The purpose of this assignment is to explore the issue surrounding screening and examination of the new born from birth. The article will look at why we perform this examination following birth and will pay particular attention to the examination of the eye. It is documented that the purpose of the first examination of the new born is to confirm normality and to provide reassurance to the parents (MacKeith, 1995, Hall, 1999) and also to identify any apparent physical abnormality (Buston and Durward 2001). However the question that we may wish to consider is ‘what is normal in a neonatal who is undergoing major physiological adaptations to extra uterine life (Blackburn and Loper, 1993) ? How as midwives can we fulfil this expectation of norm, when there is, as Hall (1999) suggests no confirmation of normality available ? Nevertheless a thorough search of the literature suggests that the neonatal examination is universally accepted as ‘good practice’, and any deviation from this practice could perhaps, potentiate negligence when subjected to the Bolam test (Sherratt, A, 2001). This test is often used as a benchmark to measure any negligence by, and examines if another professional of same standing would act in the same manner. This area will be explored in more detail later in the essay, when looking at the legal and ethical aspects of the new born examination firstly I would like to examine what is the examination of the new born, why we should do it and who us best placed to undertake the procedure ? The examination forms part of a range of post delivery screening opportunities, which include; * A midwife check immediately after birth
* Neonatal blood spot test
* Hearing test
* Eight week physical examination, usually performed by a GP. It could also be argued that it is an extension of antenatal screening tests from the beginning of the pregnancy when the mother is offered various scans and blood tests to try to ensure a safe outcome of the pregnancy. NICE (2006) outlines the content of the neonatal examination regardless of who the practitioner may be undertaking the examination. In essence this is a top to toe physical examination of the baby that involves auscultation of the heart and lungs , palpation of the abdomen and assessment of the hips, a detailed examination of the eye and assessment of the genitalia and anus. As the content of the examination is quite extensive this has been included in the index of the article for further reference. NIPE (2008) in their standards and competences document suggest that “parents should be offered information antenatally at around 28 weeks both in written and verbally and this should be repeated prior to the new born examination being offered. The information should cover the rationals for the new born physical examination as well as its limitations. The assessment of the new born being a continuing process with the parents continuing to assess their baby once they have taken it home. Therefore the examination provides a valuable opportunity to promote health and provide parents with knowledge about what to expect from their baby (Townsend et al, 2004) (Walker, 1999). The NSC (2004) increasingly presents screening as a ‘risk reduction’ and states that ‘it is not a fool proof process.’ In other words it can reduce the risk of developing a condition/complications, but it is unable to offer an absolute guarantee. Knowles et al (2005) in systematic review of the literature regarding detection and outcomes of children with congenital heart defects, shared that only half were detected. However, often screening methods such as the use of pulse oximeter may improve this (Mahle et al 2009). The examination of the new born also offers an opportunity to detect congenitally displaced hips. Gerscovich (1997) tells us that “early detection leads to early treatment, which results in complete resolution in most cases.” The current strategy being to screen all neonates using the...
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