Assessing the abdomen and back

Our assessment moves to the abdomen and back. You will again require your stethoscope and powers of observation.

First, observe the baby at rest. Assess the abdomen visually for shape and symmetry. It should be gently rounded and symmetrical (Kain & Mannix, 2018). The abdomen of a full-term infant is generally ‘plump’. In other words, it should not be scaphoid (concave).

Assessing the umbilicus

The umbilical cord should be fleshy, not withered. A thin, withered umbilical cord is indicative of intrauterine growth restriction. You should also be able to see three blood vessels. These are made up of two umbilical arteries that wrap around a central umbilical vein.

The umbilicus itself should be clean, and any evidence of discharge or inflammation should be documented and reported (Queensland Health Guideline, 2014). A cord that is yellow stained indicates the baby has passed meconium (first faeces) in utero and may be compromised at birth (Kain & Mannix, 2018).

By gently palpating around the umbilicus, the presence of an umbilical hernia can be checked for. Umbilical hernias are quite common in newborn babies (Kain & Mannix, 2018). If present, it will look like a protruding ‘belly button’ and be more obvious when the baby cries.

Other than keeping the cord clean and dry, other care (such as swabbing with alcohol) is not necessary (Kain & Mannix, 2018).

The next step is to listen to the abdomen with a stethoscope. Bowel sounds will be absent at birth, however they should be present within 15 minutes after the baby has cried and suckled at the breast.

What’s palpable and what’s not?

In the normal newborn, the liver should be palpable. You can locate it approximately one finger below the ribs on the right-hand side of the abdomen (right upper quadrant). The spleen may be palpable just above the stomach in the left hand upper quadrant of the abdomen. The bladder however, should not be palpable above the pubis (Kain & Mannix, 2018).

A note of caution!

Palpating (examining by touch) any area of the newborn can be dangerous in inexperienced hands. Take care and remember palpation should not be uncomfortable for the newborn. If there is tenderness and the baby shows signs of distress or pain, this should be reported and documented.

Examining the back

Turning the baby gently over, inspect the spinal column. Check the scapulae (shoulder blades) and buttocks for symmetry. The skin should be intact along the length of the spine. If you note any non-intact skin, tufts of hair or dimpling along the spine – this should be documented and reported. It may indicate a spinal cord defect (Queensland Health Guideline, 2014).

Your task

After watching both the instructional videos, post your questions and thoughts about assessing the newborn’s abdomen, using the comments link below.

References

Kain, V. & Mannix, T. (2018). Neonatal Nursing in Australia and New Zealand, 1st Edition. Australia: Elsevier

Queensland Clinical Guideline (2014). Routine newborn assessment.