Examination of the Newborn. Группа авторов
and applied during the history‐taking process for the newborn examination. Newborns can be subject to safeguarding, and the relevant assessments in the antenatal period can minimise potential harm with the right level of intervention and support (Brandon et al 2016). All significant information must be made available and shared through the use of multiagency protocols including neonatal and paediatric community teams and other multidisciplinary organisations involved in the protection of children in accordance with national and local policy.
Cultural practices can be disclosed during the history‐taking process in relation to female genital mutilation (FGM). This practice is illegal in the United Kingdom and is a high priority for safeguarding. The practice of FGM is common in Africa, the Middle East and Asia. It is mandatory for the disclosure of FGM to be reported to the safeguarding named midwife and local safeguarding policy activated and followed. The Department of Health (DfE 2020) provides further information on FGM for health care professionals available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/573782/FGM_Mandatory_Reporting_‐_procedural_information_nov16_FINAL.pdf.
The NIPE practitioner and maternity staff must be aware of their responsibilities in the safeguarding of children and adults. Lack of communication has been cited as a common and sadly repetitive failing of the 'Safeguarding Children' systems (The Victoria Climbié Inquiry Report) (House of Commons Health Committee 2003; CEMACH 2008; Haringey Local Safeguarding Children Board 2008; CQC 2009; NPSA 2009). Further information on safeguarding children can be found at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779401/Working_Together_to_Safeguard‐Children.pdf.
Parental dialogue and involvement with the newborn assessment process
Women and their partners may already have concerns about their newborn at the start of the examination. These concerns may have a physical or behavioural focus. The history‐taking process must include discussion with the parents, if present, prior to commencing the examination, and they must be invited to share those concerns. Some of these concerns may be delayed until the examination is completed. The dialogue regarding family history or worries demonstrates a collaborative approach to the examination, and many parents welcome the opportunity to engage with this aspect of their newborn’s care. The history‐taking interview for some parents can be therapeutic because they have a staff member who is more than willing to listen. If the mother or father was adopted, then gaining a thorough family history will be problematic; therefore, a sensitive approach will be required.
The involvement of the parents in such conversations will not only engage them with the examination but also engender an early sense of responsibility for their newborn. Blake (2008) advocates the empowerment of women to examine their newborns, thereby making an active contribution to the assessment of the neonate. This level of participation can enhance the women‐centered care experience for many mothers as well as helping to lessen the incidence of abnormalities that are missed at the newborn examination. Many women and their partners examine their newborn in detail and can often be the authority on many aspects of their newborn's external appearance and behaviour.
The culture within maternity care services requires implementation of the concept by Blake (2008) from a health promotion perspective. In the first instance, a timeline exists within those initial stages of newborn care and surveillance where the parents must assume responsibility for the welfare of their newborn. Therefore, they must be advised of the signs of illness and indicators for concern prior to discharge. This could have the following advantages:
Possible earlier detection of CHD in the postnatal period.
Probable earlier recognition of illness and a medical review by the general practitioner sought more promptly.
Potential to prevent SIDS in infants with subtle symptoms of illness.
Currently, maternity services facilitate early and very early discharge options for mothers and newborns, therefore parental awareness of the signs of illness and points of contact must be reprioritised within the health promotion agenda for the newborn examination.
Parental concern arises during the examination in relation to the cosmetic aspects of any minor findings and is often of great significance to them. The practitioner must be able to recognise what is a minor variant in comparison to possible clinical dysmorphology. There are some physical findings that may be a familial trait, e.g. syndactyly or polydactyly. See Table 1.7 for a list of common parental concerns found at the newborn examination. The practitioner must keep an open mind to the possibility of 'subtle' dysmorphic findings indicating a possible syndrome in the presence of other abnormal clinical features. There may be a contextual basis for this result, e.g. familial; therefore, examiners must assess the complete prenatal and postnatal history before seeking a senior paediatric option or expert review.
Interpretation of the information
Aside from the psychosocial skills of history taking, the ability of the examiner to interpret the information being given in a relevant way is just as significant. The history profile is only as good as the facts that are given and acknowledged as pertinent. The parents of the newborn may not recognise the significance of the questions being asked specific to family history. Some may be unaware of intergenerational traits within the family or of its significance to the newborn. Romitti (2007) commented on the accuracy of reporting family history by relatives. Interestingly, some mothers did not always disclose that they had a previous child with a birth defect; also the nature of the defect was not always accurately named. Socio‐demographic variables did influence the accuracy of detail given. However, factual details from the family are often confounded by their own understanding of the condition and their description of the condition or defect when medical terminology is not used. Indeed, they may not be clear on the exact position of the affected member in the family tree. It is not uncommon for a mother or father to contact other family members at the time of the newborn examination to obtain more information about conditions within the family.
TABLE 1.7 Common parental concerns at the newborn examination.
| Syndactyly |
| Polydactyly |
| Feeding issues, e.g. vomiting |
| Mild talipes previously undiagnosed on ultrasound scan |
| Tongue tie |
| Skin tags |
| Sinuses |
| Birthmarks |
| Pseudo‐menstruation |
| Moulding |
| Caput |
| Cephalohaematoma |
| Birth trauma markings |
| Intergenerational eczema, dermatitis and asthma |
| Intergeneration conditions and syndromes |
| Congenital abnormalities in first‐degree relatives |
As with many families who do have a positive trait for congenital anomalies or conditions, constructing the aetiology of the family from the environmental or genetic predisposition is often difficult. If a detailed family history is needed in the case of a positive intergenerational trait, then it may be desirable for the examination to be conducted by a senior paediatrician.