Importance of Newborn Assessment in Paediatric Care

As an obstetrician, parents often ask me why we look at the baby so carefully after delivery. Some even get scared that something is wrong. If you've ever had this thought, this is for you.

What you see us do is called newborn assessment. It is crucial for helping identify possible health problems early, directing interventions, and setting long-term goals for growth and development. Let's understand it in detail.

The first and most important thing to check after the baby is born is the Apgar Score. It is a quick and easy test of five essential variables that determine how well the newborn will survive in the environment after coming out of the mother's womb.

The criteria evaluated by the Apgar score are

• Appearance (Skin Colour) checks for a healthy pink colour is done, indicating good oxygenation.
• Pulse (Heart Rate) – A strong, steady pulse indicates a healthy working cardiovascular system.
• Grimace Response (Reflex Irritability) includes checking the response to stimuli like pinching.
• Activity (Muscle Tone): Evaluates muscle tone and activity.
• Respiration (Breathing effort): Observation of respiration patterns and crying.

After the Apgar score, a complete general examination is done within the first 24 hours of birth. This examination checks every detail of the baby's health and development so we can determine what abnormalities to address. Among them are:

1. General Appearance: Observation of the baby's posture, movements, and activity is done. It's primarily observing the baby's skin colour, texture, birthmarks, or jaundice.
2. Head and Neck Examination: The shape of the head and the presence of fontanelles (soft spots) are examined.
3. Eyes, Ears, Nose, and Throat (EENT): This examination includes looking for eye movement, a red reflex and signs of congenital cataracts. It also involves clearing the nasal passages and making sure ears are formed entirely and can respond to sounds.
4. Chest and lung auscultation for heart murmurs or abnormal lung sounds, as well as observation of breathing patterns and chest wall movements.
5. Abdomen and Digestive System palpations are used to check organ positioning, masses, or hernias. The umbilical cord is also examined for healing.
6. Genitalia and Anus examination is done to check for ambiguous genitalia, undescended testes, or any other abnormalities. Verify the anus is patent with meconium passing.
7. Limbs and Spines: Limb movement, symmetry, or congenital deformities are assessed. The spine is examined to determine spina bifida and other defects.
8. Neurological Examination Evaluate reflexes: Muscle tone and coordination are tested through Moro, grasp, rooting and sucking reflexes. 
    

Screening tests are the other fundamental part of newborn assessment. These tests detect underlying conditions that are not visible through a physical examination. Early identification of these disorders using these tests will ensure the proper treatment to prevent complications.

1. Blood Test Screening: Newborn Metabolic Screening, often called the heel prick test, occurs within the first 48 hours of birth. These tests look for metabolic, hormonal, or genetic defects such as PKU, congenital hypothyroidism, sickle cell disease, and cystic fibrosis.
2. Jaundice Screening: High bilirubin can cause neonatal jaundice. Specific tests determine whether the levels are too high. Untreated severe cases may cause kernicterus, a rare form of brain damage.

Physicians screen for developmental dysplasia of the hip to confirm the stability and symmetry.
 

Monitoring the growth and development of newborns is done throughout their early childhood, but it starts right after birth. Regular paediatrician visits help identify whether the baby is growing and developing as expected.

Paediatricians assess growth parameters such as weight, height, and head circumference and compare them to the average values seen in babies. In general, baby girl growth charts show slightly lower values than baby boy growth charts.

Developmental milestones are observed to ensure that cognitive, social, and motor development is progressing. Parents' involvement and education are part of newborn assessments.

Even if it feels subtle, newborns grow and change remarkably in the first three months.

• They lift their heads a few times during tummy time and move a bit smoother, kicking their legs and waving their arms.
• Their little hands begin to unclench as they find out how to grip.
• Babies also begin to focus on faces, follow objects with their eyes, and respond to familiar voices.
• Emotionally, they start noticing their parents being there, which reassures and calms them down.
• In their third month, babies begin to smile socially, coo, and make soft sounds, which are signs of early communication.

During visits, paediatricians usually educate parents on the importance of these assessments and ask them questions. Their observations on feeding patterns, sleep. and overall well-being are instrumental in the comprehensive assessment.

Newborn evaluations are critical in paediatric care because they provide precious information on the child’s health and interventions to help the child achieve this amazing beginning. As healthcare professionals, we have seen how early detection and early intervention can help a child.