Skip to 0 minutes and 7 secondsJust looking at the normal newborn, you would expect that looking at the chest and the abdomen that it's roughly bell-shaped. So your term baby has quite a fat little tummy, and of course, that's where the bulk of the breathing is because they're abdominal breathers. So they do have little pot bellies, and that's quite normal. What we don't want to see is what we call a scaphoid abdomen where it's actually depressed because then you're thinking where is the contents of the abdomen, OK? And sometimes they can move up through the diaphragm through a hernia and cause a lot of problems. So we actually want them to have a nice plump little tummy there.
Skip to 0 minutes and 43 secondsWhen we look at the abdomen, we divide it into four quadrants. So we use the umbilicus-- the belly button-- as the midline and sort of have this quarter here, and we're looking at the left upper quadrant, the left lower quadrant, the right upper quadrant, and the right lower quadrant. OK. So that's how we divide it up when we're looking at it. So we're just inspecting to start with because, of course, that is the least invasive. And I'm looking at the umbilicus. So this newborn here hasn't got an umbilicus for us to look at actually on this little baby. But what we're looking for is a nice, plump, umbilical cord.
Skip to 1 minute and 22 secondsIt will have a cord clamp on it, and it will be white or bluish colour, and that's called Wharton's jelly. And then what you will be able to see are the vessels running along the middle. So those vessels are two arteries that wrap around a large, central vein. So that's the umbilicus that is going to attach to the placenta inside the mother. So we should be able to see those vessels. And as it's cut off from the mother, we can clearly see those three vessels sitting on top of the umbilical stump. What we don't want to see is any discharge around it. We don't want it to be really thin.
Skip to 2 minutes and 5 secondsSo in babies who, for whatever reason, have been growth restricted in utero, the cord can actually be quite thin and withered. So we want it to be quite healthy and plump. We also don't want to see that it's stained with meconium-- so it's stained a yellow colour-- meaning the baby-- there's been meconium, it's passed meconium in utero, because the baby's been under stress during delivery. So it needs to be nice and clean looking as well. There used to be a time when we used to put alcohol on the stump and put other things on it. None of these things are necessary. You just need to keep it clean and dry.
Skip to 2 minutes and 41 secondsAnd after a few days, it will actually start to wither away and just drop off by itself naturally. We also gently palpate or feel around the umbilical stump to make sure that there's not a hernia there as well-- so a hernia being an outpouching of the intestines. And this can be easily repaired. And it does happen in some babies, and we call this an inguinal hernia. So just lightly palpating and making sure that there's no outpouching of the intestine around there.
Skip to 3 minutes and 16 secondsWhen we're palpating a baby's abdomen-- and I must say here-- it's very important that the person doing that palpation is very skilled because you can cause a lot of damage to the underlying organs if you're not sure what you're doing. So it's very important that this is left in expert hands. But just let me show you what the anatomical landmarks are when we're actually palpating the abdomen. So over here on the right side, just below the rib cage, is the liver. In a term baby, the liver would be palpable, or we'll be able to feel that, around about two centimetres under the bottom of the rib cage. And that is quite normal.
Skip to 3 minutes and 56 secondsOver on the left, we have the stomach, and we have the spleen that sits on top of the stomach and may also be slightly palpable under the rib cage-- the spleen being a very important organ in the lymphatic system. The bladder sits just above the symphysis pubis, or the top of the pelvis here. It should not be palpable. In fact-- and you can see here I've got the nappy sort of strategically placed over the baby's genitalia here-- because when you do palpate this area, they tend to urinate. So, this is my safety here. So that shouldn't be palpable. To palpate the kidneys, retroperitoneal over here, and you do have to palpate fairly deeply.
Skip to 4 minutes and 44 secondsSo you can see how you could cause damage to the underlying organs if you're not exactly sure what you're doing in terms of palpation.
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).
This is an additional video, hosted on YouTube.
After watching both the instructional videos, post your questions and thoughts about assessing the newborn’s abdomen, using the comments link below.
Kain, V. & Mannix, T. (2018). Neonatal Nursing in Australia and New Zealand, 1st Edition. Australia: Elsevier
Queensland Clinical Guideline (2014). Routine newborn assessment.
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