Neonatal examination, Routine

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The Routine "Babycheck":

All babies should have a detailed examination before discharge from hospital. Some midwives may undertake the 'babycheck', otherwise it is usually the duty of the on-call neonatal or paediatric SHO.

  • Homebirth babies may be brought to the post-natal ward for examination.
  • Some birthing units have a policy of allowing a minimum of 6 hours to elapse between delivery and the routine examination.
  • Follow your local proceedures / guidelines


Review of Antenatal History


  • dating and anomaly scans
  • screening tests
    • Down's Syndrome risk assessment
    • Maternal screening blood tests: HIV, Hepatits, Syphilis, etc.
  • Antenatal problems
    • Eg. pre-eclampsia
  • Family History

Review the peri-natal records

  • Labour duration and complications
  • Attended by paediatrician?
    • Resuscitation required?
  • APGAR scores
  • Fever (baby or maternal)

History from the parents

  • Review antenatal, perinatal and postnatal course
  • Family history
    • General
    • Congenital dislocated hips

Current condition:

  • Feeding
  • Passed urine?
  • Passed meconium? (when?)

Clinical Examination

The clinical examination is often best completed 'opportunistically'. Quickly do the things which require a quiet still baby (heart sounds, femoral pulses, abdomenal palpation). If the baby has its eyes open, complete ophthalmoscopy. If the baby is crying, do the things which will always upset it (check the hips, etc.).

  • General appearance
  • Head
    • Fontanelles
    • Shape and eye position
  • Skin
  • Facies (any evidence of a syndrome?)
  • Scalp (birth trauma?)
  • Ears: shape, size, position (low set?)
  • Eyes: illicit red reflex bilaterally
  • Mouth
  • Palate (Feel with your finger all the way to the soft palate - not visible on inspection)
  • Neck
  • Extremities - assess shape and movement
    • Peripheral pulses
    • Hands (double palmar crease?)
    • Fingers (5: any skin tags / extra digits / bifid phalanges, etc).
    • Feet (talipes?)
    • Toes
  • Chest appearance
  • Respiratory effort (recession / distress?)
  • Auscultation
    • Heart sounds (Murmur?)
    • Lung fields
  • Palpation: thrills / heave / apex position
  • Abdomen (soft?)
    • Liver (palpable?)
    • Spleen
    • Kidneys (ballotable?)
    • Umbilicus (infection / hernia?)
  • Femoral pulses
    • Radio-femoral delay
  • Evidence of hernias?
  • Hips (Barlow's and Ortolani's test)
  • Anus (passed stool?)
  • Genitals (ambiguity?) - document male or female
    • Penis (hypospadia?)
    • Testicles - ensure both descended
  • Spine
  • Sacrum
    • Any evidence of sacral dimple or sinus?: ultrasound if suspected to exlude underlying defect

Ellicit newborn reflexes if there is cause for concern.

Other issues

Identify and address any concerns from the parents.

  • Many questions will focus on feeding and caring for the baby. Do ask the midwives if you are not sure what to advise.

The Red Book / Handheld record

  • Fill in the relevant page in the red book.

Organise necessary follow-up

Ensure follow-up for any identified problems is arranged.

  • eg. USS hips or spine if there any concerns.

Where an investigation is arranged, different hospitals will have different arrangements as to whether the baby is brought back to clinic routinely, or whether the result is reviewed first and a letter sent to the parents.

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