Routine newborn examination and screening

The routine newborn assessment has two linked purposes: determine whether the baby is currently well and screen for conditions that may be clinically silent. A screening examination is not a diagnostic certificate. Any abnormal physiology is stabilised first, while positive NIPE findings enter a defined diagnostic pathway and normal findings are repeated because some disease emerges later.

Confirm identity, consent and relevant history before touching the baby. Review gestation and growth, fetal imaging, maternal blood group and antibodies, infections and screening results, diabetes, autoimmune disease, medicines and substances, family congenital disease, delivery mode, rupture of membranes, intrapartum antibiotics, cord gases and resuscitation. Ask about feeds, latch or volumes, vomiting, urine, meconium, alertness and parental concerns.

Observe before undressing. Normal newborn breathing can be irregular with brief pauses, and heart rate changes with sleep and crying. Persistent tachypnoea, recession, grunting, apnoea or abnormal perfusion is not dismissed because a single number lies near a conventional range. Measure temperature and plot anthropometry using exact gestation and sex; check an unexpected result with correct technique.

Inspect the head for moulding, cephalhaematoma, caput, scalp injury and fontanelle tension. Measure occipitofrontal circumference. Examine facial symmetry, ears and neck. Look in the mouth with a light and palpate the palate if necessary; a submucous cleft can be subtle. Check suck and coordinated breathing with feeding rather than provoking aspiration in an unwell infant.

Use an ophthalmoscope in a dim room to compare both red reflexes simultaneously and individually. Reflex colour varies with retinal pigmentation, but symmetry, brightness, shape and clarity matter. A white reflex, shadow, obscuration or clear asymmetry is screen positive. Do not rely on whether the infant appears to fix at this age.

Assess breathing, chest symmetry and clavicles, then auscultate heart sounds, rhythm and lungs. Palpate brachial and femoral pulses simultaneously and inspect perfusion. Murmurs can be transitional and critical disease can have no murmur. Routine pulse oximetry adds detection of hypoxaemic cardiac, respiratory and infectious disease but cannot exclude coarctation or every duct-dependent lesion.

Palpate the abdomen for liver, spleen, kidneys and masses and inspect the umbilical cord. Confirm a patent-positioned anus by inspection; do not instrument routinely. Ask specifically about bilious vomit and stool colour. Pale chalky stool and dark urine suggest cholestasis, while green vomit is intestinal obstruction until assessed.

Inspect genital anatomy without assuming sex from one feature. Locate each testis and document whether it is scrotal, palpable elsewhere or impalpable. Bilateral impalpable testes or hypospadias with an impalpable testis can signal a difference of sex development and salt-losing adrenal disease. Do not circumcise hypospadias because foreskin may be needed for repair.

Observe spontaneous symmetrical limb movement, digits and feet, and palpate the spine. Assess tone and newborn reflexes in context. Examine each hip with Ortolani, which detects a dislocated hip reducing into the acetabulum, and Barlow, which tests whether a located hip can dislocate. A true clunk differs from a benign soft-tissue click.

The NIPE screen should be completed by 72 hours and repeated at 6–8 weeks for eyes, heart, hips and testes because cataract, cardiac signs, hip instability and testicular position may evolve. Record every component, result, risk factor, referral and responsible professional in the screening system and personal child health record. A transferred or unwell baby needs a failsafe, not an assumed completion.

Newborn blood-spot screening is normally performed on day 5. As of 2026 the English programme covers sickle cell disease, cystic fibrosis, congenital hypothyroidism and seven inherited metabolic disorders, including hereditary tyrosinaemia type 1. An early disease-specific sample never automatically replaces the routine day-5 card, and a baby transfused before sampling needs the prescribed pre-transfusion pathway.

Newborn hearing screening uses otoacoustic emissions and, where indicated, automated auditory brainstem response. It identifies many congenital permanent losses but is not a full diagnostic assessment. Risk factors, caregiver concern, meningitis, ototoxic exposure or later language delay require audiology even after a pass.

Vitamin K prevents early and late vitamin K deficiency bleeding. Intramuscular prophylaxis gives reliable depot protection and avoids adherence failure. When parents decline it, explore concerns respectfully and explain that oral prophylaxis requires a complete product-specific course and is inadequate with cholestasis or malabsorption. Record formulation, route, dose and every planned follow-up dose.