Newborn examination — focused newborn check OSCE

Objectives

1. Perform a systematic head-to-toe newborn examination in a logical order, with the hips last. [19]
2. Complete the four universal screens and interpret an abnormal pulse-oximetry result. [1]
3. Communicate findings, the next steps, and a safety-net clearly to the parent. [1] [19]

Candidate brief

Eight-to-ten-minute station. You are asked to examine a 26-hour-old term newborn and to discuss your findings and the screening programme with the parent, who is watching at the bedside. During the station you are told the pulse-oximetry reading: right hand 96%, foot 88%. There are no antenatal concerns and the pregnancy was uncomplicated. [1] [19]

Expected actions

• Wash hands, warm hands, and introduce yourself to the parent. [19]
• Observe the baby first: colour, tone, posture, and any dysmorphism. [19]
• Examine head-to-toe: fontanelles, eyes with red reflex, ears, palate (visualise the posterior shelf), chest and heart with femoral pulses, abdomen, genitalia and anus, then hips (Barlow and Ortolani), spine and skin. [5] [11] [19]
• State the pulse-oximetry result and interpret it as a positive screen. [1]
• Explain to the parent in plain language that the oxygen reading is low, that it needs repeating and a heart check, and that a specialist review and a heart ultrasound will be arranged. [1] [2]
• Provide a written safety-net for poor feeding, colour change, breathing difficulty, or fever. [19]

Marking

Pass: systematic, warm examination with hips last; correct interpretation of the abnormal pulse oximetry; clear escalation plan (repeat, echocardiography, cardiology; prostaglandins if unwell); plain-language explanation and a safety-net. [1] [2] [19]

Fail: omitting the red reflex or hip examination; accepting the abnormal saturation as normal; failing to escalate or arrange echocardiography; no safety-net; dismissive or jargon-laden communication. [1] [11]

Model synthesis

The newborn examination is a systematic head-to-toe assessment with the four universal screens woven through it. An abnormal pulse-oximetry reading (foot under 90 per cent) is a positive screen that requires repeat, clinical assessment, echocardiography, and cardiology referral — with prostaglandins if the baby is unwell or duct-dependent disease is suspected. Every abnormal finding is communicated in plain language with a clear next step and a written safety-net. [1] [2] [19]