Clinical/Communication Flashcards
What are important history questions to ask in a newborn examination?
- Maternal - PMHx, pregnancy issues, drugs, infection risks
- Infant - fetal growth, fetal anomaly, delivery, resuscitation
What are the vital signs that need reviewed in a newborn examination and their relevant ranges?
- Heart rate 120-140/min
- RR 40-60/min
- Cap Refill 2-3 secs
- Work of breathing/respiratory effort
- SaO2 95%
- Others - jaundice, low tone (floppy), seizures, poor feeding, bilious vomit
What is involved in general inspection in the examination of a newborn?
- inspect colour - pallor, cyanosis, jaundice
- Assess overall appearance
- Assess general condition, proportions and maturity
- Look for asymmetry, palsy, or abnormality of facial characteristics
- Listen to cry and note sound
- Note weight and gestation of baby and position on growth chart
What should be examined on a baby’s head in a newborn examination?
- Shape of head, fontanelles, whether normal, sulken, or bulging
- Overlapping sutures
- Ventuouse/forceps marks
- Moulding
- Caput Succedaneum
- Cephalhaematoma
- Measure and record head circumference on the growth chart, take 3 measurements for accuracy
- Assess facial appearance and eye position
What is moulding in a newborn examination?
common after birth, resolves within a few days
What is caput succedaneum?
- diffuse subcutaneous fluid collection with poorly defined margins (often crossing suture lines) caused by pressure on the presenting part of the head during delivery
- Does not usually cause complications and resolves over the first few days
What is cephalhaematoma?
- subperiosteal haemorrhage which occurs in 1-2% of infants and may increase in size after birth
- The haemorrhage is bound by the periosteum, therefore, the swelling does not cross suture lines (in contrast to a caput succedaneum)
- Cephalhaematoma is more common with instrumental delivery
What should be noted on skin examination of the newborn?
- Note birthmarks, rashes, skin abnormalities
- Erythema toxicum
- Strawberry birthmarks
- Port wine stain
- Mongolian blue spots
What should be noted on eye examination of the newborn?
- Are they normal in shape and appearance?
- Check for ‘red reflex’
- Look for cataracts, coloboma, or signs of ophthalmic infection
What should be noted on ear examination of the newborn?
- Note size and shape of ears
- Normal or low set
- Check patency of external auditory meatus
- Check for family history of hearing defects
What should be noted on mouth examination of the newborn?
- Use tongue depressor to check colour of mucous membrane, observe palate form and fusion
- Check suckling reflex by inserting CLEAN little finger inside baby’s mouth, can also palpate the palate at this stage
- Observe for cholonal atresia
What should be noted on arms and hands examination of the newborn?
- Are hands moving normally, shape normal
- Look for evidence of traction birth injury (e.g. Erb’s palsy) by checking neck, shoulders, and clavicles
- Count fingers and observe shape and any deformities
- Check palmar creases
What should be noted on peripheral pulses of the newborn?
- Check brachial, radial and femoral pulses for rate, rhythm and volume
- A hyperdynamic pulse may suggest a patent ductus arteriosus
- A weak pulse may suggest a congenital cardiac abnormality, impairing cardiac output
What is checked on examination of the heart in the newborn?
- Check the cardiac position by palpation and feel for any thrill or heave
- Listen carefully to heart sounds and any added sounds and murmurs
- Suspected abnormalities require further examination and opinion
- Aortic: second right intercostal space
- Pulmonary: second left intercostal space at the left sternal border
- Tricuspid: left intercostal space at lower sternal border
- Mitral: left 5th intercostal space at midclavicular line (apex)
- Midscapular: posteriorly situated (coarction of aorta)
What should be checked on examination of the lungs in the newborn?
- Watch respiratory pattern, rate and depth for a few seconds
- Look for evidence of intercostal recession, nasal flaring and grunting
- Listen for stridor which could indicate airway obstruction
- Crackles may indicate underlying infection
- Auscultate both lung fields for added sounds
What should be checked in the abdomen on examination of the newborn?
- Observe abdominal girth and shape
- Carefully check the umbilical stump for signs of infection or hernia
- Palpate gently to feel for organs, masses, and herniae
- Note - it is normal to feel the liver and spleen in healthy babies
- Check external genitalia, look for hypospadias in boys
- Check labia, vaginal introitus, and warn to expect some spotting in girls
- Palpate for testes in boys
- Inspect anus and establish whether meconium has been passed
What should be checked on examination of the back and hips in a newborn?
- Inspect skin over back, at at spinal curvature, not symmetry
- Observe any evidence of spina bifida occulta or sinus hidden by flesh creases or dimples, and any hair tufts
- Palpate spine from neck to coccyx
- Specifically check for congenital dislocation of the hip (congenital hip dysplasia) using a combination of Barlow and Ortolani manoeuvres
- Observe groin creases for symmetry and leg length
What should be noted on examination of the legs of a newborn?
- Observe movements at each joint
- Check for evidence of talipes equinovarus
- Count toes and check for shape and normal gaps
What should be noted on examination of the central nervous system in a newborn?
- Observe tone, behaviour, movements and posture
- Elicit newborn reflexes if safe and appropriate
What are the further steps after a neonatal examination?
- Document findings of examination in postnatal care plan record and child health record
- Proforma of examination should be kept within the notes, to ensure nothing has been missed
- Routine neonatal screening is repeated at 6-8 weeks, this included visual fixation and social smiling
- Hearing screening is normally carried out by hearing screening technicians prior to discharge from hospital
