How is the newborn physical examination done?



The healthcare professional will give your baby a thorough physical examination.

They'll also ask you questions about how your baby is feeding, how alert they are, and about their general wellbeing.

Your baby will need to be undressed for part of the examination.

During the examination, the healthcare professional will also:

  • look into your baby's eyes with a special torch to check how their eyes look and move
  • listen to your baby's heart to check their heart sounds
  • examine their hips to check the joints
  • examine baby boys to see if their testicles have descended into the scrotum

What does the newborn physical examination check for?

The examination includes an overall physical check, plus 4 different screening tests.

Eyes

The health professional will check the appearance and movement of your baby's eyes.

They're looking for cataracts, which is a clouding of the transparent lens inside the eye, and other conditions.

About 2 or 3 in 10,000 babies are born with cataracts in one or both eyes that need treatment.

But the examination cannot tell you how well your baby can see.

Find out more about childhood cataracts

Heart

The healthcare professional will check your baby's heart. This is done by observing your baby, feeling your baby's pulses, and listening to their heart with a stethoscope.

Sometimes heart murmurs are picked up. A heart murmur is where the heartbeat has an extra or unusual sound caused by a disturbed blood flow through the heart.

Heart murmurs are common in babies. The heart is normal in almost all cases where a murmur is heard.

But about 8 in 1,000 babies have congenital heart disease that needs treatment.

Find out more about congenital heart disease

Hips

Some newborns have hip joints that are not formed properly. This is known as developmental dysplasia of the hip (DDH).

Left untreated, DDH can cause a limp or joint problems.

About 1 or 2 in 1,000 babies have hip problems that need to be treated.

Find out more about developmental dysplasia of the hip

Testicles

Baby boys are checked to make sure their testicles are in the right place.

During pregnancy, the testicles form inside the baby's body. They may not drop down into the scrotum until a few months after birth.

Around 2 to 6 in 100 baby boys have testicles that descend partially or not at all.

This needs to be treated to prevent possible problems later in life, such as reduced fertility.

Find out more about undescended testicles

Does my baby have to have the examination?

The aim of the examination is to identify any of the problems early so treatment can be started as soon as possible.

It's strongly recommended for your baby, but not compulsory.

You can decide to have your baby examined and screened for any or all of the conditions.

If you have any concerns, you should talk to your midwife or the healthcare professional offering the examination.

When will we get the results?

The healthcare professional who does the examination will give you the results straight away.

If your baby needs to be referred for more tests, they'll discuss this with you there and then, too.

The results will be recorded in your baby's personal child health record (red book).

You'll need to keep this safe and have it to hand whenever your baby sees a healthcare professional.

If you have any concerns, you can discuss them with your midwife or the healthcare professional who does the examination.

 

Blood Typing;

