Baby Checks at Birth and soon after

A full-term baby measures approximately between 45 and 55 cm, an average of 50 cm.
Babies weigh on average 3.5 kilos at birth but it can be between 2,6 and 4 kilos.
  • After delivery, if there are no complications with you or the baby, your baby can be placed on to your tummy for a few moments so that skin to skin contact can be felt immediately. Your baby will then be checked and quickly returned to you.
    • Once checked you can spend some time touching and caressing your baby.
    • You may feed your baby for the first time
    • The umbilical cord is clamped and cut within 5 minutes after delivering.

Initial baby check at birth

All babies are checked at birth for any abnormalities or problems encountered during labour. This care will be carried out by a midwife and if necessary a paediatrician.
  • The baby's airway may need clearing of any fluid and mucous inhaled during the delivery. A very fine tube is inserted into the baby's nose, mouth and throat to remove foreign material.
  • The baby's size, weight and crown are measured.
  • Vitamin K will be offered to your baby either as an injection or drops. Babies can be born with low levels of Vitamin K needed for blood clotting, so this helps avoid any dangerous bleeding in the brain.
  • The umbilical cord is cut and a small plastic clamp placed

Apgar score

  • This tool measures the general state and activity of the baby at birth. It gives a score which indicates if the baby requires any particular care or urgent attention.
  • It is carried out twice , approximately one minute after the birth, and then 5 minutes post delivery.

This test checks

  • Heart rate
    • If there is no heart beat: the baby scores 0.
    • If lower than 100: the baby scores 1
    • If higher than 100 : the baby scores 2
  • Breathing
    • If there is no breathing: the baby scores 0
    • If the baby's cry is weak: the baby scores 1
    • If the cry is distinct and vigorous: the baby scores 2
  • Reflexes
    • If the baby makes grimaces: the baby scores 1
    • If the baby cries: the baby scores 2
  • The skin color
    • If the skin is blue: the baby scores 0
    • If the body is pink but the hands and legs are blue: the baby scores 1
    • If the baby is completely pink: the baby scores 2
  • Muscle tone
    • If the baby is limp: it scores 0
    • If the baby makes some movements of the arms and legs: the baby scores 1
    • If the baby is very active: the baby scores 2

A normal APGAR score is between 8 and 10
  • The lower the score, the less responsive the state of the baby.

A score of 10

A score of 10 means that the baby gave a good strong cough and cry a few moments after birth:
  • Its heart beat is higher than 100
  • Its breathing is normal and effective, with about 40 to 60 breath intakes per minute
  • It is very active.
  • It movements are lively.

A Score between 7 and 10

The baby's limbs may be bluish, and not as active This anomaly can be caused by a long labour and pain relieving drugs during labour. This score generally improves a few minutes later.

A score from 3 to 6 indicates that the baby needs some help with breathing and waking up. Simple resuscitation may be given.

A score from 0 to 2

If the Apgar test score is lower than 3, the baby is transferred to a neonatal unit as ventilation is most likely required.

Newborn identification bracelet

A bracelet is placed around each ankle of the baby. The baby's sex, date of birth, hospital number and name is inscribed on one, and the mother's name and hospital number on the other bracelet to avoid any mistaken identities.

Next steps and the first examination of the baby

The paediatrician systematically assesses the baby's from top to toe. They are looking at the baby's general appearance, checking for abnormalities and observing the baby's liveliness.
  • Heart sounds are listened to along with the heart rate measured: it must range between 130 and 140 beats per minute.
  • The lungs are listened to and respiratory rate measured with a respirator rate between 40 and 60.
  • The abdomen is palpated.
  • The state of the umbilical cord is checked to make sure there is no secondary infection and that the umbilical grip - which will be removed a few days later-, is properly in place.
  • The baby's temperature is checked.
  • The legs and feet are examined.
  • The pulse in the femoral artery is measured.
  • External genitalia are examined.
    • For a boy, that the testicles have descended into the scrotum.
    • For a girl, the paediatrician checks that the labias (majora and minora) are fairly open.
  • The neck and clavicle are checked to make sure there is no hematoma or fracture of the clavicle that might have occurred during a difficult delivery.
  • The bones of the skull and fontanelles are checked, these are 2 cartilaginous spaces in the cranium - one at the front and the other at the back of the skull. These usually closed by the end of the first year of life.
  • The doctor checks the eyes, ears, nose and mouth: and a hearing test will be performed before leaving the hospital.
  • He checks any marks which could have been caused by the forceps and which disappear after a few days.
  • The red reflex is checked by shinning a special torch into the baby's eyes
  • A neurological examination then follows to evaluate the baby's activity, motor function and reflexes.
    • Stepping reflex
    • The palmar grasp reflex: the baby closes its hand when the palm of the hand is tickled
    • Reactions to the cardinal points
    • Plantar reflex
    • Tonic neck reflex

These reflexes disappear gradually after a few months.

