Initial Examination of the Newborn Flashcards
What is the APGAR score, and what does APGAR stand for?
The APGAR score was designed to assess the newborn's condition and need for resuscitation. It stands for: A - Activity P - Pulse G - Grimace (reflex irritability) A - Appearance (colour) R - Respiration
When is the APGAR score measured?
1 minute and 5 minutes after birth - NICE
What is vernix?
A ‘bio-film’ layer consisting of anti-microbial proteins and fatty acids. Provides a layer of protection.
What is the purpose of the ‘top to toe’ check?
- To screen for congenital abnormalities that will benefit from early intervention
- To make referrals for further tests or treatment as appropriate
- To provide reassurance to the parents
When conducting the top to toe check, what are you looking for when examining the head?
Shape (Excessive moulding?) Size Symmetry to the rest of the body Bruises/trauma (particularly in assisted delivery) Fontanelles
32-36cm for a full term infant
When conducting the top to toe check, what are you looking for when examining the neck and clavicles?
Neck - Movement/shape/weakness
Clavicles - Inability to move arms/irritability/symmetry/pain
When conducting the top to toe check, what are you looking for when examining the face, eyes and mouth?
Mouth - tongue tie, lips and palate (formed correctly?), sucking reflex, teeth, signs of thrush (redness, white spots or white coating)
Eyes - symmetry, stickiness, redness, discharge, swelling, cataracts, haemorrhages
Face - symmetry, any deformities or abnormalities
When does the top to toe check take place?
First 72 hours after birth
When conducting the top to toe check, what are you looking for when examining the cord and abdomen/chest?
Chest - symmetrical, two nipples
Cord - Intact, knots, clamped (unless lotus birth)
When conducting the top to toe check, what are you looking for when examining the spine?
Curvature (scoliosis)
Gaps in vertabrae, fat pads, dense tufts of hair, birth marks (spina bifida)
Ensure sacral dimple is skin lined
When conducting the top to toe check, what are you looking for when examining the hands and feet?
Ensure there is 10 x fingers and 10 x toes
Single palmer crease (sign of downs syndrome),
Clubbed foot
Polydactyly (deformity)
Syndactyly (webbing)
When conducting the top to toe check, what are you looking for when examining the genitals?
Check sex of baby
Check boys testicles have descended into the scrotum
Ensure urethra is open and in proper place
Vaginal skin tags
When conducting the top to toe check, what are you looking for when examining the anus and stool?
Ensure anus is present
Ensure stool comes from the correct place
Document colour of stool
How many wet nappies should a newborn have in 24 hours?
4-6
What is the correct procedure for conducting a newborn check?
- Wash hands/don PPE
- Confirm infant’s name & DOB
- Obtain informed consent from parents
- Adequately expose infant for assessment (down to nappy)
- Encourage parent’s participation and questions
- Work from top to toe checking each feature
- Wash hands & document findings
Why do we offer an IM injection of vitamin K to newborns?
Babies do not get enough Vitamin K from their mothers during pregnancy, or when breastfeeding. Vitamin K decreases the risk of Vitamin K Deficiency Bleeding, also known as Haemorrhagic Disease of the Newborn.
What is jaundice and why is it so common?
Jaundice is caused by the (completely normal) build-up of bilirubin in the blood.
Jaundice is common in newborn babies because babies have a high number of red blood cells in their blood, which are broken down and replaced frequently.
Also, a newborn baby’s liver is not fully developed, so it’s less effective at removing the bilirubin from the blood.
Why do we treat babies with high levels of jaundice?
This is because there’s a small risk the bilirubin could pass into the brain and cause brain damage.
How many wet nappies should a newborn have in 24 hours?
4-6
What is the correct procedure for conducting a newborn check?
- Wash hands/don PPE
- Confirm infant’s name & DOB
- Obtain informed consent from parents
- Adequately expose infant for assessment (down to nappy)
- Encourage parent’s participation and questions
- Work from top to toe checking each feature
- Wash hands, document findings & discuss findings with the parents
Why do we offer an IM injection of vitamin K to newborns?
Babies do not get enough Vitamin K from their mothers during pregnancy, or when breastfeeding. Vitamin K decreases the risk of Vitamin K Deficiency Bleeding, also known as Haemorrhagic Disease of the Newborn.
What is jaundice and why is it so common?
Jaundice is caused by the (completely normal) build-up of bilirubin in the blood.
Jaundice is common in newborn babies because babies have a high number of red blood cells in their blood, which are broken down and replaced frequently.
Also, a newborn baby’s liver is not fully developed, so it’s less effective at removing the bilirubin from the blood.
Why do we treat babies with high levels of jaundice?
This is because there’s a small risk the bilirubin could pass into the brain and cause brain damage.
Why is it important to check a newborn’s weight?
Check for any deviations from the norm
Establish a baseline weight
Establish a growth chart to monitor health
What percentage of a babies weight can we expect them to lose in the first few days after birth?
Up to 10% of their total birth weight would be considered normal
When would we conduct a newborn blood spot test?
Day 5
Which conditions does the blood spot test screen for?
Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
6 Inherited metabolic diseases: phenylketonuria (PKU)
medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