Reagents ID-Card ̋ABO/Rh for Newborns˝ contains a mixture of polyclonal and monoclonal anti-A (cell line: A5), polyclonal anti-B and anti-AB antibodies of human origin within the gel matrix. The anti-D used is a blend of human IgG antibodies. The anti-human globulin serum is a blend of rabbit anti-IgG and monoclonal anti-C3d (cell line: C139-9). The microtube ctl is the negative control. Preservative: < 0.1% NaN3. Caution: The source materials from which these products were manufactured, were found non reactive for HBsAg, HCV and HIV (1+2) when tested with licensed reagents. However, no known test method can assure that infectious agents are absent. Products from human blood should be considered potentially infectious. Do not store near any heat, air conditioning sources or ventilation outlets. Stability: see expiry date on label. Additional reagents required • ID-Diluent 2: modified LISS for red cell suspensions. • ID-Diluent 1: modified bromelin solution. (see related package insert) Further materials required • ID-Dispenser • ID-Pipetor • ID-Tips (pipetor tips) • Tubes for suspensions • ID-Working table • ID-Centrifuge 6, 12 or 24 Sample material Draw blood samples using acceptable phlebotomy techniques. Cord or heel prick samples may be used. It is normally not necessary to wash the cells before use (see ̋Remarks˝). Where cord samples are used, care must be taken to avoid contamination with Wharton’s jelly. Preferably, blood samples should be drawn into Citrate, EDTA or CPD-A. For reliable results, use of freshly collected blood is indicated. Preparation of blood sample Prepare a 0.8% red cell suspension in ID-Diluent 2 as follows: Allow the diluent to reach room temperature before use. 1. Dispense 1.0 ml of ID-Diluent 2 into a clean tube. 2. Add 10 µl of packed red cells or 20 µl of whole blood, mix gently. The cell suspension may be used immediately. Controls Known positive and negative samples should be included in accordance with the relevant guidelines of quality assurance. Test procedure Do not use ID-Cards which show signs of drying, have bubbles, damaged seals, drops of gel or supernatant in the upper part of the microtubes or on the underside of the aluminium foil. 1. Identify the ID-Card with the unique patient or donor number/details as appropriate. 2. Remove the aluminium foil from as many microtubes as required by holding the ID-Card in the upright position. 3. Pipette 50 µl of the red cell suspension to all microtubes of the ID-Card. 4. Add 25 µl of ID-Diluent 1 (allow to reach room temperature 18–25 °C before use) to the first 5 microtubes (A, B, AB, D, ctl). 5. Incubate the ID-Card for 10 minutes at room temperature (18–25 °C). 6. Centrifuge the ID-Card for 10 minutes in the ID-Centrifuge. 7. Read and record the results. ABO/Rh for Newborns ID-Card Deutsch B001017 06.13 A, B, AB, D, ctl/DAT Bestimmung der ABO/Rh Blutgruppen bei Neugeborenen mit dem direkten Antiglobulintest (DAT), mit humanen Antikörpern Produkt-Identifikation: 50061 Einleitung Anti-A-, Anti-B- und Anti-AB-Testseren werden für die Bestimmung der A/B-Antigene benötigt. Da die Antigene A und B bei der Geburt noch nicht vollständig entwickelt sind, können die Reaktionen schwächer sein als bei Erwachsenen. Untergruppen können nicht immer bestimmt werden. Das Serum von Erwachsenen enthält Antikörper gegen die auf den Erythrozyten nicht vorhandenen Antigene A und B. Diese Antikörper treten nach den ersten 4 bis 6 Lebensmonaten auf. Entsprechend kann die Serumgegenprobe bei Neugeborenen nicht durchgeführt werden. Es wird deshalb angezeigt, dass beim Neugeborenen die zu bestimmende Blutgruppe nach 2 bis 4 Jahren zu bestätigen ist, wenn die Antigene A und B sowie die Isoagglutinine voll entwickelt sind. Das Antigen D