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Physical Assessment

Nurse examining a preemie
A comprehensive physical examination can reveal certain conditions and can make doctors suspect that there may be problems ahead. Physical examination is an ongoing process. A premature baby’s first examination, which takes place immediately or near immediately after birth, is likely to be the most complete but it will not be the last. Many examinations will occur over time to gauge a baby’s progress and to spot new problems should they arise. During your baby’s first physical examination, her health care provider will likely check for the following:

Overall health

The health care provider will check your baby’s muscle tone, activity, alertness, and skin colour, and will assess whether she appears to be in good health overall.

Body temperature

Before birth, your body regulated your baby’s temperature. After birth, your premature baby needs to be able to maintain her own body temperature. Once the amniotic fluid evaporates from your baby’s body, she can quickly lose heat. If she has a low body temperature, she may need to draw on her glucose reserves to keep her body warm. This can lead to low blood glucose, which can cause your baby’s temperature to drop even further. Low glucose levels can be dangerous for your premature baby. At the physical examination, and regularly thereafter, the health care provider will check your baby’s temperature. Most likely, the health care provider will use a thermometer under your baby’s underarm, but sometimes a rectal thermometer is used instead. To help keep your baby’s temperature stable, she will be placed in an incubator, or under a radiant heater, where the temperature control is closely regulated.

Estimation of gestational age

The health care provider will assess your premature baby’s gestational age. This is important since the more premature your baby is, the more likely she will require support. Establishing the gestational age of the premature baby can alert medical staff to difficulties the baby may have simply due to prematurity. For example, a substance called surfactant, which is necessary to help the lungs stay inflated during breathing, does not develop in the lungs until the end stages of pregnancy. If the baby is moderately or extremely premature, the doctors can assume that the baby will have a surfactant deficiency and therefore will have trouble breathing.

Evaluation of size

Size and weight will also be evaluated relative to the baby’s gestational age. Babies who are small for their gestational age are also more likely to have complications that require support.

Skin

A premature baby’s skin will be examined to see if it is broken anywhere and how thick it is. Broken skin will put the baby at a higher risk for infection. Thick, unbroken skin with good colour will indicate that infection is less likely.

Breathing

The health care provider will check your premature baby for any signs of respiratory distress, such as rapid or irregular breathing, grunting while breathing, or a bluish tinge to the lips, gums, and mucous membranes.

Heart

A newborn baby’s normal heart rate ranges from 90 to 160 beats per minute. The health care provider will check that your baby’s heart rate is within the normal range and listen for any abnormal heart sounds. Unusual heart sounds or beats could indicate a problem with the structure of the heart, and the earlier these are diagnosed, the better.

Abdomen

Your baby’s stomach, liver, kidneys, spleen, and other internal organs should all be the correct size and in their proper place. The health care provider will check for this and also for any abnormalities or swellings.

Anus

The health care provider will determine if the anus is normal and open. If your baby’s anus is not open or otherwise malformed, she will need surgery to correct the problem. The doctor will also check to make sure that your baby has passed her first bowel movement, a thick, greenish-black, tar-like substance known as meconium.

Genitalia

In girls, the health care provider will check that the vagina, clitoris, and other surrounding structures are normal, and that the lips of the labia are separated. Some baby girls are born with labia that are joined, which can be corrected with surgery. In boys, the testicles are assessed to check their location. Most of the time in premature boys, the testicles have not fully descended into the scrotum yet. That should happen as the baby matures. The penis is also checked for any abnormalities. These assessment are done on all babies, premature or not.

Head

The head will be examined to see if any injury has occurred during birth and to see if there are abnormalities in the skull bones or in the way that they are positioned relative to each other. Since the skull bones do not fuse together until later, even in a full-term baby, the fontanelles, the still soft bones of the top of the skull, are a particularly vulnerable spot. If the top of the head appears to be bulging, this can be a sign of abnormal pressure in the head which may have been caused by bleeding in the brain.

Eyes and ears

Your baby’s ears may be folded over or sticking out in some way. This is normal, and should go away over time. The health care provider will check to make sure your baby’s ear canals are normal. Your baby’s ears and eyes will be checked for size and any abnormalities.

Mouth

Your baby’s mouth will also be checked. Some babies have a tongue that is attached too tightly to the floor of their mouths. This is called a “tongue-tie” and was once thought to be associated with breastfeeding and speech problems. There is no good evidence that proves this to be the case and many babies with tongue-tie breastfeed easily. The health care provider will check your baby’s gums, and the roof of her mouth, called the palate. One relatively common birth defect is a problem with the formation of the palate, called cleft palate. Cleft palate can be corrected with reconstructive surgery.

Arms and legs

The health care provider will check that each arm and leg has a pulse, that each leg is the same length, and that all the arms and legs show normal signs of movement and strength. Your baby’s arms, legs, hands, feet, fingers, and toes will all be assessed for any abnormalities. Certain abnormalities such as clubfoot, a condition where the front part of the foot is turned inward, can be corrected with surgery. Dislocation of the hips at birth is another common abnormality, and it can be corrected with a combination of splints, harnesses, and sometimes surgery.

Spine

Your baby will be checked for any evidence of spina bifida, which is a neural tube defect where part of the outer covering of the spine is exposed.

Injuries

The health care provider will assess your baby for bruises, injuries, or broken bones that could have been sustained during the birth process.

Kim Dionne, RN, MN, NNP

10/31/2009




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