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We've all been there. You walk onto the postnatal ward to see a long list of baby checks for you to do and your heart sinks. If you have limited experience in pediatrics, it can be difficult to know how to approach something so different to acute medicine and the fear of missing an important abnormality can cause you to be stressed and cautious in your examination, which further adds to your workload. I'm Doctor Matthew Sayers, a consultant pediatrician with over 10 years experience in pediatrics including doing a large number of baby checks. And in this video, I am going to share my approach to performing a newborn infant examination as required by the PC. Hr Thanks to all guidelines and documents in this video are available in the video lecture equipment. You will need the baby's Red Book, a stethoscope, an ophthalmoscope and sucrose to settle the baby if required. Ask the newborn screening questions found on page 63 of the red book. Organize any follow up that is recommended following these screening questions. The newborn exam should be done in a structured way from head to toe to avoid missing any abnormalities. We will talk about the most common and significant abnormal findings. But ask a senior colleague to review if you're unsure about any findings. Always make sure that any birth marks, bruises or injuries are marked on the neonatal body map on page 63. So that parents are not re-refer back for safeguarding assessments. If these marks are noted following discharge, examine the scalp and hair looking for any swelling or bruising. Common marks include molding caused by pressure from delivery, vacuum or forceps, marks from instrumental delivery or bruising from delivery. Common swellings are caput suum, a soft edematous, superficial swelling over the presenting part. This is typically pitting and settles quickly. It is not of any concern. Cephalohematoma is an accumulation of blood between the scalp and skull. It feels deeper and more fluctuant than a caput and does not cross the suture lines. If small parents can be reassured that we will settle in a few weeks. But to watch out for any jaundice as the blood is broken down. A large hematoma should have a senior review. It will be followed up at the six week check to ensure resolution as rarely. It can calcify. Subgaleal hemorrhages are rare but significant bleeds into the area between the skull and the galea Aponeurotica. This can lead to significant blood loss and it is important to recognize urgently in comparison to cephalohematoma. This can cross suture lines and leads to a diffuse buggy swelling with associated pallor and shock in the baby, urgent admission to the neonatal unit is required. If this is suspected palpate the suture lines in fontanelles and measure the baby's head circumference. The anterior and posterior fontanelles should be soft and easily palpable and the sutures should be mobile and non ridged. Examine skull shape for asymmetry, positional plagiocephalies in which the skull is slightly misshapen due to pressure from lying or in the womb is common. Ask for senior review if there is marked asymmetry or fixed ridged sutures, as this can indicate craniosynostosis, abnormally, early suture fusion. If the baby's head circumference is less than the naught point fourth centile or greater than the 99.6 centile. Or if the fontanelle is sunken or bulging request. A senior review, examine the face look for any dysmorphic features such as hyper or hypotelorism that is abnormally separated eyes, slanting palebral fissures, low set ears before below the level of the eyes, significant tongue protrusion or epicanthic folds. Trisomy 21 is the most commonly identified dysmorphic feature on facial examination. But there are many other syndromes with facial features. Ask for a senior review before discussing these with parents, examine the eyes. It is important for the baby's eyes to be well opened to facilitate this. This can be achieved by darkening the room, settling the baby was so close or asking the mother to lift the baby with their head, looking over her shoulder and gently rocking them forward and backward. The eyes should only be gently pulled open as a last resort examine the red reflex, put the ophthalmoscope to your eye and look through it at the baby's pupils from a distance of around 1 m. A normal response will be a bilateral red glow of the pupil similar to the red ie effect. With flash photography, the reflexes may be less bright and paler in black or Asian babies and a senior should review if unsure and opacity, obscured red reflexes or white reflexes are abnormal and should be referred to ophthalmology for a review, subconjunctival hemorrhages are common from delivery. They don't affect vision and generally settle within a few weeks. You don't need to examine specifically for them. But if they are noted incidentally, they should be planted on the neonatal body map. Sticky eyes are common most commonly, these are caused by a blocked tear duct and can be managed with regular cleaning of the eye if it fails to settle within 24 hours or it is very severe. A swab should be sent and co and ven eye drops commenced if an S ti is suspected from antenatal swabs or clinical purulent appearance of the discharge. Seek urgent senior review, examine the ears, look for any auricular skin tags, pits or abnormalities of the penis and check the patency of the ear canal externally. Previously, a renal ultrasound would be performed for auricular skin tags, but this is no longer a practice and they are a cosmetic issue. Only, all infants will have a newborn hearing screen prior to discharge. Examine the mouth, look for any natal teeth which should be referred to a dentist. Assess the baby's suck with a gloved finger, look into the mouth with a light source to ensure there is no cleft palate, do not rely on palpation alone to exclude this. Examine the neck and shoulder. Any lump over the neck or shoulder should be discussed with a senior colleague. You may notice neck position, asymmetry called torticollis or a swelling of the sternocleidomastoid muscle. Any swelling over the clavicle should raise suspicion of a fracture, especially if the baby is not using this arm or is in pain. Confirm this with an X ray and refer to physio and outpatient pediatric orthopedics examine the skin. There are a number of common skin abnormalities in newborns, jaundice. This is a yellow discoloration of the skin and it is extremely common looking at the sclera can be helpful if you're unsure if this is noted within the 1st 24 hours of life. It is abnormal and ask for a senior review. Jaundice levels can be checked with a transcutaneous bilirubinometers and plotted on an appropriate gestation chart. If this is elevated, a serum level should be checked if the level is at or above the treatment