wie auch schwaches D ist bei der Geburt vollständig entwickelt. Bei Rh-negativen Müttern ist die Bestimmung des RhD und des schwachen D beim Neugeborenen unerlässlich. Die Durchführung des direkten Antiglobulintests (DAT) bei Neugeborenen ist Routineuntersuchung, da es wichtig ist festzustellen, ob die Erythrozyten des Neugeborenen mit Antikörpern in utero beladen sind. Reagenzien Die ID-Karte ̋ABO/Rh for Newborns˝ enthält ein Gemisch aus polyklonalem und monoklonalem Anti-A (Zellinie: A5) sowie polyklonales Anti-B und Anti-AB in der Gelmatrix. Das verwendete Anti-D ist eine Mischung humaner IgG Antikörper. Das Antihumanglobulin-Serum ist eine Mischung von Kaninchen-Anti-IgG und monoklonalem Anti-C3d (Zellinie C139-9). Das Mikroröhrchen ctl dient zur negativen Kontrolle. Konservierungsmittel: < 0,1% NaN3. Achtung: Die Ausgangsmaterialien, aus denen diese Produkte hergestellt wurden, haben sich bei der Prüfung mit zugelassenen Reagenzien als nicht reaktiv für HBsAg, HCV und HIV (1 und 2) erwiesen. Allerdings kann kein verfügbares Testverfahren das Nichtvorhandensein infektöser Substanzen garantieren. Aus Humanblut gewonnene Produkte sollten immer als potentiell infektiös angesehen werden. Nicht in der Nähe von Hitzequellen, Klimaanlagen oder Lüftungsausgängen lagern. Stabilität: siehe Verfallsdatum auf dem Etikett. Zusätzlich benötigte Reagenzien • ID-Diluent 2: Modifiziertes LISS zur Herstellung der Erythrozytensuspensionen. • ID-Diluent 1: Modifizierte Bromelin-Lösung. (siehe diesbezügliche Packungsbeilage) Weitere erforderliche Materialien • ID-Dispenser • ID-Pipetor • ID-Tips (Pipetor-Spitzen) • Suspensionsröhrchen • ID-Arbeitsplatz • ID-Zentrifuge 6, 12 oder 24 Probenmaterial Blutproben werden nach allgemeingültigen Entnahmeverfahren gewonnen. Nabelschnurproben oder Fersenpunktate können verwendet werden. Die Erythrozyten müssen vor Gebrauch nicht gewaschen werden (siehe ̋Anmerkungen˝). Wenn Nabelschnurproben verwendet werden, sollte darauf geachtet werden, eine Kontamination mit Wharton-Sulze zu vermeiden. Die Probengewinnung sollte in Citrat, EDTA oder CPD-A erfolgen. Um verlässliche Resultate zu erhalten, empfiehlt sich die Verwendung von frisch entnommenem Blut. Vorbereitung der Blutprobe Eine 0,8%ige Erythrozytensuspension in ID-Diluent 2 wie folgt herstellen: Diluent vor Gebrauch auf Raumtemperatur bringen. 1. 1,0 ml ID-Diluent 2 in ein sauberes Röhrchen pipettieren. 2. 10 µl Erythrozytenkonzentrat oder 20 µl Vollblut hinzugeben; leicht mischen. Die Erythrozytensuspension kann sofort verwendet werden. Kontrollen Bekannte Antigen-positive und -negative Erythrozyten sollten in Übereinstimmung mit den gültigen Richtlinien zur Qualitätssicherung mitgeführt werden. TestduRchführung Keine ID-Karten benutzen mit Anzeichen von Austrocknung, Luftblasen, beschädigter Versiegelung oder Tropfen des Gels bzw. des Überstandes im oberen Teil der Mikrokammer oder auf der Unterseite der Versiegelung. 1. Die ID-Karte mit den Patienten- oder Spenderdaten beschriften. 2. Aluminiumfolie von den benötigten Mikroröhrchen in aufrechter Kartenposition entfernen. 3. 50 µl der Erythrozytensuspension in alle Mikroröhrchen der ID-Karte pipettieren. 4. 25 µl ID-Diluent 1 (Diluent vor Gebrauch auf Raumtemperatur 18–25 °C bringen) in die ersten 5 Mikroröhrchen (A, B, AB, D, ctl) dazugeben. 5. ID-Karte 10 Minuten bei Raumtemperatur (18–25 °C) inkubieren. 6. ID-Karte 10 Minuten in der ID-Zentrifuge zentrifugieren. 7. Reaktionen ablesen und aufzeichnen. DiaMed GmbH Pra Rond 23 1785 Cressier FR Suisse DiaMed GmbH Pra Rond 23 1785 Cressier FR Switzerland DiaMed GmbH Pra Rond 23 1785 Cressier FR 0123 Schweiz Les modifications apportées à la version 03.12 sont colorées en gris. Changes to the version 03.12 are shaded grey.

