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The newborn examination: head to toe, normal findings, gestational age and weight classification

  • Assessment

The nurse measures the newborn, examines it head to toe, classifies it by gestational age and weight, and reports anything outside the normal.

Updated

What it is

After the first hour of skin-to-skin contact (see immediate care), the newborn gets a brief first examination and its measurements, within the mother's sight. In Colombia a doctor then does a full examination within the first 4 hours and again before discharge. The nurse prepares the baby, measures it, checks temperature and vital signs, looks for birth injuries and anomalies, and classifies the baby by gestational age and by weight for that age. The classification tells the team which risks to watch, such as low blood glucose in a small or a large baby.

Reference values

  • Preterm: born before 37 weeks; term: 37 to 42 weeks; post-term: after 42 weeks.
  • Late preterm: 34 weeks 0 days to 36 weeks 6 days. Early term: 37 weeks 0 days to 38 weeks 6 days.
  • Normal temperature: 36.5 to 37.5 °C.
  • Vital signs every 6 hours during the first 24 hours: heart rate, breathing rate, temperature, blood pressure and oxygen saturation.
  • Physical methods of estimating gestational age have an error of about 2 weeks, larger in preterm and growth-restricted babies.

What you need

  • A warm room or a radiant warmer, and warm cloths.
  • A scale, a length board, a non-stretch tape measure and a thermometer.
  • A pulse oximeter with a neonatal sensor.
  • The growth charts or neonatal tape, and the newborn record.

How to measure it (and why)

  1. Read the maternal and birth history first — diabetes, infection, drug use or a hard birth change what you look for.
  2. Examine under a heat source and uncover one part at a time — the newborn loses heat fast.
  3. Weigh the baby naked, measure length lying flat with one leg straight, and head size at its widest — a standard method allows comparison.
  4. Plot the weight against gestational age and classify it as small, appropriate or large — each group carries different risks.
  5. Measure temperature, heart and breathing rate and saturation, and record them — they show how the baby is adapting.
  6. Look from head to toe: skin colour, fontanelles, face and palate, chest, abdomen and cord, genitals, spine, limbs and hips — finds injuries and anomalies.
  7. Watch tone, alertness, suck and swallow — they show neurological state and readiness to feed.
  8. Check that the baby has passed urine and meconium, and record the times — confirms the gut and kidneys work.
  9. Record everything and explain the findings to the parents — they learn what is normal and what to watch.

How to read it

  • Small for gestational age or growth-restricted: higher risk of hypoglycaemia and electrolyte problems; the protocol usually orders blood glucose and electrolytes at about 12 hours.
  • Baby of a diabetic mother, large or small: severe risk of hypoglycaemia; the protocol sets early glucose checks.
  • Late preterm babies have more feeding difficulty, hypoglycaemia, jaundice, unstable temperature and apnoea than term babies.
  • Three or more minor anomalies call for referral to look for a hidden major malformation.
  • Hips: every newborn gets a clinical hip exam; imaging is only for specific risk factors or an abnormal exam.

Next step: when to call for help

  • Temperature below 36.5 °C or above 37.5 °C: warm or cool as appropriate and tell the doctor.
  • Breathing difficulty, apnoea pauses, cyanosis, pallor, or jaundice in the first 24 hours: call at once.
  • Suspected congenital anomaly: tell the doctor; in Colombia it is a notifiable public health event.
  • No meconium in the first 24 hours: the doctor must assess the baby.
  • Weight below the 10th or above the 90th centile: inform the team so the glucose monitoring plan starts.

Test yourself

Think of the answer, then tap the question to see it.

Which four measurements does Resolution 3280 ask for in every newborn?

Weight, length, head circumference and chest circumference, recorded and compared with the gestational age.

How is a newborn's weight classified for its gestational age?

Small below the 10th centile, appropriate between the 10th and 90th, and large above the 90th centile.

Which method does the Colombian preterm guideline recommend to estimate gestational age after birth?

The New Ballard score; it advises against the Capurro method.

What is the normal temperature range of a newborn?

36.5 to 37.5 °C; values outside it are a danger signal.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018); Salud sexual y reproductiva: guías para el continuo de atención de la mujer y el recién nacido focalizadas en APS, 3.ª ed. (CLAP/SMR 1577) (Organización Panamericana de la Salud, CLAP/SMR, 2011); Guía de práctica clínica del recién nacido prematuro (Guía No. 04) (Ministerio de Salud y Protección Social de Colombia, Colciencias, 2013); Guía de práctica clínica del recién nacido sano: para padres y cuidadores (Guía No. 02) (Ministerio de Salud y Protección Social de Colombia, Colciencias, 2013).

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