Integrated Maternal and Newborn Care Basic Skills Course ...

Chest
• Look for symmetry and movement during breathing.
• The breasts in both boys and girls may be engorged and secrete a small amount of milk.
Do not express the baby’s breasts, as it may lead to trauma and infection.
• Listen to the heart sounds with a stethoscope. The rate is faster in the newborn period,
the range being 110-160/minute. Soft murmurs may be normal in the early newborn
period.
Abdomen
Anus
• The abdomen should be rounded and soft.
• Check the umbilical cord for:
o The presence of two arteries and one vein which is normal. The vein is seen as an
elongated open slit and the arteries as thin cord-like structures.
o Oozing of blood. If present, tie the cord again.
o Signs of infection. In case of a pus discharge from umbilicus or the base of the cord,
lift the cord to see the base. Redness or swelling over the surrounding skin and/or a
foul smell are features of a major infection.
• Later, after the umbilicus heals well, a small umbilical hernia may develop in some
babies. It usually resolves spontaneously. Do not apply a coin or a pressure bandage
over it.
• Gently palpate the abdomen for masses. The liver and spleen are normally palpable.
• Note when the baby passes stools (usually at birth or within 24-48 hours of the delivery).
• At birth or when seen for the first time during the first few days after birth, check the
position of the anus and ensure the patency of the anal opening. Where there is doubt,
verify patency carefully and gently with a clean blunt rectal thermometer.
Male genitalia
• The urethra opens at the end of the penis.
• Do not try to retract the prepuce, as it is often adherent at this stage.
• One or both the testes are felt in the scrotum in a full term baby, but they may be
undescended in a preterm infant.
• If the baby has been circumcised, check for any signs of bleeding or infection.
• Examine the groin and scrotal sac for hernias and hydroceles:
o Hernias are reducible and are not trans-illuminated with a torch/flashlight. Although,
usually it is not an emergency unless impacted or strangulated, such babies need to
be referred to an appropriate hospital for assessment and planned management.
o Hydroceles which can be trans-illuminated with a torch/flashlight may also be noted.
They usually disappear in a few months or by the first birthday.
Female genitalia
• Examine the labia and clitoris; make sure there is no fusion of the labia.
• The hymen is often prominent and may project out as the “hymenal tag,” which is
normal.
166
Integrated maternal and newborn care
Basic skills course