The newborn examination is largely seen as a screening examination for congenital anomalies or for problems that are expected to present soon after birth. The recommendations as to the optimal timing of the examination vary, and while a thorough examination can be carried out in the delivery room, recent years have seen a renewed emphasis on the importance of this time for families to bond with their newborn, for the establishment of successful breastfeeding, and for limiting medicalization. Moreover, while some major anomalies should be apparent at birth, other conditions are less apparent and may evolve over time, making later examination of higher value. For these reasons, and following from the United Nations Children’s Fund (UNICEF)/World Health Organization (WHO) Baby Friendly Initiatives, many hospitals now seek to limit initial examination of newborns immediately after birth to a health screen with a more thorough examination taking place later on but prior to hospital discharge (Table 46-1).
TABLE 46-1DIAGNOSTIC PERFORMANCE OF THE NEONATAL PHYSICAL EXAM FOR DETECTING TARGET CONDITIONS |Favorite Table|Download (.pdf) TABLE 46-1DIAGNOSTIC PERFORMANCE OF THE NEONATAL PHYSICAL EXAM FOR DETECTING TARGET CONDITIONS
|Target Condition ||Sens ||Spec ||PPV ||NPV ||LR+ |
|Cardiac diseasea ||63% ||98% ||1.35 ||99.98 ||32.4 |
|Developmental hip dysplasiab ||74–99% ||98–99% ||NR ||NR ||37–99 |
|Congenital cataractc ||85 ||94.3 ||18.7–42d ||99.96 ||14.9 |
|Neurologic abnormalitye ||91 ||79 ||76 ||92 ||4.3 |
The neonatal examination is best performed in an appropriately equipped, well lit, warm, draft-free room, with the parents present. Examining the infant under a servo-controlled radiant warmer is an alternative. Thorough hand-washing before and after handling each infant is essential to prevent the spread of pathogenic organisms, and if the infant has not had a first bath, gloves should be worn.
Parental presence is important so that one can address their specific concerns. Observation of the undisturbed infant’s appearance, posture, and state of consciousness should precede the formal aspects of palpation and auscultation. Isolated minor congenital anomalies are quite common, with some studies reporting these in as many as 15% of the newborn population, but the presence of 3 or more increases the risk of the infant having a syndrome. Evidence of trauma in 1 part of the baby should lead to a search for trauma in other areas, particularly in large infants and in infants who underwent difficult deliveries such as breech or forceps delivery. It is also important to be able to distinguish malformations from deformations as the etiology and managements differ.
A thorough history that includes the maternal medical, antenatal, and obstetric history is crucial ...