of respiration will vary between levels of activity. The chest should expand symmetrically.

You can read: How to Identify High Risk Newborn | Newborn Danger Signs

Abnormalities to look for include the following:

• Unilateral chest expansion and diminished breath sounds on one side.
• Tachypnoea (rate above 60/minute).
• Ketraction (inspiratory pulling in of the chest wall above and below the sternum or between the ribs).
• Nasal flaring.
• Grunting; an abnormal expiratory sound.
• Apnoea, cessation of breathing for 20 seconds or more.

d. Assess a newborn for cardiovascular abnormalities:

The normal heart rate of a term newborn is 120 to 160 beat / minute and of a preterm infant is 130 to 170 beat/minute.

Cardiovascular abnormalities:

• Cardiovascular dysfunction should be suspected in infants who present with lethargy and breathlessness during feeding. Other signs include- Slowness with feeds and pale at times or fast labored breathing.
• Infant who appear breathless with little or no rib recession and no grunting may have heart disease. Presence of a murmur heard on routine examination may be suggestive of an underlying cardiac lesion.

e. Assessment of a baby’s heart:

• Begin by recording pulse rate, rhythm, strength and character.
• Check for central perfusion; capillary refill time should be less than two seconds.
• Palpate and percuss the anterior chest wall for heart size and the site and nature of the apex beat.
• Also determine the presence of any thrill.
• Listen to the first heart sound, then the second heart sound, then the sounds between these and then any murmurs between heart sounds.
• Note the timing, character, loudness, site and distribution of any murmur.
• Chock if this is transmitted to the neck.

If disease of the heart or kidney is suspected, record blood pressure.

You can read: Classification or Types of High Risk Newborn or Neonates

f. Infant/ newborn assessment for insufficient lactation:

Possible signs of insufficient lactation in the exclusively breastfeeding infant in the first month after such as-

• Low urination pattern: at least six wet diapers is the norm.
• Low stooling frequency: at least three greenish-yellow, seedy, soft stools is the norm.
• Very irritable or sleepy infant, nursing less than seven times a day.
• Weight loss of more than i\vo of the birth weight or continued weight loss after day 10 of life.

Assessment Procedure of a Baby’s Heart:

It includes the following:

• Explain what you wish to do, and obtain informed consent from the mother.
• Examine the baby when he is quiet-using the time when he is awakening.
• Observe his colour and respirations.
• Aim for minimal disturbance, removing the baby’s clothing gently, ensuring that he is kept warm.
• Identify the apex of the heart.
• Warm the paediatric stethoscope head, and apply this to the chest.
• After five seconds (allowing the baby to settle) count the heart rate.
• Listen for 30 full seconds to the rate (speed), rhythm – whether the heart rate sounds even with no additional beats.
• Make a note of the heart rate, and record it in the baby’s notes.
• Explain to the mother what you have heard, and confirm whether any further action will be required.