Routine Newborn Exam

Amplified
Checklist

Routine Newborn Examination - Amplified

Timing and Setting

The newborn and infant physical examination (NIPE) should be done:

  • Within 72 hours of birth
  • In a warm environment
  • With parents present (they provide history and observe)

Always identify the baby (wristband) and wash hands.

Systematic Approach

General Inspection (Before Touching)

Colour:

  • Pink centrally is normal
  • Acrocyanosis (blue hands/feet) normal in first 24 hours
  • Central cyanosis = cardiac/respiratory emergency
  • Jaundice: if <24 hours = pathological

Activity:

  • Flexed posture at rest (term baby)
  • Spontaneous movements
  • Response to handling

Cry:

  • Normal cry is vigorous
  • High-pitched cry: CNS irritation
  • Weak cry: sick baby

Head

Fontanelles:

  • Anterior: diamond shaped, soft, flat when calm
  • Posterior: triangular, may be closed
  • Bulging = raised ICP
  • Sunken = dehydration

Sutures:

  • May overlap (moulding) after delivery
  • Widely separated = raised ICP

Cephalhaematoma: subperiosteal bleed, doesn't cross suture lines (vs caput which does)

Eyes

Red reflex:

  • Most important eye check
  • Shine ophthalmoscope from 30cm
  • Normal: bilateral orange/red glow
  • Absent/white: URGENT referral (cataract, retinoblastoma)

Mouth

Palate:

  • Visualise with torch
  • Palpate with (clean) finger
  • Submucous cleft can be missed visually

Cardiovascular

Auscultation:

  • Normal rate 120-160 bpm
  • Murmurs common in first 24 hours (ductus closing)
  • Pathological: loud, harsh, radiating

Femoral pulses:

  • Palpate with baby's legs flexed
  • Weak/absent = coarctation until proven otherwise

Hips

Risk factors: breech, family history, oligohydramnios, female

Ortolani (detects dislocated hip):

  • Flex hips to 90°, knees flexed
  • Abduct while lifting with middle finger on greater trochanter
  • "Clunk" = head reducing into acetabulum = positive

Barlow (detects dislocatable hip):

  • Same position
  • Adduct and push posteriorly
  • "Clunk" = head dislocating = positive

Genitalia

Male:

  • Both testes in scrotum (premature may be higher)
  • Check meatus position (hypospadias)

Female:

  • Patent vaginal opening
  • Mucoid discharge normal

Spine

Look and feel for:

  • Midline pits, dimples (if deep or >2.5cm from anus → spinal US)
  • Hair tufts
  • Scoliosis

Limbs

  • Count digits
  • Extra digits: tie off if pedunculated
  • Talipes: positional (corrects with gentle pressure) vs structural

Documentation and Communication

  • Document all findings clearly
  • Discuss with parents
  • Ensure Vitamin K has been given
  • Arrange follow-up for any abnormalities