line, commence phototherapy erythema toxicum. These are small white vesiculopustular papules on an erythematous base which develop over the first few days of life. They last for around one week and are completely benign stork marks. This is a red discoloration which is common on the forehead or back of the neck. This is completely benign and tends to fade with time, blue spots. These are blue, dark discolorations over the lower spine and buttocks. They are more common in non caucasian babies. They're completely benign but do make sure that it is documented on the neonatal body map. Do you avoid being mistaken for inflicted bruises, port wine stains. These are extensive dark red discolorations which occur particularly over the face. These are abnormal and ask for a senior review. If noted hemangiomas, these usually occur on the head or neck. If it is solitary, small and superficial, no treatment is required and parents should be reassured that they will regress in 1 to 2 years. Although they may grow initially if the hemangioma are multiple, deep or large. Ask for a senior review, listen to the lung fields and count the respiratory rate. If this is elevated request, a senior review urgently listen to the heart. If there's any loud murmur or a murmur that persists over 24 hours request. A senior review do not discharge a baby with a murmur until it has had a senior review and they are older than 24 hours. Perform pulse oximetry in the baby's right arm and right leg and compare the values if either value is consistently less than 95% or if there is a difference of three or greater request, an urgent senior review as this can indicate severe heart problems, even in the absence of a murmur, pectus excavatum is a relatively common abnormality in which the sternum and ribs are abnormally shaped and sunken into the chest. It generally doesn't cause significant symptoms and parents can be reassured if it is very severe surgery may be required when the child is older. Mild symmetrical breast swelling in both male and female babies is common due to maternal hormones. Reassure parents that this will settle if it is asymmetrical, very large or tender. Requesting your review, examine the abdomen for distension or Gono megaly or hernias. A two centimeter, palpable liver and a one centimeter palpable spleen is acceptable. Any larger need seen your review, umbilical hernias are common and benign parents can be reassured that these will settle. Inguinal hernias need senior review and referral to ped surgeons. Even if they are reducible diathesis. Recti is very common in babies. It is a long thin swelling between the two rectus abdominis muscles. It is completely benign and resolves with time. The umbilical stump may be necrotic and smelly. This is normal and sure there is no redness of the margins of the stump or on the abdomen as this indicates omphalitis. Ask for a senior review. If this is present, examine the genitalia for a boy, the stretched penis length should be at least two centimeters. The foreskin is normally I retractable. Don't attempt to retract it. Ensure a good urine flow has been seen and check the urethral meatus is at the tip request senior review. If it is lower on the penis, this is called hypospadias. Examine the testes, both should be felt in the scrotum if not palpable, palpate the inguinal canals as commonly they are mobile. A unilateral undescended testes can be followed up at the GP 68 week check and referred to the surgeons. If this persists a bilateral undescended testes not palpable in the inguinal canal needs a senior review. If there is testicular swelling, attempt to transilluminate it with a pen torch if it transilluminate. Well, it is likely a hydrocele and this can be followed up at the six week check as they often resolve spontaneously if it doesn't easily transilluminate request, senior review. If the external genitalia of a male or female baby looks abnormal or ambiguous request, urgent senior review and don't discuss your concerns with parents until a senior has reviewed check the position of the anus and its external patency check. If the baby has passed meconium through the anus, this should occur within 48 hours of birth, but the baby doesn't need to remain an inpatient until this occurs as long as they are appropriately safety netted. A baby should be observed to pass urine prior to discharge, especially if they are a male, examine the arms and legs for spontaneous movements and abnormalities. Suspect an obstetric palsy if the baby is not moving one arm and request an X ray to exclude a fracture. Examine both hands for accessory digits, abnormalities or single palmar creases, unilateral single palmar creases common and not concerning if there's no other dysmorphic features. If there are bilateral single palmar creases request a senior review. Look for signs of talipes and abnormal posture of the baby's foot. Fix talipes where the baby's foot cannot be straightened to a normal position. Need referred to orthopedics, positional talipes are common. Parents should be given exercises to help straighten them and referred to physiotherapy. Examine the hips before oran's maneuver by pressing both hips firmly downwards. A clunk or obvious dislocation with this maneuver should prompt senior review, an urgent orthopedic referral, perform a Barlow maneuver by bilaterally abducting both hips. A clunk or relocation should prompt Ortho review. A mild click or crease asymmetry is not concerning ensure follow up is arranged for screening hip questions and abnormal examination as per local policy, examine the back for any obvious spinal abnormalities. Dimples do not need further investigation. If the base is visible dimples without a visible base, Tufts of hair or other swellings over the spine should have a senior review and an ultrasound of the spine requested. Ensure the baby has passed urine and the lower limb movements are normal. Finally check the baby's morrow. This is normally left to the end as it can upset the baby, put your hand below the baby's shoulder and suddenly drop your hand simulating a fall. A normal response will be rapid arm abduction followed by abduction, a prolonged abduction without abduction, an absent or asymmetric response should prompt senior review document all your findings on page 65 of the red book and plot the height weight and head circumference at the back of the red book. Also make sure the body map on page 63 and the newborn assessment part one screening questions on page 64 are complete if the baby requires follow up. Sure, this is arranged prior to discharge and explain any abnormal findings to the parents. Thanks for watching. We hope you find this video useful. Please like comment and subscribe to our channel on youtube, Instagram and Twitter. We release regular videos across our platforms and we hope to see you again soon.