Immediately after birth, all infants should be briefly examined
for major congenital abnormalities, signs of serious illness, or
discrepancy between expected gestational age and weight for gestation.
The number of nursing evaluations in the next few hours depends
on anticipated problems and should focus on heart rate, respiratory
rate and effort, temperature, skin perfusion, skin color, and neuromuscular
activity. Observation of the first feeding, usually within 4 hours
of birth, indicates any underlying difficulty with sucking and swallowing.
If no abnormalities are noted at birth, further newborn observation should
occur at least every 8 hours. Any abnormalities detected at any
time warrant more frequent, thorough examinations and possible investigation
and initial therapy.
All infants should undergo a detailed medical examination within
24 hours of birth to ensure that investigation, treatment, or preventive
management, when indicated, is implemented as soon as possible and
to answer any concerns that a parent may have. Reassurance to a
mother (or guardian) shortly after delivery is immensely important
regardless of maternal experience with deliveries.1 Further
detailed examinations are necessary if any neonatal problems are
detected; infants discharged early, before 24 hours, should be reexamined
by 3 to 4 days of age.
The neonatal examination is best performed in an appropriately
equipped, warm, draft-free room, preferably with the mother present;
examining the infant under a servocontrolled radiant warmer is an
alternative. Thorough hand-washing before and after handling each infant
is essential to prevent the spread of pathogenic organisms. If possible,
the infant’s mother or guardian should be present during the
examination so the examiner may address any specific parental concerns
or questions and observe parental-infant interaction. Observation
of the infant’s appearance, posture, and state of consciousness
should precede the formal aspects of palpation and auscultation. Presence
of 1 anomaly suggests presence of another, since anomalies often
coexist. Constellations of physical findings may indicate the presence
of a syndrome. Evidence of trauma in one part of the baby should
lead to a search for trauma in other areas. Signs of birth trauma
are particularly common in large infants and in infants who underwent
difficult deliveries such as breech or forceps delivery.
The obstetric history of the pregnancy and delivery may provide
a clue or sign of possible neonatal problems. For example, polyhydramnios
may signal bowel obstruction; oligohydramnios may signal renal anomalies
and pulmonary insufficiency; small-for-gestational-age and postmature
infants are suspect for hypoglycemia and polycythemia; and prolonged
rupture of the membranes, maternal fever, and fetal tachycardia
may signal neonatal sepsis. The neonatal consequences of intrauterine
growth restriction, prematurity, multiple births, maternal diabetes,
and meconium-stained amniotic fluid are discussed in detail in other
The infant’s gestational age should be estimated and
body size compared with appropriate normal standards.
There are several ways to estimate gestational age, including