How a newborn baby is examined by a neonatologist

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Indications: performed on all newborns.

Contraindications: none.

Delayed initial examination of a newborn who is in serious condition at the time of transfer from birth.

hall, in this case, a short examination is carried out in order to exclude developmental defects and assess the volume of necessary assistance, and a full examination of organs and systems, as well as anthropometry, is carried out after stabilizing the child’s condition or establishing the required volume of treatment (ventilation, infusion, etc.).

Required tools:

• Warm room;
• Sufficient lighting;
• Stethoscope;
• Individual or sterilized measuring tape;
• Flashlight;
• Electronic balance;
• Gloves.

The purpose of a medical examination according to the scheme of a complete systematic objective examination is to obtain answers to the following questions:

• Are there any birth defects that require medical intervention or dysmorphic changes;
• Has adequate cardiorespiratory adaptation occurred;
• Does the newborn have clinical signs of infection;
• Are there other pathological conditions that require urgent examination and intervention;
• Is the child healthy?

Methodology:

1.

Before conducting a full medical examination according to the scheme of a complete systematic objective examination of the newborn, the doctor who conducts the examination must analyze the medical history, read the medical documentation and obtain information about the state of the mother’s health, the course of pregnancy and childbirth. The doctor obtains additional information that is not in the medical documentation by interviewing the mother. If a woman has group 0 (I) and/or Rh-negative factor, a laboratory test of umbilical blood is performed to determine the group, Rh factor and bilirubin level.

2.

The primary medical examination of the newborn according to the scheme of systematic objective examination is carried out in the delivery room by a pediatrician-neonatologist, a pediatrician (in his absence, an obstetrician-gynecologist, a general practitioner - family medicine) before transferring the child to a ward where mother and child stay together. Examination of the newborn at birth. hall or in a ward where mother and child are together should be carried out in the presence of the mother. You should introduce yourself to the mother and explain the purpose of examining the child.

3. The newborn is examined systematically, avoiding hypothermia.

Scheme of systematic objective examination of a newborn.

Child's pose.

Flexor or semi-flexor (the head is slightly brought to the chest, the arms are moderately bent at the elbow joints, the legs are moderately bent at the knee and hip joints), hypotension and atony may be observed in severe condition or significant immaturity of the newborn. Normally, a 28-week child has only minimal flexion of the limbs, a 32-week child has flexion of the legs, a 36-week child has flexion of the legs and, to a lesser extent, the arms, and at 40 weeks, flexion of the arms and legs (flexion).

Scream. Loud, medium tension, weak, emotional or lack thereof.

Leather. Skin color reflects the degree of cardiorespiratory adaptation. Warm, healthy newborn babies have pink all over skin (erythema neonatorum) after the first few hours of life. During a cry, the skin may acquire a slight cyanotic tint, which may be a variant of the norm, with the exception of central cyanosis of the skin and mucous membranes (cyanotic tongue).

Children with polycythemia may also appear cyanotic without signs of respiratory or heart failure. Premature babies and babies born to mothers with diabetes look pinker than normal babies, while post-term babies look paler. The skin is elastic and can be covered with generic lubricant.

The appearance of jaundice on the first day is pathological. Pay attention to the presence of edema, palpate the lymph nodes. When pressed on soft tissue, the white spot should disappear within 3 seconds. If the stain lasts longer, this indicates a violation of microcirculation.

Depending on the gestational age, the skin may be covered with a thick lubricant and veins may be visible; in newborns with a gestational age closer to 37 weeks, peeling and/or rash and few veins may be observed; there is a lot of vellus hair, it is thin, covers in most cases the back and the extensor surface of the limbs; In newborns with a gestational age close to 37 weeks, areas without lanugo are noted.

Thin or absent subcutaneous fat. The skin on the soles has slightly noticeable red lines, or only the anterior transverse fold is noted; in newborns with a gestational age close to 37 weeks, folds occupy 2/3 of the skin surface.

Head and skull. The head is brachycephalic, dolichocephalic (depending on the position of the fetus during childbirth). Head circumference is 32-38 cm in full-term infants. Premature babies have rounder heads than full-term babies. The skull bones are thinner. The seams and crown are open. Head circumference is from 24 cm to 32 cm depending on gestational age.

There may be a birth tumor – it has a pasty consistency and extends beyond the boundaries of one bone. No treatment required.

The presence of a cephalohematoma is determined and its size is indicated.

The large fontanel is measured, and, if present, the small fontanel, normally at the level of the skull bones. The condition of the cranial sutures is assessed: the sagittal suture can be open and its width is no more than 3 mm. Other sutures of the skull are palpated at the border of the bone junction.

Face. The general appearance is determined by the position of the eyes, nose, mouth, and signs of dysmorphia are determined.

When examining the oral cavity, the normal mucous membrane is pink. The symmetry of the corners of the mouth, the integrity of the palate and upper lip are noted.

Eyes. Pay attention to the presence of hemorrhages in the sclera, jaundice, and possible signs of conjunctivitis.

When examining the ears, the external auditory canal is examined, the shape and position of the auricles, and the development of cartilage in them. Changes in the shape of the ears are observed in many dysmorphic syndromes.

Nose. In addition to the shape of the nose, attention is paid to the possible participation of the wings of the nose in the act of breathing, which indicate the presence of respiratory failure.

