Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
CHAPTER 9: Basic Systematic Examination of a
Newborn at Peripheral Centers
In major hospitals the pediatrician/neonatologist performs a systematic and complete
examination of the newborn. This kind of evaluation is presently not feasible in the peripheral
centers where such specialists are not available. The purpose of this manual is for peripheral
healthcare workers to acquire competence in basic evaluation and care of the newborn infant,
and the manual will therefore focus on basic components of care and evaluation. A somewhat
more detailed systematic examination, noted in Appendix B, may be relevant at some of the
larger, more established centers.
While in general there is a systematic method of examination, it is important in some cases to
adapt the steps to take into consideration certain situations that apply to very young babies such
as newborns. The newborn infant is frequently asleep, for example, so it is advisable to take
advantage of this to carry out those steps that require a quiet infant, such as counting the
respiratory rate. On the other hand, if the baby is crying, it becomes easier to look into the
mouth to identify the presence of problems such as a cleft lip or an infection such as thrush. If
necessary, newborns can usually be calmed with breastfeeding, which provides an opportunity
to evaluate sucking and attachment at the breast.
PREPARING FOR THE EXAMINATION
Timing of the Examination
Examinations should be done at the following times:
• As soon as feasible after birth when the baby is stable and warm.
• At least once a day as long as the baby is in the facility.
• Before discharge. This is extremely important in order to detect any high risk factors or a
danger sign in the early stages. The latter may necessitate a longer stay at the facility,
beginning treatment/referral to the hospital, or recommending an earlier follow-up visit.
The early postpartum period is very important as 75 percent of deaths in newborns take
place in the first week following birth.
• At the first and subsequent follow-up visits in the postpartum period.
Equipment and Supplies Needed for the Examination
• a source of clean water, soap, alcohol/glycerine hand rub and clean towels
• a clean examination table/mother’s bed (should be free of drafts and well-lit)
• a baby weighing scale
• a clean stethoscope
• a clinical thermometer for recording axillary temperature
• cotton swabs and alcohol
• a tape measure
• a watch or clock with a second hand or a timer to aid in measuring the respiratory rate
• a mother/baby card
Integrated maternal and newborn care
Basic skills course
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