Initial Newborn Evaluation

Key Points

• A comprehensive physical examination of the newborn should be completed and discussed with the parents within the first 12 to 18 hours of life.

• The newborn examination should include observation of the infant at rest, including resting muscle tone, skin color, and respiratory effort.

• Periodic breathing is a normal breathing pattern in the newborn.

• A normal infant may need several hours to clear the lungs of excess fluid, and fine pulmonary crackles can be a normal physical finding.

• A soft systolic murmur can be a normal physical finding in the first hours of life, as the ductus arteriosus remains partially open.

• Asymmetric limb movements and reflexes should prompt further evaluation.

• All newborns should be screened for hearing loss before discharge.

Once the infant has been stabilized immediately after delivery, maternal and infant bonding should be encouraged. Initiating breastfeeding within the first 60 minutes after birth can increase the chances of successful breastfeeding (Sinusas and Gagliardi, 2001).

Within the first 12 to 18 hours of life, a comprehensive physical examination should be completed and discussed with the parents. During the examination, the infant should be kept in a comfortable environment. Keeping the infant quiet and calm is important for adequate examination in the newborn period. The examination should begin with observation of activity, skin color, muscle tone, and respiratory effort while the infant is quiet. Listening to the heart and lungs should be completed next, disturbing the infant as little as possible. An infant often begins to cry at the touch of a cold stethoscope or cold hands, making the cardiopulmonary examination particularly difficult. The rest of the examination can then be completed in a calm and thorough manner.

As with the examination of adults and children, a complete history should be obtained on every patient. For the newborn, this includes the maternal history, antepartum course, course of delivery and any complications, and any postpartum complications. Specific attention to maternal medication and drug use, maternal medical conditions, traumatic events during delivery, neonatal resuscitation measures required, and maternal postpartum course assist in developing an appropriate assessment and plan for the neonate.

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