Neck. The shape and symmetry of the neck and the range of its movements are assessed.

The chest is normally cylindrical (the lower aperture is developed, the position of the ribs is close to horizontal and symmetrical).

In premature infants, the lower aperture is deployed, the course of the ribs is oblique. The chest circumference ranges between 21 cm and 30 cm depending on the gestational age.

Heart. Percussion is performed to determine the boundaries of cardiac dullness, auscultation of the child’s heart is performed, the heart rate, the nature of the tones, and the presence of additional noise are determined.

Belly . The abdomen is round in shape, takes part in the act of breathing, is soft, accessible to deep palpation. The border of the liver and spleen is determined. Normally, the liver can protrude 1-2.5 cm from under the edge of the costal arch. The edge of the spleen is palpated under the costal arch.

Examination of the genitals and anus. The genitals can be clearly formed according to the female or male type. In boys, phimosis is physiological.

The testicles of full-term babies are palpable in the scrotum; they should not appear bluish through the scrotum, this is a sign of spermatic cord torsion. In full-term girls, the labia majora cover the labia minora.

During examination, it is necessary to separate the labia majora to determine possible vaginal abnormalities.

The anus is examined and its presence is visually determined.

Inguinal region - the pulse on the femoral artery is palpated and determined for symmetry. Pulse filling decreases with coarctation of the aorta and increases with open ductus arteriosus.

Limbs, spine, joints. Pay attention to the shape of the limbs, possible clubfoot, the number of fingers on both sides of the hands and feet.

The presence of dislocation and hip dysplasia in the hip joints is checked: when the hip joints are separated, the separation is complete, there is no “clacking” symptom.

When examining the back, pay attention to the possible presence of spina bifida, meningocele, and dermal sinuses.

Neurological examination. Muscle tone is determined - the child’s posture is flexor, with ventral suspension the head is in line with the body; physiological reflexes are checked: searching, sucking, Babkin, grasping, Moro, automatic gait, support.

Searching, sucking and swallowing reflexes can be assessed during feeding.

In premature babies, muscle tone and spontaneous motor activity are usually reduced, small and intermittent tremor of the limbs and chin, small and intermittent horizontal nystagmus, a moderate decrease in reflexes with a satisfactory general condition of the child is transient and does not require special therapy.

4. The doctor must assess the child’s physical development according to the anthropometric data in the table.

• At the end of the initial examination, the doctor makes a conclusion about the child’s condition based on the following signs:
• A full-term healthy child, or a child with low body weight, a premature child, and/or the presence of a Congenital pathology, Birth trauma, Suspicion of infection, plus the child received neonatal resuscitation, suffered Hypothermia, has Respiratory disorders, Other.
• In the case of physiological adaptation of the newborn (loud cry of the child, activity, pink skin, satisfactory muscle tone), which occurs in conditions of early unlimited contact between mother and child, early initiation of breastfeeding in the absence of congenital malformations, signs of intrauterine infection, taking into account the results of a complete objective After systematic examination, the child can be considered healthy.

5. Explain the results of the examination to the parents. The mother should be asked if she has any questions regarding the baby's condition. After the examination, fill out the development history of the newborn.

6. If necessary, prescribe a laboratory or other additional examination, justifying it (high level of bilirubin in the umbilical blood, the presence of anamnestic data regarding placental blood loss, the condition of the child, etc.).

7. Monitoring the child’s general condition and providing the necessary assistance if it worsens should not depend on whether a medical examination was performed or on the extent of it.

Complications and errors:

• Hypothermia of the child, non-compliance with the thermal chain, prolonged examination.
• Conducting a medical examination and anthropometry immediately after the birth of the child.
• Performing routinely unnecessary procedures without indications (checking the patency of the anus, esophagus, cleansing enema, etc.).
• Underestimation of the severity of the child’s condition, the need and scope of treatment.
• Incorrect assessment of the child’s condition (especially a premature one), providing assistance to a child who does not need it.
• Removal of a child who requires maternal observation and temporary transfer to the intensive care unit for laboratory tests.

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The entry “Initial examination of a newborn” was published in the section RESEARCH METHODS, Pediatrics on Thursday, February 16th, 2012 at 6:53 pm

Source: http://detvrach.com/metodi-issledovania/pervichnii-vrachebnii-osmotr-novorozhdennogo/

Mandatory procedures in the maternity hospital with a newborn baby

You are expecting a baby and, of course, you are very concerned about the question of what will be done with him in the maternity hospital.

Perhaps you know something from the stories of other mothers and friends, for example, that all newborn babies are no longer taken away from their mother immediately after birth, but are placed on the mother’s chest, that the child is examined by a neonatologist in your presence, the baby is weighed, measured, and treated , then in the maternity hospital he gets vaccinations and tests. In this article we will talk in detail about what happens to the baby in the maternity hospital at different stages after birth.

What happens to the baby immediately after birth?

The midwife immediately dries the newly born baby with a warm diaper and places it on the mother’s belly, closer to the chest, putting a hat on it and covering it with a blanket on top. This stage happens very quickly, you won’t even have time to get your bearings. But it is very important for the baby.

