Clinical/Comm Skills - Week 5 - Neonatal Newborn Examination

Question 1

Neonatal examination When does the neonatal examination generally take place?

Answer 1

The neonatal examination generally takes place within 72 hours of birth but usually by 24 hours

Question 2

When introducing yourself and gaining consent, what questions should be asked?

Answer 2

Simply the ask the parent about the pregnancy - apropprioate amount of scans or any emergency, ask about the type of delivery, and ask about any family history of disease

Question 3

The examination is a top to toe examination so it makes sense to start with the head What is the first thing done in the examiantion?

Answer 3

Important to have a look at the baby - look at resting tone and colour

Question 4

What is the first thing palpated? How can you tell if there may be an infection or if the baby is dehydrated?

Answer 4

Palpate the fontanelles - anterior and posterior Feel along the sagittal suture from anterior to posterior fontanelle

Question 5

After palpating the foentanelles, what is looked for on the face and the eyes? What measurement is taken?

Answer 5

Look at the face for symmetry Look at the eyes and check the Red Reflex using the ophthalmoscope - looks for congenital cataracts Also assess for coloboma Look for any low set ears or malformed ears (also tags or pits) Then measure the OFC (occipito frontal head circumference) - 3 measurements are taken for consistency

Question 6

After palpating fontanelles, looking at eyes and face and measuring OFC The nose and mouth is looked at What is looked for here?

Answer 6

Nose - check nose position and look for spetum Mouth - very gently open the mouth Look inside using torch for the - visualise gumline and tongue and Look at palate using wooden spatula to depress tongue - assess for no evidence of hard or soft palate cleft Also palpate the palate - checking sucking reflex and gagging reflex using a clean finger Assess for choanal atresia in the mouth

Question 7

What is choanal atresia?

Answer 7

Choanal atresia is when the back of the nasal passage is blocked due to a failure to connect with the nasopharynx

Question 8

When undressing the baby - look to see how it responds - try not to distress baby - assess the babies tone and check all four limbs are mving and assess skin What is looked for on the arms?

Answer 8

Check arm length, axillae rashes, grasp reflex in both hands and count fingers Also count palmar creases

Question 9

Next the heart sounds are listened to What are the areas of the heart that are listened to?

Answer 9

Listen to all areas of the heart with bell and diaphargm of stethoscope The aortic area - right sternal edge 2nd intercostal space The pulmonary area - left sternal edge 2nd intercostal space The tricuspid area - left sternal edge 4th intercostal space Mitral (bicuspid) area - 5th intercostal space mid clavicular line Mid-scapular area listened to when baby on front later on

Question 10

What is done for respiration assessment?

Answer 10

Watch respiratory pattern and rate for a few seconds -no signs of sternal recession , grunting, nose flaring tachypnoea Listen to both lung fields to assess good bilateral air entry

Question 11

After listening to the heart and lungs, time to assess abdomen What is carried out here?

Answer 11

Look at umbilical area for signs of infection and observe if any abomdenal distension Gently palpate all 4 quadrants using three fingers for lumps and hardness - superficial and deep palpation Use fingers in loin area to feel for two kidneys also

Question 12

What is looked for in the genital area in the neonatal examination?

Answer 12

Feel femoral pulses and if they are equal - coarctation of the aorta Check genital area - two testis in males and normal penis (no signs of hypospadius) (the testis may be hidden ininguinal canal if cold remember) Female - vagina urethra and clitoris and pseudomenstruation - this is due to the hormones from the mother crossing the placenta

Question 13

What is the anus assessed for?

Answer 13

Assess the anus for patency and position

Question 14

So head has been examined, so has arms, heart, lungs, abdomen, genitals Next is moving on to the legs What is assessed in the legs?

Answer 14

The legs should be able to open like a book (nicely abducted) Look for groin creases - should be symmetrical Look at leg length - pull legs gently down Bend knees to check equal knee height Also assess feet for talipes and count toes and examine plantar reflexes

Question 15

After looking at the legs, examine the hips What are the two tests carried and how are they carried out?

Answer 15

Barlow - adduct the hip and push leg posteriorlyto try and displace the femoral head Ortalani - abduct the hip and push anteriorly to move femoral head back into place These look for developmental dysplasia of the hip

Question 16

Where is finger placement on the hips during the Barlow an ortalni procedure?

Answer 16

Stabilise the pelvic using the non procedure hand - place the middle finger of the other hand on the greater trochanter of the femur - this finger is what pushes the femur back into the acetabulum in ortalanis

Question 17

After assessing the babies hips, what reflex is done when turning the baby over? important to reassure the parents about what you are going to do

Answer 17

Assess the babies Moro reflex - baby should abduct arms before adduting and then crying

Question 18

When the baby is on his tummy what is assessed?

Answer 18

Look at the back of the head for any birthmarks, look all the way down the spin - usually babies have a sacral dimple Also check spine alignment and look for any tufts of hair assess the mid-scapula area here for coaraction of the aorta

Question 19

What primitive reflexes are assessed in the neonatal examination? Name two other primitive reflexes?

Answer 19

Sucking and gagging (optional) reflex Palmar reflex Plantar reflex - present due to the neonate having low myelination the corticospinal tracts - sign of an UMN lesions in adults Moro/startle reflex Asymmetrical tonic neck reflex Walking/stepping reflex

Question 20

What are the four important points to remember about the neonatal examination of the newborn?

Answer 20

Examination of the Red reflex of the eyes Careful examination of palate including visualisation Palpate femoral pulses (and listening to mid-scapular area) - coarctation of the aorta Thorough examination of the hips