 

Parents' blood group Possible groups in offspring Groups not possible in offspring
A×A A, O B and AB
A×B A, B, AB, and O
A×AB A, B, and AB O
A×O A and O B and AB
B×B B and O A and AB
B×AB A, B, and AB O
B×O B and O A and AB
AB×AB A, B, and AB O
AB×O A and B AB and O
O×O O A, B, and AB

 

CONCLUSION

 

Infant mental health refers to the behavioural and social development of children from birth to the age of three. Research has shown that babies are born biologically programmed to seek contact and to form relationships. The care giver is the baby’s first relationship, and first relationships matter. Parents may be surprised to discover that their baby is drawn to their face, their voice and their smell and indeed craves physical contact. Encourage parents to follow their baby’s cues and to talk and sing to their baby. These behaviours help them to form a strong attachment or bond with their baby. The Newborn Clinical Exam can be used as an opportunity to demonstrate this to the parent, encouraging early relationship building strategies such as following the baby’s cues, talking, singing to, and holding their baby. These behaviours help them to form a strong attachment or bond with their baby.

 

 Health promotion

 

 The newborn clinical examination is a wonderful opportunity for a healthcare professional to engage and involve parents in the health of their newborn baby, and to offer opportunistic health promotion. Messages that can be delivered at this time include:

 · The importance of breastfeeding

 · Nutrition and weaning

 · SIDS prevention

 · Prevention of accidents and injuries

 · Immunisations

 · Recognition of illness

 

 

Blood typing:

 

Blood group evidence has been accepted by courts of law in cases of disputed paternity for more than 50 years, but it is only in the last few years that a legal framework has been recognized in this regard (Vij, 2011). The question of disputed paternity may arise in cases of alleged adultery and suits for nullity of marriage, when the child is born in lawful wedlock, and the husband denies being the father of the child and seeks divorce on these grounds. In other cases, the mother can accuse or even blackmail a particular man as the father of a child, although the man denies the accusation. Maternity, however, may be questioned in instances when two women claim to be the mother of the same child, in accusations of swapping of newborns in hospital, in cases of missing and abandoned children, or in cases of a kidnaped child when the kidnaper claims to be the mother of the child, etc.

Lately, blood grouping has been largely replaced by DNA methods in most forensic laboratories throughout the world; however, it is still used as a reliable investigation in developing countries.

                                                                           

REFERENCES:

 

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Examination of the Newborn Royal Australian College of Physicians Available at: http://www.adhb.govt.nz/newborn/Guidelines/Admission/ExaminationoftheNewborn-08_05_2009.pdf NIPE Newborn and Infant Physical Examination Service Specification No. 21 Public Health England (September 2018) Available at: https://www.england.nhs.uk/wp-content/uploads/2017/04/Gateway-ref-07842-180913- Service-specification-No.-21-NHS-Newborn-and-Infant-Physical-Examination.pdf NIPE Newborn and Infant Physical Examination Screening Programme Handbook Public Health England (April 2018) Available at: https://www.gov.uk/government/publications/newborn-and-infant-physical-examinationprogramme-handbook/newborn-and-infant-physical-examination-screening-programme-handbook NIPE Newborn and Infant Physical Examination Screening Programme Standards 2016/2017 Public Health England (April 2016) Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/692020/NIPE_ Programme_Standards_2016_to_2017.pdf Queensland Clinical Guideline Routine newborn assessment (previously examination of the newborn baby) MN14.4.V4.R19 Queensland Clinical Guidelines Steering Committee (Oct 2014) Available at: https://www.health.qld.gov.au/__data/assets/pdf_file/0029/141689/g-newexam.pdf Rahi JS, Dezateux C. 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(2006) WHO Child Growth Standards: Length/Height-for-age, Weight-for-age, Weight-for-length, Weight-for-height and Body Mass Index-for age Methods and Development ISBN 92 4 154693 X. 68 Acknowledgement List for those involved in the development of the Newborn clinical Examination handbook: · Prof John Murphy, Consultant Neonatologist, Clinical Lead Paediatric & Neonatology Clinical Programme. · Dr. Caroline Mason Mohan, Specialist in Public Health Medicine, Department Of Public Health, Donegal. · Ms. Geraldine Duffy, Assistant Director of Midwifery, National Maternity Hospital, Holles Street, Dublin. · Ms. Grace Turner, Programme Manager, Integrated Care Programme for Children, Clinical Strategy & Programmes Division. · Ms. Carmel Brennan, Programme Manager, National Healthy Childhood Programme, Dept Public Health, Tullamore. · Dr. Fiona McGuire, Senior Medical Officer Public Health, Dept Public Health, Tullamore (joined the group in October 2016). · Dr. Jacqueline McBrien, Consultant Paediatrician, HSE Midland Regional Hospital Portlaoise, (Community Paediatrician with special interest in Child Health) (Resigned from the group in April 2017). · Dr. Jana Semberova, Consultant Paediatrician, Coombe Women and Infant’s University Hospital, Midlands Regional Hospital Portlaoise/ Our Lady’s Children’s Hospital Crumlin (joined the group in May 2017). · Ms. Jacinta Egan, Administrative Support, National Healthy Childhood Programme, Dept Public Health, Tullamore

 

 

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