Firstly, the baby is born wet. The temperature difference between the mother’s body where the newborn baby was (36.6°C) and the air temperature in the delivery room (at best 24°C) is at least 10°C. This is too big a difference for a baby.

Since all newborn babies have poor body temperature control, to keep the baby from freezing, it must be quickly dried with pre-heated diapers and then placed in skin-to-skin contact with the mother.

A hat for a baby is also very important, since the largest heat loss occurs from the surface of the baby’s scalp - about 25%. 

Skin-to-skin contact with mother is necessary for the baby not only to avoid freezing. As you may know, a newborn baby is born sterile. The first microorganisms with which he comes into contact are the microflora of the mother.

Then the baby encounters bacteria, viruses, fungi, etc., that are in his environment (air in the delivery room, clothing, care items, staff hands, tools, etc.). They may pose a potential danger to the child's health.

Therefore, the most useful microorganisms for the baby are the mother’s.

And if the baby is placed in skin-to-skin contact with his mother for at least 2 hours, his skin and mucous membranes will be contaminated with maternal bacteria that are beneficial to him, which will protect him from opportunistic or pathogenic environmental microorganisms.

It is at these moments that an invisible connection arises between mother and baby, on which their future relationships and affection for each other depend.

This also affects breastfeeding, since skin contact is a powerful stimulator of the production of hormones responsible for the production of milk in the mother.

What happens to the baby during the first 2 hours after birth?

Within the first 30 seconds after birth, the midwife cuts the umbilical cord. If the baby's father is present at the birth, he can, if desired, cut the umbilical cord himself.

If it is necessary to collect blood from the umbilical cord for tests (blood type, bilirubin, etc.), then this is done right there. Then the neonatologist conducts an initial assessment of the baby’s condition and decides whether the baby needs resuscitation or not.

If all is well, the baby is left in skin-to-skin contact with the mother for at least 2 hours.

What is happening at this time?

At the end of the 1st and 5th minutes, the doctor performs an Apgar score. 15-20 minutes after birth, as a rule, babies develop an appetite and begin to look for their mother’s breast. This is a signal that it is time to put the baby to the breast.

Breastfeeding within the first 30 minutes after birth is very important for the baby's health.

A newborn baby receives colostrum, which is essentially a cocktail of immunoglobulins, hormones, vitamins and other beneficial substances that are so necessary for the child.

Thanks to early breastfeeding, the baby's intestines are seeded with microflora, which in the future protects him from allergies and dysbacteriosis. In addition, the intestines are cleared of meconium, which prevents severe jaundice. That's why it's so important to put your baby to the breast as soon as he starts looking for it.

During the first two hours, while the mother and baby are in the delivery room, the baby must have their body temperature measured at least 2 times: 30 minutes after birth and before being transferred to the postpartum ward. This is necessary to prevent hypothermia, which is very dangerous for newborns. Thermometry is carried out with an electronic thermometer, as it better records the child’s low temperature.

Approximately 1 hour after birth, but always after eye-to-eye contact between mother and child, the midwife treats the baby’s eyes with 0.5% erythromycin ointment or 1% tetracycline ointment to prevent conjunctivitis, which can cause blindness in the child. Therefore, the use of antibiotics at such an early age should not scare you, because this is done in the name of the baby’s health.

What do you do 2 hours after birth?

After 2 hours, the neonatologist conducts a full examination of the newborn baby. He must discuss the results of the examination with his mother.

Then, before being transferred to a shared ward, the child is weighed, the body length and head circumference are measured, a disposable clamp is applied to the remainder of the umbilical cord, tags are put on the arms with the mother's name and the date of birth (the same are given to the mother), the weight and gender of the child and dressed in home clothes (vest, rompers, hat, socks). For the same reason that it is so important that the baby is in skin-to-skin contact with his mother for 2 hours, the child must be dressed in home clothes. After all, it contains exactly those microorganisms with which the baby will live when he returns home. They are the guarantee of his health. Therefore, before going to the maternity hospital, new clothes bought in a store need to be washed and given the opportunity to lie in the house so that they become contaminated with home microflora.

What happens later after childbirth?

After being transferred to a shared ward, mother and baby are not separated for a minute. Doctors' examinations, blood samples taken for tests, vaccinations - everything takes place in their shared ward. This is very important for both the baby and the mother. This way mother and baby have the opportunity to get to know each other better.

This is also important for establishing breastfeeding and feeding the baby at his first request. The mother takes care of the baby herself, which is also important, because at home she can feel more confident.

If you need help or advice, children's nurses or midwives are always ready to help.

It is mandatory to measure the child’s body temperature (2 times a day), monitor urination and stool, as well as the breastfeeding process.

The doctor must look at how the baby latch onto the breast, whether sucking is effective, whether there are any problems with feeding, correct mistakes if any, and help the mother become more confident in her own abilities.

48 hours after birth, blood is taken from the baby’s heel to test for diseases such as phenylketonuria, hypothyroidism, cystic fibrosis, adrenogenital syndrome. The results of these tests will come to your place of residence.

According to the national vaccination calendar, in the maternity hospital the child receives three vaccinations: against hepatitis B and tuberculosis (BCG), as well as vitamin K to prevent hemorrhagic disease of newborns. The child is vaccinated against hepatitis B on the first day of life (as well as vitamin K), but against tuberculosis only on the third day, before discharge.

