Newborn Baby Checks

Overview – Newborn Baby Checks

Newborn baby checks are comprehensive postnatal assessments performed shortly after birth to evaluate a baby’s general health, identify any congenital anomalies, and assess the need for urgent intervention. These checks include a combination of maternal history, vital signs, physical examination, reflex testing, and anthropometric measurements. Early identification of red flags—such as cardiac defects, respiratory distress, or developmental anomalies—is critical for prompt management and improved outcomes.

Background History

• Neonatal history
• Maternal/foetal blood group: Beware Rh incompatibility (Rh-negative mother with Rh-positive baby)
• Obstetric history:
  • Gestational diabetes
  • Pre-eclampsia
• Delivery method:
  • Vaginal (spontaneous, forceps, suction)
  • Caesarean section
• Sepsis risk assessment

Vital Signs

• Pulse (P):
  • Bradycardia → Often responds to ventilation → may require resuscitation
• Respiratory rate (R):
  • Signs of respiratory distress → investigate and resuscitate
• Temperature (T):
  • Fever may indicate infection (e.g. Group B Streptococcus, Chlamydia) → investigate and consider antibiotics

General Inspection

• Colour:
  • Pink = Normal
  • Yellow = Often physiological jaundice
  • Blue = Cyanosis → pathological
• Signs of distress (especially respiratory)
• Red reflex: Presence confirms intact retina
• Extremities: 10 fingers and 10 toes
• Anus: Confirm patency (meconium passage ≠ patency)
  • Watch for ano-vaginal fistulas
• Genitalia: Check for normal appearance

Palpation

• Fontanelles:
  • Bulging → Hydrocephalus
  • Sunken → Dehydration
• Palate:
  • Check for cleft or high-arched palate (Marfan’s sign)
• Primitive reflexes:
  • Rooting reflex
  • Palmar grasp reflex
• Femoral pulses: 120–180 bpm; absent or weak pulses may suggest cardiac anomaly
• Hip examination:
  • Barlow manoeuvre → dislocates unstable hips
  • Ortolani manoeuvre → reduces dislocated hips
• Muscle tone:
  • Low tone = “floppy baby” → may indicate neuromuscular condition
• Spine:
  • Palpate for neural tube defects (e.g. spina bifida)

Auscultation

• Heart sounds:
  • Listen for murmurs (often benign early on)
  • Confirm normal position (exclude dextrocardia)
• Lung sounds:
  • Crackles, wheezing, stridor
• Bowel sounds:
  • Should be present within first hours of life

Measurements

• Head circumference:
  • Plot on growth chart
  • <10th or >90th centile may require investigation
• Length and weight:
  • Monitor for intrauterine growth restriction or macrosomia
• Blood glucose (BSL):
  • Particularly important in babies of diabetic mothers

Summary – Newborn Baby Checks

Newborn baby checks provide an essential, structured approach to the early identification of neonatal issues. A combination of history, vital signs, physical assessment, and reflex testing ensures a thorough evaluation. Early detection of abnormalities allows timely referral and intervention. For more content on newborn care and screening, visit our Obstetrics Overview page.