Neonatal assessment

An infant with an undifferentiated condition requires careful head-to-toe assessment and monitoring.

History

• Attempt to identify any changes in the infant's behaviour of concern. A thorough assessment of the infant's usual cues and feeding patterns may not be possible with very young infants.
• Prenatal history. Check the blue book if available. Include:
• gestational diabetes
• preeclampsia
• prenatal health checks and screening.
• Birth history, including any complications, resuscitation requirements and APGARs
• Birth weight and current weight.

Look

Respiratory

• Complete assessment with the infant fully exposed.
• Consider placing the patient in an infant warmer or engaging in skin-to-skin contact.
• Look for signs of upper airway obstruction.
• Assess their colour, peripherally and centrally.
• Count their respiratory rate and assess.
• Pattern of respirations:
• regular
• irregular
• shallow
• tachypnoeic
• bradypnoeic.
• Work of breathing:
• mild
• moderate
• severe.
• Use of accessory muscles:
• tracheal tug
• intercostal
• suprasternal
• substernal
• supraclavicular
• abdominal
• head bob
• nasal flaring.
• Evaluate chest expansion for symmetry.
• Check the trachea is midline.
• Listen for audible sounds, e.g. stridor, hoarse cry, wheeze, grunting or cough.
• Measure the oxygen saturations.

Listen

• Auscultate the lung fields with a stethoscope. Listen for:
• quality of breath sounds
• adventitious breath sounds, e.g. wheeze, crackles, crepes or stridor
• location of the sounds.

Feel

• Feel for even chest expansion.
• Feel for skin temperature, turgor and moisture.
• Measure the capillary return, centrally and peripherally.

Circulation

Cardiac exam

• Compare upper and lower limb pulses
• Look for oedema.
• Auscultate the apex beat.
• Compare the apex beat to the peripheral pulses. They should be similar.
• Auscultate across all four heart valves.
• Listen for arrhythmias and murmurs.
• Palpate peripheral and central pulses.
• Assess rate, rhythm and volume.

Skin

• Complete a skin inspection.
• Consider common neonatal rashes:
• milia
• erythema toxicum neonatorum (ETN)
• pityrosporum folliculitis
• miliaria
• nappy rash.
• Consider the need for tapes or cardiac dots on the skin and carefully remove any that aren't required.

Pain assessment

• Neonates frequently experience pain in hospital and can suffer immediate or long-term consequences of unrelieved pain.
• Accurate assessment of pain is essential to provide adequate management. Use an appropriate pain scale tool, such as the Modified Pain Assessment Tool (mPAT) (appendix), and reassess pain as needed.
• If the pain is unrelieved by comfort measures, escalate as per local CERS protocol.