Before discharge, on the third day, the child will be weighed again to find out the degree of physiological loss of body weight. If the adaptation period proceeds well, then the mother and baby are discharged on the 3rd day after normal labor and on the 5th day after cesarean section.

Upon discharge, the mother is given a birth certificate for the baby, which is a document on the basis of which the newborn child will be registered in the registry office and a birth certificate will be issued. The mother is also given an extract from the maternity hospital for the local pediatrician, which contains complete information about the baby’s health at the time of birth and stay in the maternity hospital.

Source: https://teddyclub.info/ru/novorozhdennyj/malysh-v-roddome/obyazatel-nye-procedury-v-roddome

Clinical examination of the newborn

Clinical examination of a newborn is carried out at a room temperature of at least 22°C, no earlier than 30 minutes after feeding in natural light. They examine him on a heated changing table or in an incubator. The doctor's hands must be warm, otherwise contact will be broken, which will complicate the examination process. External examination of a newborn A healthy full-term newborn is characterized by a calm facial expression, unique lively facial expressions, and a loud emotional cry. The movements are excessive, uncoordinated, and often athethesis-like. Characteristic is a physiological increase in the tone of the flexor muscles, which determines the child’s posture (flexion posture, fetal posture): the head is slightly brought to the chest, the arms are bent at the elbow joints and pressed to the side surface of the chest, the hands are clenched into fists, the legs are bent at the knee and hip joints .The facial expression and posture of a healthy newborn during examination depend on the position of the fetus during labor. With extension insertions (frontal, facial), the face is swollen, abundant petechiae and poor facial expressions are possible. The head is usually thrown back. With breech presentation, the legs can be sharply bent at the hip joints and straightened at the knees. Facial expression: dissatisfied, “painful” - observed in many diseases of newborns, “frightened” look - with subarachnoid hemorrhages, hypomimic occurs in children with subdural hematomas and encephalopathy. cry is assessed both in strength and in duration and modulation. A weak cry can be observed in a very premature baby; aphonia can be a consequence of tracheal intubation or damage to the central nervous system - subdural hematoma, hemorrhages in the ventricles of the brain, as well as severe somatic diseases. An irritated (“brain”) cry accompanies subarachnoid hemorrhages and increased intracranial pressure. With congenital hydrocephalus, the cry acquires a monotonous hue. Motor activity in newborns can be weakened with lesions of the central nervous system and somatic diseases and increased (hyperexcitability). During an external examination, the following signs of increased neuro-reflex excitability can be noted: small-scale tremor of the hands and lower jaw with restlessness of the child and large-scale - occurs with bilirubin encelopathy. Spontaneous Moro reflex, spontaneous shudders, spontaneous and induced clonus of the feet, convulsions (with intracranial birth trauma, severe brain hypoxia, intrauterine infection, toxic damage to the nuclei of the brain by free bilirubin, metabolic disorders, hereditary metabolic disorders, etc. .).

Muscle tone in sick newborns is often weakened. A sharp decrease or absence of muscle tone is one of the diagnostic criteria for fetal damage during childbirth. During examination, weakening of tone may also be due to prematurity or immaturity.

In full-term infants, low muscle tone indicates severe hypoxia, subdural hemorrhage, acute adrenal insufficiency and can accompany hypoglycemia and acidosis, hereditary diseases (Down's disease, etc.). Increased muscle tone is possible with subarachnoid hemorrhage, purulent meningitis, bilirubin encephalopathy.

Muscle tone is assessed by the results of a traction test and by the ability to hold the body in a horizontal position, face down, above the surface of the changing pad (on the palm of the subject), as well as by the symptom of “flaccid shoulders.” The examined newborn is placed in a vertical position, supported by the axillary areas.

If the child’s head “retracts into the shoulders”, this is an indicator of ischemia of certain areas of the brain. Changes in muscle tone underlie the occurrence of such pathological postures:

The “frog” pose - the arms lie limply along the body, the legs are on the surface of the changing pad, wide apart at the hips and slightly bent at the knees. This position is physiological for very premature babies.

In full-term infants, it indicates a sharp decrease in muscle tone.

This pose is associated with a sharp increase in muscle tone - extensors. Characteristic of purulent meningitis, subarachnoid hemorrhage, bilirubin encephalopathy.

The “Fencer” pose - the head is turned to the shoulder, the arms and legs of the same name are in an extension position, with the arm extended to the side. The other arm is abducted at the shoulder and bent at the elbow joint. And the leg is slightly abducted at the hip and bent at the knee; the head is slightly thrown back, the legs are sharply bent at the knee and hip joints and brought tightly to the stomach. This position occurs with purulent meningitis;

asymmetrical postures according to the hemitype - the arm and leg of one side of the body are in a physiological position, on the other side the limbs are extended with reduced muscle tone: according to the TYPE of paraplegia (decreased muscle tone in both the upper and lower extremities); according to the monotype - a decrease in motor activity and muscle tone of one limb.

Asymmetrical postures occur mainly in children with damage to the central nervous system. Pathological positions of the hands - “clawed foot”, drooping hand, “monkey” hand - are characteristic of damage to the central nervous system of various origins.

