Newborn Care: Newborn Physical Exam
One of the most important steps of newborn Care is a Newborn Physical Exam. The newborn baby is thoroughly examined by the doctor, within 12 hours after its birth. The baby is weighed and its length, as well as head circumference, are measured and recorded. A newborn’s average weight is considered to be seven pounds. However, birth weights falling within a wide range of the average is normal. 20 inches is the average length at birth, but variations of one or two inches are common. The face, head and skin of the baby are examined by the doctor to exclude any birth trauma . The functioning of the nervous system, the heart and that of the lungs is checked. The abdomen, the limbs, and the genitals are also inspected.
The newborn baby’s skin appears generally reddish in color, but in the early hours following the birth, the extremities like the fingers as well as toes may look bluish due to poor circulation of blood. Sometimes, destruction of the fat tissue known as subcutaneous fat necrosis may have developed wherever the bones have exerted pressure on the skin. The skin of certain areas such as the head, neck and the cheeks of the baby may look lumpy due to this. This condition is very common when the baby has been delivered with the help of forceps. A clear liquid, yellowish in color, may be discharged from wherever the lumps have broken through the skin, but usually they heal without any treatment.
When a baby is delivered vaginally, there may be bruise marks present on the face, and elsewhere in the body, due to the pressure the baby is subjected to, while passing through the birth canal. The compression may have changed the shape of the head so that the face appears asymmetrical. This is normal, and it usually gets resolved in a few days. But occasionally, the asymmetry may be the result of damage caused to a facial nerve at the time of delivery. In such cases, the recovery may take several weeks.
In a vaginal delivery, the baby’s head comes out first, and as a consequence, the head gets slightly squeezed out of shape. When the head gets compressed in the pelvis, the bony plates which form the skull may overlap each other to facilitate the passage of the head along the birth canal. It may cause bruises and swelling of the scalp. If there has been a little bleeding from the one of the skull bones, it may show up as a small bump which will gradually disappear over a few weeks’ time.
In case of breech delivery, when the baby’s buttocks are the first part to come out, the feet, genitals and the buttocks may be bruised instead of the head. Since breech delivery is very risky, in case a baby is lying in breech position, vaginal delivery is avoided to reduce complications, and a cesarean section is performed instead. In a cesarean section, incisions are made on the abdomen, and on the uterine wall, to take the baby out.
The heart sounds and breathing are checked for any abnormalities by listening to the chest with a stethoscope. The pulse is felt to assess its strength. The skin color, muscle tone, as well as the overall condition of the baby is inspected for abnormalities.
The doctor checks for possible nerve disorders by testing the reflex reaction of the baby. A newborn baby displays a number of reflexes, the most important ones are:
- The Moro reflex – the startle reaction at loud sounds and sudden movement.
- The rooting reflex – when one cheek is touched or stroked, the head turns to that direction in a searching gesture.
- The sucking reflex – when an object touches the palate, baby starts sucking.
There are a number of other reflexes also, which the doctor may check out to ensure that there are no abnormalities with the nervous system of the newborn.
A Newborn physical exam cannot detect many of the abnormalities that may be present in the newborn. Certain blood tests may reveal some disorders of a serious nature which can be treated for better outcome, if detected early. The state laws have made some blood tests mandatory because early detection and appropriate treatment of certain abnormalities can often prevent conditions which may impair the healthy growth and development of the baby.
The abdomen of the baby is examined to see if any abnormalities are present. Gently pressing on the abdomen, the doctor tries to assess the size and shape of the different internal organs as well as their location. If there is enlargement of kidneys, it may be a sign of urinary obstruction.
The genitals of the newborn are examined carefully by the doctor to make sure that the urethra or the urinary opening is properly located. The scrotum of the boy infant is checked to see if the testes have descended into it. The labia of a girl baby are usually swollen due to the effect of the maternal hormones while the baby was in the womb. It may remain in that condition for a few weeks after birth. The anus is examined to ensure that it is open.
The arms and legs of the baby are examined to ensure mobility and flexibility of joints. The doctor checks the hips to see if there is any dislocation.
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Yasser Elnahas
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