Neonatal Skeletal System

Question 1

What history do you need to look at before examining the neonatal skeletal system?

Answer 1

Family
Oligohydramnious: deficiency of amniotic fluid will affect the skeletal system from developing
Breech: increase risk of hip dysplasia
Ultrasound: short femur is a marker for downs syndrome
Birth:
Gestation: term babies have flexed limbs. Preterm do not

Question 2

What features do midwives examine?

Answer 2

Skull  
Clavicles
Upper limbs
Legs 
Spine
Hips

Question 3

What are we observing in the examination?

Answer 3

Symmetry of movement
Posture
Any sign of discomfort

Question 4

What is examined when observing the upper limbs?

Answer 4

Clavicle: fractures are undetected only can be detected by palpating. The clavicle will heal as another bone forms and a bump is formed.
Humerus
Radius and ulna
Arm length: the arm should be long enough for the baby to be able to touch their bum
Palm creases
Syndactyly: the condition of having some or all of the fingers or toes wholly or partly united
Polydactyly: born with extra digits of toes or fingers. If they have an extra fingers in each hand they may have a chromosome abnormalities and are important markers for other conditions
Clinodactyly: congenital condition where the the little finger is curved. May only have one joint. Maybe genetic and a marker for downs syndrome

Question 5

What are talipes?

Answer 5

If the babys feet can straighten and flex it doesnt have talipes
Should be picked up on the 20 week scan

Question 6

What is examined when observing the spine?

Answer 6

important to turn the baby over so there is no curvature of the spine. Dimples: midwives need to make sure it is covered - could be a minor form of spina bifida
Spine integrity-observe and palpate
Anal patency
Gluteal folds

Question 7

What is examined when observing hips?

Answer 7

Examine within 72 hours
1:100 instability
1:1000 dislocation
Putting both feet together and the knees are the same length)
Abduction (if hip doesn’t abduct it can be a detector of hip dysplasia)
Flat, firm surface
Ortolani- OUT leg out and rotating in the acetabulum
Ultrasound- HIP SCAN WITHIN TWO WEEKS. Scan instead of x ray as the the hip is mainly cartilage
Referral
Treatment-Pavlik harness, surgery Ongoing assessment and prevention Pavlic Harness