From the Guidelines
A comprehensive 2-week newborn exam is crucial for assessing the infant's health and development, and it should include a review of feeding patterns, weight gain, voiding and stooling habits, and any parental concerns, as well as a physical examination covering all body systems, screening for congenital abnormalities, and assessment of parent-infant bonding. The exam should begin with a review of the infant's feeding patterns, including the frequency and volume of feedings, as well as any concerns about latching, sucking, or swallowing 1. The infant's weight gain, voiding and stooling habits, and any parental concerns should also be assessed. Vital signs, including temperature, heart rate, respiratory rate, and blood pressure if indicated, should be evaluated. Growth parameters, such as weight, length, and head circumference, should be plotted on growth charts to ensure appropriate development.
The physical examination should cover all body systems, including:
- Skin: jaundice, rashes, or birthmarks
- Head: fontanelles and shape
- Eyes: red reflex and tracking
- Ears: positioning and response to sounds
- Mouth: thrush or anatomical abnormalities
- Chest: respiratory effort and heart sounds
- Abdomen: organomegaly or umbilical healing
- Genitalia: normal development
- Extremities: range of motion and hip stability
- Neurological assessment: tone, reflexes (particularly Moro, rooting, and sucking), and general alertness.
The exam should also include screening for congenital abnormalities, such as hip dysplasia, and assessment of parent-infant bonding, including the parent's ability to respond to the infant's needs and the infant's ability to respond to the parent's interactions. According to the most recent study on motor development, at 2 weeks, infants should be able to lift their head and chest in prone, and have hands unfisted 1. This comprehensive evaluation is crucial as the first few weeks of life represent a critical period for identifying congenital issues, feeding problems, or developmental concerns that may require early intervention to prevent long-term complications.
From the Research
Key Components of a 2-Week Newborn Exam
The 2-week newborn exam is a crucial assessment that includes various components to ensure the overall health and well-being of the newborn. Some of the key components of this exam are:
- Examination for size, macrocephaly or microcephaly, changes in skin color, signs of birth trauma, malformations, evidence of respiratory distress, level of arousal, posture, tone, presence of spontaneous movements, and symmetry of movements 2
- Measurement of total and direct bilirubin levels in newborns with jaundice, and a complete blood count in those with pallor or a ruddy complexion 2
- Evaluation for associated anomalies in newborns with one anatomic malformation 2
- Assessment of the newborn's overall development, including identification of malnutrition, immunization status, level of development, screening for 4 Ds (Defects at birth, Deficiencies, Diseases and Developmental Delay including Disability), hearing and visual assessment, and detection of child abuse 3
Physical Examination
The physical examination of a newborn should consider the age and developmental level of the child. It is essential to make the child comfortable with pleasant surroundings and playful behavior to yield maximum information from the examination 3. The examination should include:
- Assessment of the skin, head, neck, chest, and respiratory and cardiovascular systems 2
- Evaluation of the newborn's posture, tone, and presence of spontaneous movements 2
- Examination of the hips to check for any abnormalities 4
Importance of the Newborn Exam
The newborn exam is critical in identifying any potential health problems early on, which can help prevent or minimize long-term health issues in children 5. It is also essential to identify risk factors for neonatal hyperbilirubinemia, such as low vitamin D levels, to decrease the incidence of this condition 6.
Who Can Perform the Newborn Exam
The newborn exam can be performed by either a senior house officer (SHO) or a midwife, with no significant difference in appropriate referral rates or maternal satisfaction 4. In fact, midwives may be more appropriate to perform the exam, as it can result in improved quality of examinations and higher satisfaction from mothers, while also reducing overall health service costs 4.