Neonatal Examination

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Neonatal Examination
Neonatal Examination
Video: Neonatal Examination
Video: "Newborn Exam" by Nina Gold for OPENPediatrics 2023, February
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Neonatal examination

The newborn is examined for the first time in the delivery room immediately after birth to assess maturity and health. Various further examinations follow in the first days and weeks of life. These help to identify diseases and undesirable developments as early as possible. This enables therapeutic measures to be initiated in good time and a healthy development of the child to be ensured.

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  • What happens during the initial examination of the newborn?
  • When does the basic newborn examination take place?
  • When does the hip ultrasound examination take place?
  • Who is doing the research?
  • How are the costs going to be covered?

What happens during the initial examination of the newborn?

The first examination takes place immediately after the birth. The newborn is weighed and its length and head circumference are measured. The palate is palpated with the little finger in order to rule out a possible gap formation (cleft lip and palate). The doctor or midwife get a first general impression of the child's state of health. The following examinations are carried out:

  • APGAR test,
  • pH value determination in umbilical cord blood,
  • Blood group determination in newborns (obligatory if the mother's blood group is rhesus negative).

APGAR test

The so-called APGAR test assesses the health of the newborn on the basis of five characteristics. This assessment is made immediately after birth and is repeated after five and ten minutes. The evaluation provides information about how vital the newborn is. The abbreviation APGAR stands for:

  • A tmung
  • P uls (heartbeat)
  • G rundtonus (muscle tone)
  • A ussehen (skin color)
  • R eflexe

Points are awarded for the characteristics according to the following scheme:

  • null = not available
  • one point = not pronounced
  • two points = good

Accordingly, the maximum value that a newborn can achieve is ten points. A low score (under five on a five-minute APGAR) may indicate the newborn needs medical attention. The newborn is also examined for any externally recognizable malformations.

APGAR overview

APGAR

investigation

0 1 2

breathing

no irregular, snapping regular, vigorous screaming
Pulse is missing weak (<100 / minute) strong (> 100 / minute)
Basic tone limp, motionless reduced active

spontaneous movements

Appearance, skin color pale or blue slightly pink, extremities blue completely rosy
Reflexes absence sluggish, grim massaging Coughing, sneezing, screaming

pH value and blood group determination

In addition to the APGAR test, the pH value of the newborn must be determined. To do this, blood is taken from the umbilical artery and vein and examined for acidosis (acidosis). Testing is important because acidosis in newborns can indicate lack of oxygen during labor. In this case, therapeutic measures are taken immediately. Furthermore, the blood sugar of the newborn can be determined from the blood.

If the mother has a Rhesus factor negative blood group, a blood group determination is also carried out on the newborn. If the child rhesus factor positive, this can have dangerous consequences: If there is contact between maternal and child blood (eg during childbirth), the mother's immune system begins to form antibodies against the rhesus proteins in the child's blood; one speaks of a rhesus intoleranceor rhesus incompatibility. This is not a problem in the first pregnancy. However, if the woman becomes pregnant again and is expecting a Rhesus-positive child again, the antibodies directed against the Rhesus proteins can get into the child's circulation via the placenta or during childbirth and the red ones there Attack blood cells. Severe anemia, water retention, or life-threatening jaundice can result. Antibodies (immunoglobulins) are given to the child as therapy to stop the destruction of the red blood cells. To prevent Rhesus intolerance, all Rhesus-negative women receive so-called anti-D prophylaxis during pregnancy.

When does the basic newborn examination take place?

The basic examination for newborns takes place in the first week of life. The newborn is weighed and measured again. The pediatrician examines the child again carefully for abnormalities. It also checks whether the child suffers from acute illnesses such as neonatal jaundice. So-called newborn screening, a hip ultrasound and a hearing test are also carried out. More on the topic: mother-child pass

Note In the case of a hospital birth, this examination is usually carried out before the mother and child are discharged from the hospital (around the third to fourth day of life), but it can also be carried out on an outpatient basis. In the case of an outpatient or home birth, it is important to make an appointment in good time with a pediatrician who will carry out this basic examination. Some pediatricians also make house calls.

When does the hip ultrasound examination take place?

In the mother-child pass examinations of all newborns, the hip joint is assessed using an ultrasound. The doctor can recognize and treat congenital malpositions of the hip joint (hip dysplasia) in good time. The earlier the disease is recognized, the easier the therapy and the better the chances of recovery. The mother-child pass provides for a hip ultrasound in the first week of life and a control in the sixth to eighth week of life; If the findings are abnormal, the controls are carried out at shorter intervals. A pediatrician, but also an orthopedist can carry out this examination.

In the case of hip dysplasia, the acetabulum is not properly formed, which means that the head of the hip cannot be held in it. In the most severe case, the head slips out of the socket, which is called a hip dislocation. Hip dysplasia does not initially cause the newborn any symptoms. Problems can only arise at a later age - usually when you start running. Since the hip joint is not yet fully developed after the birth, therapy can still influence its development relatively easily. If hip dysplasia is left untreated, the joints wear out more quickly in adulthood. Osteoarthritis can result.

Hip dysplasia is always treated on both sides, even if only one hip is affected. The therapeutic measures depend on the severity of the malformation. They range from a special wrapping technique ("wide wrapping") to wearing spreader pants or a hip cast. The hip joint only needs to be operated on in very rare cases. The doctor checks the success of the treatment through regular ultrasound examinations.

Who is doing the research?

The first examinations of the newborn - including the basic examination - are carried out by a doctor in the hospital. When giving birth at home, the midwife performs the initial examination of the newborn at home. The basic examination in the first week of life is carried out by a pediatrician, as is the case with an outpatient birth.

How are the costs going to be covered?

The initial and basic examination of the newborn as well as the hip ultrasound are included in the mother-child pass and are therefore free of charge.

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