creation date: 2026-05-13 19:28
tags: Assessments
Newborn Exam
Background
The newborn exam is done within 24 hours of birth to assess for the newborns transition into life. Similar exams are performed at subsequent visits, although components may not be as thoroughly assessed.
The exam here describes the components done by the physician. Some elements of the newborn screen (eg. blood tests, hearing test) are performed by other providers.
Examination
History
From the caregiver, enquire about:
- Feeding
- Latching concerns
- Frequency of feeds (should be q2-3 hours)
- Volume of feeds (10mL for each day of life up to 90mL, after 9 days: 90-120mL)
- Duration of feeds (15-20 min ideal)
- Stools/voids (≥1 prior to discharge)
- ≥4 of void/stool each per 24 hours
- Other concerns
In the clinic, enquire additionally about:
- Hearing test (ie. done in hospital, outside hospital)
- Jaundice
Physical Exam
In addition to a general inspection, the following should be a part of the examination. Parts are done opportunistically, but order described will be in order of likelihood of upsetting the infant.
- Auscultate the heart
- Auscultate the lungs
- Inspect, auscultate, and palpate the abdomen (incl. umbilical cord)
- Palpate the fontanelles (anterior, posterior)
- Inspect the ear position (1/3 above the eye line)
- Inspect ear for adhesions or protrusions
- Palpate the clavicles
- Barlow and Ortalani
If at any point, the infant wakes or begins crying:
8. Assess suck reflex
9. Palpate the palate
10. Inspect for a tongue tie
11. Assess plantar and palmar reflexes
12. Assess for red reflex
Removing the diaper:
12. Assess femoral pulses
13. Check genitalia
- Male: assess for hypospadias, undescended testes
Turn the infant over (or roll):
14. Inspect and palpate entire spine
15. Assess for sacral dimpling
Finally:
16. Assess Moro reflex
Weight and Bilirubin
Weight
A neonate should not lose >10% of their birth weight within the first 5-7 days of their life. The weight is expected to be regained by 14 day of life.
Ideal growth rate is approximately 25-30g per day.
Bilirubin
A bilirubin level is ordered at 24 hours of life. The management guidelines are based off the 2025 hyperbilirubinemia guidelines. In summary, a nomogram is used which has a treatment threshold based on GA and day of life. Assess:
- Total bilirubin level
- Rate of change in bilirubin
- Delta from the treatment threshold
Depending on the findings, management options are:
- Discharge for family physician
- Follow up in newborn clinic in 24-48 hrs or 3-4 days
- Admit for repeat bilirubin in 12 hours and monitoring
- Admit and initiate phototherapy
- Consideration of transfer for exchange transfusion/IVIG
In the case of follow up bilirubins following phototherapy, be aware of rebound hyperbilirubinemia, which may cause an upwards rise in bilirubin levels despite apparent downward trend.
References
Tools / Guidelines
CPS - Guidelines for Detection and Management of Hyperbilirubinemia in Term or Late Preterm Newborns