Assessment and development

Newborn examination

Overview and approach

The newborn check identifies congenital abnormalities and supports feeding, growth and family care.

  • In Australia every newborn should have a full physical examination within 48 hours and before discharge, with follow-up in the first week and at 6-8 weeks (1)(2).
Assessment and clinical features

Review antenatal/delivery history, gestation, adaptation, feeding, urine/stools and parental concerns.

  • Review antenatal and delivery history, gestation, adaptation, feeding, urine and stools, and parental concerns.
Differentials and investigations

Examine general appearance, heart and femoral pulses, red reflex, hips, palate, abdomen, spine and genitalia; interpret weight and jaundice by age.

  • Examine general appearance, heart and femoral pulses, red reflex, hips, palate, abdomen, spine and genitalia; interpret weight and jaundice by age.
  • Pulse oximetry screening for critical congenital heart disease is ideally around 24 hours: 95% or more in the right hand and a foot with a difference of 3% or less is normal; below 90% needs urgent review (3).
Management and follow-up

Explain findings, support feeding and arrange newborn screening and follow-up. Hip manoeuvres require appropriate training.

  • Explain findings, support feeding, and arrange newborn bloodspot screening (generally 48-72 hours) and hearing screening (2)(4).
  • Hip manoeuvres require appropriate training.
Red flags and clinical pearls

Cyanosis, absent femoral pulses, abnormal red reflex, bilious vomiting or poor feeding with lethargy requires prompt escalation.

  • Also escalate for abdominal distension, no urine or meconium, ambiguous genitalia, respiratory distress, abnormal hip findings or dysmorphic features (1)(2).
References
  1. Queensland Health. Routine newborn assessment, Maternity and Neonatal Clinical Guideline: https://www.readkong.com/page/routine-newborn-assessment-maternity-and-neonatal-8421478
  2. Ausmed. Examination of the newborn: https://www.ausmed.com/learn/articles/examination-of-the-newborn
  3. CAHS WA. Pulse oximetry screening to detect critical congenital heart disease: https://www.cahs.health.wa.gov.au/~/media/HSPs/CAHS/Documents/Health-Professionals/Neonatology-guidelines/Pulse-Oximetry-Screening-to-Detect-Critical-Congenital-Heart-Disease-CHD.pdf
  4. RACGP. Preventive activities in childhood: https://www.racgp.org.au/wip-sites/preventive-activities-in-general-practice/development-and-behaviour/childhood-development

Last updated from Sen’s notes on 9 October 2026.