Neonatal skeletal system and hip dysplasia screening

Question 1

National guidance

Answer 1

3 documents:
PHE Service specification 21
NIPE standards
NIPE handbook- read before exam

Parents can decline a NIPE but needs to be offered and documented if declined
NIP examination should be done within 72 hours of birth: 95% of babies

Question 2

Hip screening national consultation

Answer 2

Breech presentation
Twins
Family history
Should all have a hip screen to detect if there is hip dysplasia
About 80% of hip dysplasia is female babies

Question 3

Equipment for examination

Answer 3

Equipment: 
• Overhead heater 
• Thermometer 
• Billimeter: measuring TCB
• Ophthalmoscopes: Looking at the eye  
• Computer

Question 4

Risk factors

Answer 4

• Morphology: the physical appearance of the baby. Fetal alcohol syndrome/maternal age risk of downs and trauma. You can pick up 80% of abnormalities from the face. Sodium vibirate (epilepsy) dismorphic features 
• Cardio-respiratory: 
Cardiac: family history, downs syndrome, low birth weight  
Respiratory: sepsis, mecomium 
• Skeletal: breech presentation, teratogenic abnormalities (toxic), family history, risk of hip dysplasia birth trauma. Oligohydramnious 
• Thermoregulation: maintaining temperature 
hyper/hypothermia
Exercising 
Infection 
Can all increases baby’s temperature
-  hypothermia
- BAT
- bathing baby
-  less skin-to-skin
• Glucose metabolism 
Diabetes
• Infection 
• Risk of jaundice 
37 weeker
Mediteranian decent 
Infections and instrumental deliveries 
• Centile
2nd centile is what we are worried about the most: only 2% of babies born are smaller than them the rest 98% are bigger than them 
Risk of jaundice,
Poor placental function 
Ethnicity
Smoking 
Drug abuse
Chromosomal abnormalities

Question 5

Observations - colour and tone?

Answer 5

• Colour and tone (poor colour and tone not well)
Baby is well perfused → pink 
Baby is blue: hypoxia 
Tone: floppy ?hypoxia
Jaundice 
Cardiac problem

Question 6

Observations - Temperature

Answer 6

Test temp on the axilla
Or touch the chest
Skin to skin contact is an example of conduction

Question 7

Observations - Cardio respiratory

Answer 7

APGAR Score 1,5 and 10 minutes
Heart rate, pulse, respiration rate (40 breathes)
Increased respirations: tachyapnia
Decreased respirations: sternal recession
Nasal flaring - is when the nostrils widen when you breathe. It is often a sign that you are having trouble breathing.
Chest movement
How well the baby is perfused
Acrocyanosis
Lung fluid volume depends on labour and birth
By 3 days all these things should be gone

Question 8

Observations - Morphology & Skeletal

Answer 8

• Morphology 
Head: markers caput succenduem, moulding- symmetrical (crying), tongue, if the fontanelle. Low set of ears and third fontanelle is a marker for downs
• Skeletal 
Abnormalities
Polydactily
Clynodactly
Syndalctily 
Fractures of the humerus or clavicle 
Hip dysplasia
Talipes: detected at scan of 20 weeks

Question 9

Observations - Abdominal and genitalia

Answer 9

Family history
poly /oligohydramnious for rectal dysfunctions
Perineal area: anus if present and if not how severe is it
Male genitalia
Female genitalia

Question 10

Referrals and care

Answer 10

]• Dysmorphic features
Chromosomal abnormalities → offered blood tests
• Hearing screening
Offered to all babies
Family history is a risk factor → ASK THE QUESTION
• Genitalia ambiguous/imperforate anus
Chromosomes and hormone levels to detect the sex of the baby
If no anus they require surgery as they are risk of problems of GI Tract
Bowels is not complete
A lot of bowel missing so we will need to wait for it to grow