1. Step By Step Guide to Examination of the Newborn Anne Lomax

2. Check your Trust’s criteria for Examination of the Newborn (EON). Make sure the baby you are about to examine falls within these guidelines. Are you sure you know which babies you can examine and which you cant? This website contains some examples from various Trusts of relevant criteria for examination of the newborn. Look through the examples -how does your Trust compare to these? Step One Which babies can you examine?

3. Step Two Preparation Prepare the environment –make sure the room is private, warm and well lit. Prepare the equipment – A firm surface - important for examining the hips Ophthalmoscope Stethoscope –neonatal or paediatric, small torch Tape measure Thermometer Gloves Scales See the competency tool (competency 1) on this web page for more information about preparation and checking equipment)

4. Step Three Study the maternal notes Use a history sheet to record the significant antenatal risk factors. The history sheet can then be placed in the infants’ medical records as evidence of the history taking process. Access the examination of the newborn history profiling model on this website. It which outlines a schematic structure to the history taking process. Access the maternal history checklist on this website. It will provide you with a checklist of the factors you must look at and a rationale for the criteria used.

5. Step Three cont Study the maternal notes Access the serology checklist. It will help you see what investigations to look for in the notes. Access the family history checklist. It will help you see what congenital conditions are inherited. Access the life style checklist. It will help you see which social factors can affect the fetus.

6. Step Four The Physical Examination Look at the Competency Tool (competency 4 and supplementary information) on this website and use this as your checklist for the physical examination. Gain consent Explore any concerns the mother and father may have Ask how the baby feeds/handles/responds to them Has the baby passed urine and meconium Observe the baby whilst quiet- look at posture and behavioural state

7. Step Five The Physical Examination Conduct a top to toe examination Examine the head and fontanels. Measure the head circumference and record. Illicit the red reflex –Look at the Newborn and Infant Physical Examination (NIPE) website to access the examination of the neonatal eye eLearning unit http://newbornphysical.screening.nhs.uk/

8. Step Six The Physical Examination Examine the mouth for cleft lip and /or palate and tongue tie – Access the Cleft Lip and Palate Association video ‘Easing the First Few Hours’ for more information : http://www.clapa.com/medical/video/1163/ Also see the new RCPCH guidelines: http://www.rcpch.ac.uk/improving-child-health/clinical- guidelines-and-standards/published-rcpch/inspection- neonatal-palate http://www.rcpch.ac.uk/improving-child-health/clinical- guidelines-and-standards/published-rcpch/inspection- neonatal-palate Examine the neck and clavicles

9. Step Seven The Physical Examination Examine the respiratory and cardiovascular systems. Look on the website for a wide range of learning resources to help you through this process. Palpate the abdomen and look closely at the umbilical cord Palpate the kidneys Check the spine and neurological reflexes

10. Step Eight The Physical Examination Examine the skeletal system Access the NIPE e learning package for information on examination of the hips http://newbornphysical.screening.nhs.uk/ You can also see a video of examination of the hips here http://surgicalmultimedia.com/DDH/player.html STEPS Charity Here you can access lots of information and leaflets to help the mother and father of a baby with lower limb conditions http://www.steps-charity.org.uk/

11. Step Nine The Physical Examination Examine the genitalia Access the NIPE e learning package for information on examination of the testes here: http://newbornphysical.screening.nhs.uk/

12. Step Ten Feedback to parents and documentation of findings Explain your findings to the mother and father and allow time for discussion Complete the appropriate records and Red Book Make referrals where necessary using the appropriate channels Communicate with the wider multidisciplinary team if necessary

13. Are you a member of the Royal College of Midwives? If so you can log in and access the Examination of the Newborn module. This is an excellent learning resource in the ‘i learn/professional and practice’ section of the website. It contains learning units on all aspects of the examination as well as a vast choice of resources and videos. https://www.rcm.org.uk/