Early Neonatal Care & Physiological Changes (W/S 12&13) Flashcards
Prior to conducting a cephalocaudal examination ensure:
- Parental explanation and consent
- Wash and glove hands
- Ensure adequate lighting
- Check the baby is warm
Cephalocaudal examination - skin
- Colour
- Skin integrity
- Rashes
- Birthmark
- Bruising
- Swelling
Cephalocaudal examination - head and face
- Shape and symmetry
- Suture lines and fontanelles
Are they of normal size and appearance?
Posterior fontanelle often appears closed at birth due to the moulding. The anterior fontanelle should be palpated. - Signs of moulding and caput succedaneum, trauma
- Head circumference
- Eyes: size, shape and any slanting, ?cataracts, ?discharge, pupils; round
- Nose: may be squashed, ?nasal flaring (resp distress)
- Mouth: asymmetry could be indicative of facial palsy, ?cleft
- Palate: ?cleft, ? Epstein’s pearls (white or yellow tinted bumps/spots on gum line / roof of mouth, cyst, OK) or teeth, length of the frenulum
- Ears: correct positioning (trace an imaginary line from the outer canthus of the eyes horizontally back to the ears; the top of the pinna should be above this line). Patency of external auditory meatus, ?accessory skin
- Neck: ?swelling (e.g. sternomastoid tumour), tags, folds of skin.
- Hair
- Bruising / abrasions
Cephalocaudal examination - chest
- Movement with respiratory, recession, shape, symmetry
- Accessory nipples? Breasts may appear enlarged; this is normal and of little significance unless there are signs of infection.
- Heart rate, rhythm and sounds
- Colour
- RR
- Signs of respiratory distress
- Nipples and breast tissue
Cephalocaudal examination - abdomen
- Shape, colour and size. Rounded and soft?
- Umbilicus
- Umbilical clamp secure
- Number of cord vessels
- Presence of obvious masses
- Bowel sounds
Cephalocaudal examination - genitalia / anus
- Passage of urine
- Males
Penis, foreskin, testes (descended?), urethral meatus (central?) - Females
Vaginal and urethral orifice
Presence of clitoris
Vaginal discharge - normal - Anus
Anal patency - contraction on palpation
Passage of meconium
Cephalocaudal examination - musculoskeletal
- Arms/Hands/Digits: same length, moving freely; number of digits, polydactyly (extra) or syndactyly (webbed), palmar creases
- Legs/Feet/Digits: symmetry, size, shape and posture. Position of the feet in relation to the legs, shape of the feet should be noted, including oedema or a ‘rocker bottom’ appearance, number of toes, polydactyly (extra digits), syndactyly (webbed). Talipes?
- Neck and spine: dimples, malformations. ?spina bifida, any swelling, dimpling or hairy patches; these could indicate an abnormality of the spinal cord or vertebral
column. Assess the curvature of the vertebral column by running the fingers lightly over the spine. Gently part the cleft of the buttocks, look for any dimples or sinuses and confirm the presence of the anal sphincter. - Hips - dislocated or unstable? Barlow’s test or Ortolani’s test.
- Clavicles: ?intact (particularly if there was a
breech presentation or shoulder dystocia)
Cephalocaudal examination - neurological
- Muscle tone, posture, movements
- Test neurological reflexes
Moro - startle reflex, clap hands, “drop and catch”
Grasp - grasp finger
Rooting
Suck
Stepping
Traction Response - pulled by the arms from a lying to a sitting position, the head lags at first. The baby then flexes, lifting the head to the midline of the rest of the body before it falls forward.
Babinski - toes splay out when bottom of foot touched
Cephalocaudal examination - completion
- Record weight, length and head circumference
- Temperature: per axilla 36.5-37.3 C
- HR and sounds: listen for a softer quality to one of the sounds, or an extra sound. 110-160 bpm
- RR 40-60bpm
- Document findings
- Offer skin to skin contact
- Advise parents of findings
- Notify paed if any abnormalities detected
What are the 4 ways heat can be lost in the neonate?
Through:
- Evaporation
- Radiation
- Convection
- Conduction
Describe evaporative heat loss in the neonate and how to reduce/prevent it.
Heat loss occurs through evaporation of water from the skin and respiratory tract, (and is highest immediately following delivery and bathing).
Heat loss can be reduced if:
– the baby’s head is dried after birth and following a bath
– a hat is put on the baby
– wet towels are removed quickly following birth
– the bath is delayed until the baby’s temperature is stable and above 36.8°C.
Describe convection heat loss in the neonate and how to reduce/prevent it.
(Current) Heat is lost to moving air or fluid around the neonate. The amount of heat lost depends on the difference between the skin and air or fluid temperature, the amount of body surface exposed to the environment, and the speed of air or fluid movement.
Heat loss can be prevented by:
- increasing the birthing room temperature
- keeping room temperature above 25C when the baby is naked
- covering the baby with a blanket.
Describe radiation heat loss in the neonate and how to reduce/prevent it.
Heat is radiated from the skin to surrounding colder solid objects such as windows or incubator walls. This
is the predominant mode of heat loss after the first week of life in babies born before 28 weeks and in all other babies throughout the neonatal period.
Heat loss can be prevented by keeping the baby
away from windows, draughts and cold solid objects.
Describe conduction heat loss in the neonate and how to reduce/prevent it.
Babies conduct heat to cold objects they come into contact with such as a cold mattress, scales and radiograph plates.
Heat loss can be prevented by:
- warming the resuscitaire and bedding
- covering the scale with a sheet or blanket prior to weighing the baby
Cold stress may cause _________ and unless rectified will lead to ___________________________.
jitteriness and unless rectified will lead to hypothermia, hypoglycaemia, hypoxia, acidosis, lethargy and eventually death.
Feeding is essential to help prevent hypothermia
