Transcript Baby Check Click to

Newborn Baby Examination
Ellie Duckworth
Stage 3 student, University of Cambridge School of Clinical Medicine
2nd May 2015
Newborn examination
• Newborn babies must be examined within 24 hours of birth
• Purpose of the examination:
• Detect congenital anomalies not already detected at birth
• Check for potential problems arising from maternal or familial disease
• Checked again at 6 weeks old (usually by GP)
Examination routine
• Usually described as examining ‘top to toe’
• In reality, adapt the order of examination to when the baby is settled
or crying:
• Auscultation first (before removing rest of clothing)
• Palate – more visible when the baby is crying, or feel with finger
• Sucking reflex – can also help to calm the baby down
• Leave most distressing parts until the end e.g. Moro reflex & hip examination
History
• Key points in taking a history from the mum:
• Pregnancy and mode of delivery
• Did they cry straight after birth? Any problems with breathing?
• Family history
• Congenital heart disease
• Hearing problems
• Hip dysplasia
• Has baby passed urine or meconium yet?
• Any problems with breast/bottle feeding?
General observations
• Undress down to the nappy
• Remember to look at the baby’s back as well
• Skin
• Colour
• Skin lesions
• Respiratory effort
• Spontaneous movements and posture – symmetrical?
• Dysmorphic features
Illustrated textbook of paediatrics (Lissauer)
Peripheral cyanosis
Milia
Illustrated textbook of paediatrics (Lissauer)
Mongolian
Blue spot
Erythema
toxicum
(neonatal
urticaria)
Illustrated textbook of paediatrics (Lissauer)
www.nursingcrib.com
Head
• Measure head circumference
• Fontanelle
• Tense
• Raised ICP
• Meningitis (late sign)
• Sunken
• Dehydration
• 3rd fontanelle
• Downs
• Check skull and facial bones for birth injuries
www.quickmedical.com
www.abclawcenters.com
Eyes
• Check red reflex with ophthalmoscope
• Lack of red reflex
www.kellogg.umich.edu
• Cataracts
• Retinoblastoma
• Ophthalmic infections
Retinoblastoma
Ears
www.gethelponline.org
• Shape and size
• ‘Low set’ ears
• Down’s
quizlet.com
• Edwards
• Di George
• Turners
• Noonan
Edwards Syndrome
• Patency of external auditory meatus
Di George Syndrome
www.mothering,.com
Mouth
www.clapa.com
High arched palate
• Colour of mucus membrane
• Palate
• High arched – Marfan’s
• Cleft lip/palate
newborns.stanford.edu
beyondspine.com
• Tongue tie
Cleft lip
• Sucking reflex
• Rooting reflex
Rooting reflex
Tongue tie
Arms & Hands
Simianline.handresearch.com
• Check neck, shoulders & clavicles for traction birth injury
• Count fingers
• Shape of fingers – clinodactyly
• Palmar creases – multiple or single
cai.md.chula.ac.th
• Grasp reflex
Single palmar crease
Clinodactyly
Erb’s Palsy
shoulderdystociainfo.com
Illustrated textbook of paediatrics (Lissauer)
Legs & Feet
wikipedia
• Watch movement of each joint
• Check for talipes equinovarus
• Count toes
hellomrdoctor.com
• Shape of toes
Talipes equinovarus
• Babinski reflex
• Grasp reflex
Babinski reflex
• Peripheral pulses
• Brachial, radial & femoral
• Radio-femoral delay
• Heart
• Apex beat
• Heaves or thrills
• Auscultation
• Lungs
• Watch respiratory pattern, rate and depth
• Grunting, head nodding, intercostal recession, stridor
• Auscultation
Abdomen
• Abdominal girth and shape
medscape.com
• Omphalocoele/gastroschisis
• Umbilical stump
• Infection (Omphalitis)
• Hernia
• Palpate for organs, masses or hernia
• normal to be able to feel liver and/or spleen in newborns
• External genitalia
• Undescended testes
• Inspect anus for patency
Omphalitis
www.cdc.gov
Exomphalos/Omphalocoele
www.cdc.gov
Gastroschisis
Back
• Check for skin lesions
• Palpate down the spine
• Looking for:
• Spina bifida occulta
• Pilonidal sinus
biology-forums.com
Reflexes
wikipedia
Moro reflex
Hips
Checking for
developmental
dysplasia of the
hip (DDH)
Illustrated textbook of paediatrics (Lissauer)
Guthrie test
www.mun.ca
• Blood sample (heel prick) taken on day 5-9 of life
• In UK, all infants screened for:
• Phenylketonuria
• Hypothyroidism
• Haemoglobinopathies
• Cystic fibrosis
• MCAD (medium-chain acyl-CoA dehydrogenase
• Others e.g. Maple syrup urine disease
namrata.co
Hearing screening
• Early detection and intervention of severe hearing impairment
• Prevents delay in speech and language development
• Evoked optoacoustic emission (EOEA)
• Earphone over the ear to emit sound
• The sound evokes an echo/emission from the ear if cochlear function is normal
• Automated auditory brainstem response (AABR)
• If normal test not achieved
• Uses computer analysis of EEG waveforms
www.homerton.nhs.uk
Vitamin K
• Vitamin K deficiency can cause haemorrhagic disease of the newborn
• Usually mild symptoms – bruising, haematemesis, melaena, prolonged bleeding
around umbilical stump
• Can be severe – intracranial haemorrhage
• IM injection of vitamin K given to most newborn infants in the UK immediately
after birth
• Parents can request oral vitamin K but this requires 3 doses over first month of life
to achieve adequate liver storage
Questions?