Congenital hip dislocation

  • The spinal cord and the hips are examined: The hips are examined to ensure there is no dislocation of the hip caused by an anomaly in the hip joint.
  • Approximately 5 in 1000 babies have a hip dislocation at birth and 1 in 1000 babies at 3 weeks.

Risk factors for a potential hip dislocation:
  • A family history of hip dislocation
  • Baby in Breech position
  • Oligohydramnios - a condition in pregnancy where there is a small amount of amniotic fluid in the uterus, therefore making it very difficult for the baby to move.
  • more common in first born
  • more common in girls

How is this anomaly detected?
  • The paediatrician will check for this by bending the baby's knees and moving the thighs outwards. He may hear a characteristic noise and or feel a click which reveals a subluxation or dislocation of the head of the femur which is a rounded ball that fits into the pelvis or acetabulum.
  • An ultrasound scan is carried out in young babies and an x-ray if aged 4 months or over.

To prevent long term complications early treatment is necessary.
  • For small babies under 3 months a Von Rosen padded splint may be used.
  • A 'Pavlik' harness is used in older infants. It keeps the legs bent and turned outwards which is adjusted as the child grows. Another method is the use of a plaster cast, which is applied whilst the child is anaesthetized. It keeps the hip in the correct position and is kept in place for a minimum of 12 weeks.
  • When the harness is unsuccessful or if the child was much older when diagnosed, surgery may be required to loosen the tendons around the hip.

Guthrie test

A drop of blood (bloodspot test) is taken from the baby's heel between the 5th and 8th day after the baby's birth. The purpose of this test is to seek out certain rare diseases, like Phenylketonuria, hereditary neurologic disorders, congenital hypothyroidism, cystic fibrosis, adrenal hyperplasia and sickle cell anemia.
  • Phenylketonuria: causes irreversible neurologic disorders, and mental disability. A diet without or very little phenylamine will allow for a normal cerebral development.
  • Cystic fibrosis: a genetic disease of the respiratory system.
  • Congenital hypothyroidism: this is lack of thyroxine which is essential to development of the central nervous system.
  • Congenital adrenal hyperplasia: This can be fatal but can be avoided with steroid drugs.
  • Sickle cell anemia: disease of the hemoglobin which affects children originating from certain countries like Black Africa or certain areas like Antilles or Guyana. Early detection can help decrease the complications of this disease.

Technological advances now enable us to screen for nearly 50 diseases, however ethical problems arise when not all these screened diseases have treatments, therefore should we be looking for them.

Hearing test of the new born:

The hearing test identifies those children possible hearing problems.
1 baby out of 1,000 is born with permanent hearing loss or deafness with 90% born to families with no history of deafness,

Risk factors for hearing disorders

  • Birth weight lower than 1.5kg
  • Family history of deafness
  • Rubella or toxoplasmosis
  • Prematurity

Signs of hearing impairment in a baby / child

  • A very calm baby, vacant staring, chattering little,...
  • Does not react to a loud noise
  • Fixing faces, as if it did not hear very well
  • It does not make much effort to try to speak and presents with a language delay
  • It suffers from repetitive ear infections

Vision disorders

A child's vision continues to develop after birth. Babies smile at 6 weeks, therefore if you smile at your baby without making any noise and they then smile back, you know they can see.

About 1 or 2 in 10,000 babies have problems with their eyes.

90% of what a baby notices is through its vision.

There are some congenital eye disorders, which can prevent their vision from developing normally.
  • The eyes are checked for a white coloured pupil with an absent red reflex.
  • Any discharge from the eyes should be investigated and treated.
  • Watery eyes is a common problem in babies and is usually due to delayed opening of the tear duct. By the age of 1 year 90% have resolved.

Routine baby checks conducted in the first year

Apart from emergency situations or situations requiring medical advice, you can expect the following as a minimum;-
  • Soon after birth - a full physical examination
  • 5 - 8 days - heelprick blood spot test
  • 10 - 14 days; a new baby review
  • A hearing test within the first month
  • 6 -8 weeks - a full physical examination
  • 8, 12, 16 weeks - immunisations
  • 12 months a health review
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