Pathological positions of the feet: vagal position - disconnection of the foot from the axis of the limb in the medial direction; valgus position - disconnection of the foot from the axis of the limb in the lateral direction.

The pathological position of the feet may be associated with orthopedic pathology; heel position - dorsiflexion of the foot; Foot drop is noted when the spinal cord is damaged. The position of the newborn's head may be deviated from the axis of the body up to the shoulder (in case of injury to the uterus).

Body proportions are sometimes disturbed due to premature birth of a child, microcephaly, hydrocephalus. Features of intrauterine development also reflect disturbances in body weight.  

Macrosomia is expressed in children with diabetic fetopathy and in post-term infants; low birth weight at term is possible in the case of severe gestosis in the second half of pregnancy, malnutrition of a pregnant woman, chromosomal diseases, etc.

Dysembryogenetic stigmas indicate a violation of intrauterine development. The detection of 5 or more stigmata is considered diagnostically significant. The smell emanating from a newborn can be one of the early symptoms of hereditary diseases: “mouse” in phenylketonuria; boiled vegetables - if there is a violation of valine and leucine metabolism.

The skin of a healthy full-term newborn is soft, elastic, velvety to the touch, and instantly straightens when you try to fold it. Its dryness is possible with low functional activity of the sweat glands.

They are retention cysts of the sebaceous glands and disappear by the end of the neonatal period, do not require treatment; mild petechial hemorrhages in the skin of the presenting part and hemorrhages in the sclera, caused by increased vascular permeability, appear during childbirth; telangiectasias - reddish-bluish vascular spots on the dorsum of the nose , upper eyelids, at the border of the scalp and the back of the neck. They disappear when pressed, differing in this from hemangioma; 1apido-vellus hair mainly on the face, shoulders, back skin; Mongoloid spots - in the area of ​​the sacrum and buttocks, bluish in color (due to the presence of pigment-forming cells); birthmarks are often brown or bluish-red in any location; tshapa sp51aNpa - pinpoint bubbles resembling “dew drops” - the result of blockage of the sweat glands, are noted on the face, do not require treatment.

Skin color of healthy newborns. In the first minutes after birth, general cyanosis, acrocyanosis, and perioral cyanosis (around the mouth) are noted; birth is less likely to be pink. After the primary toilet or a few hours after birth, the skin acquires a bright pink tint.

This occurs due to the reaction of peripheral vessels to tactile and temperature stimulation. This state of adaptation is called physiological erythema, lasts 1-2 days, in immature and premature babies - 1-1.5 weeks.

At the end of the second and third days of life, in 60-70% of children, the skin acquires an icteric tint. The icteric coloring disappears by the end of the first to the middle of the second week and is classified as a borderline condition (for details, see the section on adaptation of newborns).

The earlier appearance of jaundice, its greater intensity, protracted or wave-like course allows it to be classified as pathological.

 

Pathological changes in skin color. Upon examination, persistent cyanosis can be a sign of a number of diseases.

There are three groups of causes that cause cyanosis: a) of a central nature - with asphyxia, intracranial birth injury, injury to the cervical spinal cord, intrauterine infections with damage to the central nervous system; b) pulmonary origin - with pneumonia, pneumopathy, diaphragmatic hernia, pulmonary aplasia, etc. c) cardiac origin - congenital heart defects of a “blue” color, persistent, ductus arteriosus, etc. Facial cyanosis is observed in children born with tight entanglement umbilical cord around the neck. It can last for several days. Acrocyanosis and distal cyanosis - in the early neonatal period occurs in healthy children when the temperature in the department is disturbed, screaming and anxiety. Persistent perioral cyanosis is more common with congenital cardiogenic pathology.

Cyanosis and some swelling of the legs are observed in those born in a breech (usually foot) presentation, as well as in cases of spinal cord damage; isolated cyanosis of the upper limb is possible if the arm falls out during childbirth with the fetus in a transverse position.  

Eye examination. In children, the first day of life is often difficult, since they are closed. Convergent strabismus may periodically occur, and short-term small-scale horizontal nystagmus may occur when changing position.

Perinatal damage to the central nervous system can be accompanied by such pathological symptoms as: ptosis, lagophthalmos, persistent horizontal nystagmus and convergent strabismus, Graefe's symptoms, "setting sun", fixed gaze, doll's eyes, floating movements of the eyeballs. 

Examination of the oral mucosa. The color is bright pink, somewhat dry (slight salivation). If there are defects in care, white spots appear. Cleft of the upper lip (cheiloschisis) and hard palate (palatoschisis) are the most common anomalies of facial development. Examination of the chest. The shape is barrel-shaped, the lower aperture is deployed, the ribs are horizontal.

The chest is symmetrical, its lower sections take an active part in the act of breathing. Respiration and heart rate are counted during sleep using a stethoscope (the phonendoscope membrane distorts auscultation). RR - 40-60 per minute, heart rate 140-160 per minute, blood pressure - 55/30-80/55 mm Hg.

The counting is carried out over 60 seconds, since these indicators are very labile.

Palpation of the chest. When a clavicle is fractured, swelling, crepitus, or callus is detected. Increased chest rigidity is characteristic of lung diseases (pneumonia, pneumopathy) and some developmental anomalies (diaphragmatic hernia).

