Examination of the Newborn

An Evidence-Based Guide

Anne Lomax

• Publisher: Wiley-Blackwell
• Year: 2021
• Print ISBN: 9781119645597
• eBook ISBN: 9781119645627
• Edition: 3
• Topic: Medicine
• Subtopic: Nursing

Examination of the Newborn is essential reading for students and practitioners involved in neonatal examinations. Now in its third edition, this practical evidence-based guide reflects the most current Public Health England (PHE) Newborn and Infant Physical Examination (NIPE) Standards to help readers deliver high quality, family-centered care within current national guidelines. Each chapter is firmly placed within the context of the current PHE standards to help ensure good practice in both hospital and community settings.

This fully-revised edition incorporates current educational and healthcare guidelines relevant to the neonatal examination, including up-to-date information on the new Nursing and Midwifery Council (NMC) Standards for Education. New and expanded topics include history taking and the examination of the newborn, midwifery professional issues, the use of pulse oximetry, and the importance of observing maternal and infant attachment during examination. An invaluable guide to neonatal examination, this book:

• Reflects the most current UK National Screening Committee (UK NCS) Standards of clinical practice
• Includes contributions from a multidisciplinary team of specialists, covering cardiovascular and respiratory assessment; examinations of skin, head, neck and eyes; chromosomal and genetic problems; newborn behavioural aspects, and more
• Features full-colour photographs and illustrations, clinical case studies, and an updated and expanded companion website containing interactive questions, checklists, links to video resources, and a wealth of information on all aspects of examining the newborn

Examination of the Newborn is an indispensable source of authoritative knowledge for nursing students, midwives, neonatal nurses and practitioners, pediatricians, physiotherapists, and general practitioners.

CHAPTER 1
HISTORY TAKING AND THE NEWBORN EXAMINATION : AN EVOLVING PERSPECTIVE

Claire Evans

Warrington and Halton Hospitals NHS Foundation Trust, Warrington, Cheshire, UK

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KEY POINTS

• The principal aim of history taking is to screen for predictive risk indicators that may predispose the newborn to an adverse postnatal transition or presence of an abnormality that requires an appropriate and timely referral for further diagnostics.
• The newborn examination history‐taking process should be mapped to the Public Health England (PHE) Antenatal and Newborn Screening Programme and be used as a benchmark for screening and assessment of risk factors in the neonatal period and beyond.
• Identification of risk factors within the newborn examination can isolate and target health promotion issues.

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Introduction

A comprehensive history taking is implicit to all health care disciplines to aid the diagnostic consultation process and to inform the optimal course of management. The skill of history taking has changed over the decades and has adopted a wider context as a predictive diagnostic tool. To facilitate a more holistic approach to the examination of the newborn, a thorough evaluation of the maternal and newborn history is essential. Short‐term outcomes, long‐term morbidities or even mortality can be influenced by the quality of the history taking in terms of the predictive risk for some adverse clinical conditions.

This chapter outlines the context of the history profile from the maternal, perinatal and familial perspective. It also addresses history taking as a skill as well as the potential barriers that may reduce the effectiveness of the process. The aim of this chapter is not only to address common risk factors but to embrace the wider context of history taking from a psychosocial and safeguarding perspective (see also the website that accompanies this book for more information on safeguarding and the newborn examination). The focus on history taking must be meaningful, achievable and valuable to the newborn examination practitioner. History taking remains the principal standard underpinning the clinical examination; to disregard the importance of history taking may lead to suboptimal practice and outcomes. Effectively gathering a history demands time and should not be rushed because it is a powerful instrument that can influence the quality of the examination.

Historically, the profile of the newborn examination systematic history assessment has been raised over the decades (NHS QIS 2008; NICE 2015; PHE 2020c; Skills for Health 2019). However, history taking is an essential component of the newborn and infant physical examination (NIPE) that has been validated through the development of the UK National Screening Committee (NSC) NIPE Programme (PHE 2018a) and implementation of the national NIPE Programme guidance documents mandating the programme (PHE 2018; 2020c).

For the purposes of this chapter, the National Health Service (NHS) Antenatal and Newborn Screening Programmes will be used as a framework to underpin the history‐taking process. This approach should encompass all relevant information from the maternal and newborn medical records, dialogue with the mother and/or father and information from clinical staff.

The NIPE Programme Handbook, standards and service specifications can be found on the gov.uk website:

https://www.gov.uk/government/publications/newborn‐and‐infant‐physical‐examination‐programme‐handbook/newborn‐and‐infant‐physical‐examination‐screening‐programme‐handbook

https://www.gov.uk/government/publications/newborn‐and‐infant‐physical‐examination‐screening‐standards

https://www.england.nhs.uk/wp‐content/uploads/2017/04/Service‐Specification‐No.21‐NIPE.pdf.

The NIPE Programme Newborn Screening Pathway can be found as an appendix to the Programme Handbook and on the following weblink:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/702100/NIPE_Screening_Programme_Newborn_Pathway.pdf.

Objectives and characteristics of good history taking

The principal aim of the history‐taking exercise is to identify predictive risk indicators for those newborns that may be risk of an adverse postnatal transition extending into childhood. Families with newborns who are identified as being at risk will then benefit from early detection, intervention and treatment options. To achieve this, the history profile must be factual, accurate, concise, informative and relevant. Discussions with the parents, to gather the history, can also offer a platform that targets health awareness and safety issues to promote optimal health in the neonatal period and beyond. A review of maternal and parental lifestyle habits in general, e.g. smoking, addictive behaviours and high‐conflict relationships, can be identified, and appropriate timely referrals or support can be arranged. Other health promotion issues including BCG vaccination to high‐risk populations can be actioned.

A quality history‐taking process is largely dependent upon the skill of the practitioner. Health care professionals who conduct the newborn examination are fortunate in having pre‐existing skills that are transferable. Doctors, midwives and neonatal nurses engage in history taking on a regular basis wit...

Table of contents

• Cover
• Table of Contents
• Title Page
• Copyright Page
• List of contributors
• Acknowledgements
• Introduction
• About the companion website
• CHAPTER 1: HISTORY TAKING AND THE NEWBORN EXAMINATION
• CHAPTER 2: Cardiovascular and respiratory assessment of the baby
• CHAPTER 3: The neonatal skin: examination of the jaundiced newborn
• CHAPTER 4: Examination of the head, neck and eyes
• CHAPTER 5: Assessment of gestational age and newborn reflexes
• CHAPTER 6: Examination of the newborn abdomen and genitalia
• CHAPTER 7: Developmental dysplasia of the hip and abnormalities of the foot
• CHAPTER 8: Chromosomal and genetic problems: giving feedback to parents
• CHAPTER 9: Newborn behaviours: supporting parents to develop early attachments
• CHAPTER 10: Examination of the newborn: professional issues in practice
• APPENDIX 1: step‐by‐step guide to examination of the newborn
• APPENDIX 2: Useful website addresses
• Index
• End User License Agreement