Neonatal Assessment Flashcards
What are the goals of a newborn baby assessment?
- Identify physical abnormalities
- Parental re-assurance
- Health education
What are the components of a newborn baby assessment?
- Hx (antenatal, labor, medications of mother)
- Obs
- Measurements for growth tracking (%iles)
- Physical exam
Why do we check for the red reflex in babies?
- Red reflex is caused by reflection of light off the blood-vessel rich retina of the eye
- If this reflex is absent, this means something’s blocking it (e.g. cataracts), or the vessels in the retina itself are abnormal (e.g. retinoblastoma)
What physical exam signs do we check for in a newborn baby assessment? (Of course, we assess other stuff too, but these are the non-inspection stuff)
- Special senses (vision/hearing (why?), red reflex (why?))
- Hips (check for dysplasia)
- Peripheral O2 sat
- Primitive reflexes
What do we check for during general inspeciton on baby exam?
- Colour (jaundice/cyanosis)
- Is it making any spontaneous movements on its own?
- Behaviour (are they unsettled?)
- Plot growth (weight, head circ, height)
What do we check for when assessing baby head shape? What are abnormal signs?
- Check for normal sings (caput, molding)
- Abnormal signs include microcephaly, macrocephaly (?hydrocephalus), cephalohematoma, plagiocephaly, scaphoceaphly (boat-head)
What is abnormal when assessing a baby’s fontanelles?
- Bulging/sunken
- Very small/large
- Immobile sutures
Outline the exam of the newborn baby’s face
- Any dysmorphism?
- Eyes (position + red reflex)
- Ears (tags/pits)
- Mouth (symmetry when crying (?__ nerve palsy), cleft palate (can be sign of genetic predisp to hearing loss)
- Vision (fixing and following light)
- Hearing (reacts to sounds)
What do we check for on a baby’s neck?
- Masses
- Webbed neck (?turners)
- Range of motion
Baby exam thorax
- Breath sounds normal?
- Chest wall expansion?
- Any heart murmurs?
- Shape/symmetry
Baby exam abdo
- Shape (distension, masses)
- Tenderness
- Soft/tense
- Overlying skin changes
- Defect in abdo wall (such as omphalocele)
Baby exam limbs
- Equal length?
- ROM?
- Number of fingers and toes
- Creases (?genetic conditions)
- Complete nails/bones
Baby pelvis/genitalia exam
- Creases symmetrical?
- Inguinal masses?
- Femoral pulses palpable?
- In boys, check for hypo/edpispadias (WIT?)
- Descended testes
- Position/patency of anus (?meconium)
Baby back/spine exam
- Check for scoliosis
- Check for dimple/hair growth (?spina bifida)
Hip dysplasia risk factors
- First born
- Female
- FHx
- Breech
Why is it important to screen for certain conditions in newborn babies (bloodspot test)?
Early detection can help reduce the chances of developing long term physical/neurodevelopmental disability.
What are the requirements before a heel prick test can be taken? What happens during the test?
- Performed at 48-72hrs age
- Baby must have established feeds (if pre-term, multiple are done)
- During test, heel is pricked, and blood is spotted onto 4 areas of the test card
What conditions are screened for on the heel prick?
- Metabolic disorders (amino acid disorders, fatty acid oxidation disorders, organic acid disorders)
- Endocrine disorders (CAH [21-dehydroxylase deficiency [WIT?], primary congenital hypothyroidism)
- Severe combined immunodeficiency (SCID)
- Other (CF, Spinal Muscular Atrophy)
Is the heel-prick the only screening that occurs during early life?
- No
- Also peripheral O2 sats, and hearing tests, and newborn baby examination
What treatments do we give to babies right at the time of birth? Why?
- Delayed cord clamping (why?)
- Vitamin K (why?)
- Thermo-neutral environment (reduce hypothermia risk)
- Blue light therapy
- Nutritional supplementation (pre-term formula/fortification of breast milk)
- Probiotics (to reduce risk of necrotizing enterocolitis)
- Caffeine (reduce apnea/increase resp rate; increased diaphragm contractility + increased resp drive)
- Exogenous surfactant
What is haemorrhagic disease of the newborn/vitamin k deficiency bleeding? Why does it occur? How to prevent?
- Vitamin K poorly crosses the placenta; babies may not be able to make enough clotting factors
- The first week of life, this can lead to internal bleeding such as gastrointestinal bleeding. Later (up to 6 months), this can lead to serious intracranial haemorrhage
- We prevent this with vitamin K injections
Why do we put jaundiced babies in sunglasses under blue lights?
- Blue light of specific wavelengths converts bilirubin into its water soluble form, enabling excretion
- This bypasses the need for bilirubin conjugation