Percussion when examining newborn lungs is carried out with the middle finger, placing the child on the palm with support from the axillary areas. Shortening of the percussion sound, dullness, and a boxy tone are characteristic of infectious and non-infectious lung lesions.

Breathing over all pulmonary fields is puerile, that is, inhalation and 1/3-1/2 of exhalation are heard. In premature babies, breathing is often weakened in the first days of life (pulmonary atelectasis).

A change in breathing pattern (weakened, harsh) may be due to extrapulmonary causes (narrow nasal passages, swelling of the nasal mucosa during ARVI or trauma during resuscitation measures) or be a sign of a large group of diseases and anomalies of the respiratory system.

Wheezing over the lungs in the first minutes of life is heard in most healthy newborns (the presence of remnants of intrauterine pulmonary fluid in the lungs). An abundance of different types of wheezing indicates aspiration syndrome. The presence of wheezing at birth and subsequently always indicates pathology.

Heart sounds are clear, sonorous and pure. The number of heart contractions less than 100 per minute is bradycardia, more than 160 per minute is tachycardia. Muffled or dull heart sounds are characteristic of severe intrauterine hypoxia, infectious myocardial damage, and congenital heart defects.

The presence of systolic murmur in the first hours and days of life does not always indicate a congenital heart defect (functioning of the ductus arteriosus and/or oval window).

Systolic murmur on days 3-5 of life, which tends to increase and extend to the axillary region and to the back, indicates a congenital heart defect. 

The abdomen of a healthy newborn is round in shape, actively participates in the act of breathing, the subcutaneous fat layer is well developed. Bloating is possible with overfeeding (artificial), and can also be a symptom of low intestinal obstruction, necrotizing enterocolitis, peritonitis, sepsis, pneumonia, intrauterine infection.

Retraction of the abdomen is characteristic of high intestinal obstruction and dehydration. Abdominal asymmetry is observed with diaphragmatic hernia (retracted), anomalies in the development of the anterior abdominal wall (protrusion). A change in the color of the skin of the anterior abdominal wall (shiny, bright pink) is characteristic of inflammatory changes in the abdominal cavity.

 

On palpation, the abdomen is soft, accessible to deep palpation with calm behavior. The anterior abdominal wall is elastic and elastic. Pastosity of the anterior abdominal wall is possible in premature infants, with inflammatory diseases of the abdominal organs, scleredema, and anomalies of kidney development. The umbilical cord sheds off between 4 and 7 days of life.

The umbilical wound is dry and clean. The presence of hyperemia and serous-purulent discharge indicates ompholitis. The liver protrudes from under the edge of the costal arch no more than 2 cm along the midclavicular line. Liver enlargement is possible with perinatal infections, severe asphyxia, congenital heart defects, some jaundice, and tension-type headache.

Disorders of intestinal motility during auscultation of the abdomen often accompany severe asphyxia, intracranial hemorrhage, and intrauterine infections. 

Examination of the genital organs. In healthy full-term boys, the testicles are lowered into the scrotum; in girls, the labia majora cover the labia minora; In premature boys, the testicles are not descended into the scrotum; in girls, the genital gap is typical.

The scrotum may be enlarged in size (dropsy of the testicles, differentiated from inguinal-scrotal hernia). Significant hypertrophy of the clitoris in girls sometimes makes it necessary to determine sex chromatin to clarify the sex of the child.

The presence of the anus, the passage of meconium, and the onset of urination are recorded. 

Examination of the hip joints. Despite the physiological hypertonicity of the muscles, it is possible to spread the legs almost to the surface of the changing pad.

Restriction of mobility - with damage to the central nervous system or dysplasia of the hip joints (positive Marx's sign - a clicking symptom); pathological mobility - with a decrease in muscle tone of the lower extremities (prematurity, spinal injury, Down's disease, arthrogryposis).  

Concluding the examination, the neonatologist once again evaluates the newborn’s reaction to the manipulations, the stability of his thermoregulation, analyzes neurological and somatic features, and the dynamics of adaptation states. A meticulously conducted clinical examination, along with a carefully collected anamnesis, contributes to timely diagnosis and proper treatment of the patient.  

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Source: http://neonatology.narod.ru/neonatology/clinical_investigation.html

First medical examination. What awaits the baby in the delivery room? Birth of a child

Content:

• Umbilical cord treatment
• Necessary procedures
• First "score"
• At the doctor's appointment

The baby was born, but he was not immediately placed on his mother’s stomach - the doctors took the baby away and performed some mysterious manipulations on him. What awaits the baby in the first minutes of life?

A pediatric neonatologist examines the newborn in the delivery room, and he, along with obstetricians and gynecologists, is present at the birth.

The midwife (doctor) prepares for childbirth as for a surgical operation, washes her hands with a disinfectant solution, puts on a sterile gown, gloves, and mask.

Currently, when attending childbirth, most maternity hospitals use a sterile disposable kit, which is preferable.

Umbilical cord treatment

The newborn is received in sterile, warmed diapers. The ligation and treatment of the umbilical cord is carried out in two stages.

During the first 15 seconds after birth, for a child who has not cried, two sterile clamps are placed on the umbilical cord: the first at a distance of 10 cm from the umbilical ring, and the second 2 cm outward from it.

Then the section of the umbilical cord located between the two clamps is treated with a 5% alcohol solution of iodine or 96% ethyl alcohol and cut. If the child screamed in the first seconds of life, then it is better to apply clamps to the umbilical cord approximately 1 minute after birth.

After the described treatment, a sterile gauze bandage is applied to the remainder of the umbilical cord.

Necessary procedures

For initial treatment of a newborn, a sterile individual kit is used. Treatment of the baby's skin is carried out with a sterile cotton swab moistened with sterile vegetable or petroleum jelly from an individual disposable bottle.

Considering that the child’s parents may have a latent form of gonorrhea, which is asymptomatic and with negative laboratory diagnostics (this disease can lead to gonorrheal eye infection in a newborn), gonoblenorrhea is prevented immediately after birth.

For this purpose, a 20% solution of sodium sulfacyl (ALBUCID) is instilled into the child's eyes. The solution is instilled 1 drop alternately onto each retracted lower eyelid. Then close the eyelids and gently wipe both eyes.

1 drop of a 20% solution of albucid is instilled into the conjunctival sac of both eyes again 2 hours after birth - already in the neonatal department. For girls in the delivery room, 1-2 drops of a 1-2% solution of silver nitrate are instilled into the genital slit.

Immediately after birth, the neonatologist should warm the newborn by placing him on a table with radiant heat, and put his head in the correct position: the baby lies on his back, with his head tilted back and slightly to the side (sneezing position). The baby's upper respiratory tract is cleared of mucus and remaining amniotic fluid. Then the child must be dried, stimulating his breathing. The neonatologist carries out all these activities in the first minute after the birth of the baby.

First "score"

In the first 30 seconds of a child’s life, a neonatologist assesses his condition.

If the baby is not breathing (apnea) or the heart rate is less than 100 beats per minute, the neonatologist helps the baby breathe using an oxygen bag or mask.

The main task of these activities is to deliver a sufficient amount of oxygen to the lungs, to help the child breathe and expand the lungs.

The baby inhales air to obtain oxygen using its own lungs. His first cry and deep breath are powerful enough to clear fluid from his airways. As soon as the required amount of oxygen enters the blood, the baby's skin, which has a gray-blue tint, turns pink.

However, if the lack of oxygen continues, the baby will make several attempts to get air and then go into a state of secondary apnea, where stimulation can no longer get the baby to breathe.

In this case, assisted ventilation may be required, which is performed by a neonatologist in the delivery room.

When the child screams and begins to breathe effectively, the neonatologist evaluates the baby’s condition using the Apgar scale. This scale was developed and proposed in 1952 by Virginia Apgar, who assessed five main signs in points (heart rate, breathing, muscle tone, reflex irritability to a catheter in the nostrils and skin color).

Apgar score
Sign	Sum of points
	1	2
Heart rate	missing	less than 100 beats/min	more than 100 beats/min
Breath	absent	irregular	effective, scream
Muscle tone	weak	some flexion	active movements
Reflex irritability (catheter in the nostrils, tactile stimulation)	no reaction	grimace	cough, sneeze, scream
Skin color	blue or pale	pink body, blue limbs	completely pink

Apgar scores quantify and summarize the newborn infant's response to the ectopic environment and resuscitation. Each of the five signs is assigned a value of 0, 1 or 2. The five values ​​are then added together to form the Apgar score.

Apgar scores should be determined at 1 and 5 minutes after birth. The higher the score, the better. If the sum at 5 minutes is less than 7, additional measurements should be taken every 5 minutes for the next 20 minutes.

Many years of experience show that in prematurely born children, the sum of Apgar scores 1 minute after birth determines the severity of asphyxia (the so-called lack of oxygen as a result of respiratory disorders) and allows you to choose the most adequate set of resuscitation measures immediately at the birth of the child.

The results of the Apgar score are recorded in the birth history.

Basic parameters of physical development
Gestation period at which birth occurred, weeks.	Body weight, g	Body length, cm	Head circumference, cm	Chest circumference, cm
37	2771+/-418	47,6+/-2,3	33,7+/-1,5	31,7+/-1,7
38	3145+/-441	49,6+/-2	34,7+/-1,2	33,1+/-1,6
39	3403+/-415	50,8+/-1,6	35,5+/-0,9	34,3+/-1,2
40	3546+/-457	51,5+/-2,1	35,7+/-1,3	35,0+/-1,7
41-42	3500+/-469	51,5+/-2	35,3+/-1,2	34,6+/-1,9

At the doctor's appointment

• After assessing the Apgar scale, the midwife weighs the newborn, measures the head circumference and chest circumference, which are also recorded in the birth history.
• After the necessary measurements have been taken, the pediatric neonatologist begins a direct examination of the newborn.
• Normally, the child breathes rhythmically, makes automatic movements of the limbs in sufficient volume and symmetrically.

In a full-term newborn, the head makes up 1/4 of the body. Its large size is associated with the prevailing development of the brain. Determining head shape and skull circumference at birth is important.

During the first 2-3 days of life, the child retains the configuration of the skull, due to the passage of the head through the birth canal. Normal variants include skull shapes such as anteroposteriorly elongated (dolichocephalic), transversely elongated (brachycephalic), and tower skull.

The bones of the skull are somewhat elastic; they are observed to be located on top of each other along the sutures. The parietal bones can be located on the occipital or frontal.

The circumference of the skull in full-term children is 33-36 cm and can exceed the circumference of the chest by 1-2 cm. The anterior (large) fontanel is open, its dimensions (distance from the sides of the rhombus formed by the bones) normally do not exceed 2.5-3 cm. Size posterior (small) fontanel - no more than 0.5 cm.

A birth tumor is typical for most newborns. This is swelling of the soft tissues of the head during cephalic presentation; the skin over the tumor is often bluish, with many small hemorrhages or large bruises.

A birth tumor can be the cause of prolonged jaundice in a newborn: blood from the hematoma area is absorbed, and bilirubin is formed, which causes longer-lasting jaundice.

The birth tumor does not require treatment and goes away on its own within 1-2 days.

Minor developmental anomalies
Location	Nature of the anomaly
Scull	The shape of the skull is small (microcephalic), large (hydrocephalic), the skull is elongated in the anteroposterior direction (dolichocephalic), in the transverse direction (brachycephalic), tower-shaped. Low forehead, pronounced brow ridges, overhanging or flattened nape.
Face	Straight line of sloping forehead and nose. Mongoloid eye shape. Saddle nose, flattened nasal bridge, crooked nose. Facial asymmetry. Increased or decreased distance between the inner edges of the eye sockets (hypo- and hypertelorism). Macrognathia or micrognathia (large or small size of the upper jaw), cleft chin, wedge-shaped chin.
Eyes	Low standing eyelids, asymmetry of the palpebral fissures, absence of the lacrimal caruncle (third eyelid), double growth of eyelashes (distichiasis), irregular shape of the pupils.
Ears	Large protruding ones, small deformed ones, different sizes, located at different levels, located low; anomaly in the development of the helix and antihelix, accretion of the earlobes.
Mouth	Small mouth (microstomia), large mouth (macrostomia), fish mouth, short tongue frenulum, folded or forked tongue.
Neck	Short, long, torticollis, with pterygoid folds, excessive folds.
Torso	Long, short, sunken breasts, chicken breasts, barrel-shaped, asymmetrical, large distance between the nipples. Accessory nipples, low navel, hernias.
Brushes	Shortening of fingers (brachydactyly), unusually long and thin fingers (arachnodactyly), complete or partial fusion of adjacent fingers or toes (syndactyly), transverse groove of the palm, short curved fifth finger, curvature of all fingers.
Feet	Brachydactyly, arachnodactyly, syndactyly, sandal cleft, flat foot, overlapping toes.
Genitals	Underdevelopment or absence of testicles in the scrotum (cryptorchidism), phimosis (incarceration or fusion of the foreskin), underdevelopment of the penis, underdevelopment of the labia, enlargement of the clitoris.
Leather	Depigmented and hyperpigmented spots, large maternity spots with hair, excessive local hair growth, hemangiomas, areas of lack of skin (aplasia) of the scalp.

Cephalohematoma - hemorrhage under the periosteum of any bone of the cranial vault; may appear clearly only a few hours after birth, observed in 0.4-2.5% of newborns.

The tumor initially has an elastic consistency, never spreads to the adjacent bone, does not pulsate, is painless; upon careful palpation, fluctuation (softening) and a sort of cushion along the periphery of the hematoma are detected. The surface of the skin over the cephalohematoma is not changed, although sometimes there are bruises (petechiae).

In the first days of life, the cephalohematoma may increase in size, and jaundice is often observed due to increased extravascular formation of bilirubin (a breakdown product of hemoglobin). At 2-3 weeks of life, the size of the cephalohematoma decreases, and complete resorption occurs at 6-8 weeks.

A full-term newborn has a fairly well-developed subcutaneous fat layer, the skin is pink, velvety, covered with vellus hair, mainly in the shoulder girdle area. The isola of the mammary gland is well developed (1 cm or more in diameter). The striation of the sole occupies 2/3 of its surface. The cartilage of the auricles is elastic, the nails are dense.

The umbilical ring is located in the middle of the distance between the womb and the xiphoid process; in boys, the testicles are lowered into the scrotum; in girls, the labia majora cover the labia minora.

The child's cry is loud. The muscle tone and physiological reflexes of a full-term newborn are well expressed, the child takes a flexor position (fetal position, or flexion position).

The sucking function of a full-term baby is well developed, and if there are no contraindications, then in the first 30 minutes after birth the baby is applied to the breast.

In the absence of visible malformations and general satisfactory condition, the newborn is in the postpartum ward for the first 2 hours of life, where he is observed by a pediatric neonatologist, and then, together with his mother, is transferred to the postpartum ward of a joint stay.

During normal labor, postpartum examination and examination are predominantly indicative in nature, i.e. boil down to determining the sex of the child, assessing his vital signs using the Apgar scale, or establishing a diagnosis of serious anomalies that can be detected with just one examination.

If, due to the condition of the newborn, there is no need to take special measures, for example, emergency therapy or accelerated transfer to another department, then the postnatal examination of the newborn is completed by the pediatrician - an assessment of the condition and an indication in which of the departments will provide further care for him.

Source: https://www.7ya.ru/article/Pervyj-medosmotr-Chto-zhdet-malysha-v-rodzale/