Neonate Examination Flashcards
Why would the moulding of the skull not disappear ?
Plagiocephaly (flat skull) remains because they are in specific position.
Craniosynostosis : premature joining of skull bone.
Type of head swellings ?
Cephalohematoma : firm and fluctuating, unable to spread cross a suture
Capital succedaneum : subcutaneous oedema, able to spread across suture
Signs and cause of facial palsy ?
Nasolabial fold flattened, eye that do not close, corner of the mouth does not move.
Due to neuropraxia by intrauterine compression.
Facial asymmetry of the corner of the mouth ?
Congenital defect of depressor anguli oris muscle.
Permanent condition.
Abnormalities of the nose ?
Crooked nose : compression in the womb.
Non patent nostrils : choanal atresia (congenital disorder where the choana are obstructed by soft tissue)
Abnormalities of the mouth ?
Cleft lip / palate
Microretrognathia : too small jaw, displacement of the chin posteriorly. Consequence of Pierre robin syndrome.
What is Pierre Robin syndrome ?
Congenital birth defect characterized by an underdeveloped jaw, backward displacement of the tongue and upper airway obstruction.
Abormalities of the ear ?
Abnormal shape and low ears : hereditary and chromosomal
Unilateral ear abnormality : look for kidney condition
Symptoms of congenital cataract ?
Congenital clouding of the lens.
- bilateral one : 10% of blindness. If not treated nystagmus develop.
Absent pupillary light reflex (also in other condition)
Cause of congenital cataract ?
Genetic abnormalities, intrauterine infection, metabolic storage, underlying eye disorder disorder, idiopathic.
What are congenital abnormalities of the eyes ?
Congenital cataract
Congenital nystagmus
- may be caused by neuropathy
Congenital glaucoma : 5-13% of childhood blindness
- large eyes, tears excessively, photophobia
Congenital hole in iris : Colomboma of iris
Ptosis, abnormal iris color, conjunctivitis
What are abnormalities of the neck ?
Neck position : often torticolis
- caused by oligohydramnios development in cervical spine
Sternocleidomastoid muscle hematoma causing lateral swellings in neck.
- also could be : lateral, median neck cyst
Enlarged thyroid
What are abnormalities of the abdomen ?
Distended or depressed abdomen :
- bowel obstruction : vomiting and delayed méconium
- enlarged abdominal organ
- ascites
Local swelling in groin : inguinal / femoral hernia
What are abnormalities of the umbilical cord ?
<1% of children : born with only one artery
- increased risk of abnormalities : gastrointestinal atresia
- ultrasound recommended
What are genital abnormalities in males ?
Physiological retractile testis : in the inguinal canal and can be moved into scrotum.
Cryptorchidism = non scrotal testis : congenital or aquired
Characteristics of cryptorchidism ?
Cannot be brought in stable scrotal position.
Normally testis descend around the term but can also be in the first 6 month. After that it should be surgically corrected, because of long term malignancy degeneration.
What are abnormalities of external genitalia in females ?
Synechiea: labias stuck together
Highly enlarged clitoris : adrenogenital syndrome / use of virilisions medication by the mother
What are abnormality of the back ?
Excessive body hair, skin abnormalities, swellings
- spinal malformation, spina bifida occulta
Lumbosacral dermal melanocytosis = Mongolian spot : harmlesss local blue patch
Asymmetrical gluteal fold
- hip dysplasia suspicion
Clinical significance of hypertonia ?
Acute or chronic intracerebral pathology
- asphyxia, convulsion, septic meningitis, congenital cerebral defect
Clinical significance of hypotonia ? (MINSe)
- Severe illness : sepsis, post asphyxia
- Intoxicant : medication, drug, accumulation of toxic metabolites
- Neuromuscular disorder
- Metabolic disorder
APGAR score ?
Ademhaling :
- strong crying, regular powerful breathing
- weak crying, irregular breathing, gasping
- none
Pulse rate :
- above 100 bpm
- under 100 bpm
- absent
SpierspanninG :
- resistance against extension, movement
- slow return to flexion after extension
- flaccid
Aspect :
- pink
- pink with blue extremities
- blue or pale
Reactie op prikkels :
- retraction, grimace, crying
- moderate response
- none
Skull of a neonate ?
During delivery, it needs space between the skull bones to ensure that the skull can be distorted to pass more easily through the pelvis.
- moulding : temporary distortion with skull bones riding over each other
Sutures :
- lambdoid
- Sagittarius
- coronal
- metopic
Fontanelles of the skull ?
Anterior fontanelle :
- Diamond shaped
- 2x2 cm large
Posterior fontanelle :
- triangle shaped over occipital
- Large as a fingertip
Characteristics of foetal circulation ?
Lung do not perform any oxygenation function and intestines do not play part in digestion.
- Placenta perform these functions : oxygen and nutrients rich blood from placenta flows via umbilical vein, ductus venous to IVC
The 2 side of the heart still function as a unit.
Heart of a foetus ?
Foramen ovale : blood flow from right atrium to the left
- bypass lungs
Ductus arteriosus : blood remaining in right ventricles goes to the right ventricle then pulmonary trunk where it flows directly to the aorta
- bypass the lungs
Transition from foetal to neonatal circulation ?
Closure of ductus venosus : Triggered by cessation of blood flow through the umbilical vein after umbilical cord is cut.
Closure of foramen ovale : Alveoli fill with air and the resistance in pulmonary circulation is reduced. Increased pressurising left atrium.
Closure of ductus arteriosus : 10-15h postpartum. Increase in Pa of O2 causing a decrease in prostaglandin production.
What is present in the first routine examination ?
Apgar score
General impression
Skin
Body part :
- head and neck
- chest
- limbs
- back
- external genitalia
General neurological reflex
Weight
Head circumference
What do you inspect in general impression ?
Done just after first APGAR score then after 10 min.
Characteristics :
- color
- attitude : calm, relaxed, agitated
- muscle tone
Signs of underlying cardiovascular or respiratory problems
- cyanosis, pallor, tachycardia, tachypnea, dyspnea, nasal flaring
- full term : 120-160 bpm, 30-40 breaths/min
- pre-term : 140-180 bpm, 40-60 breaths/min
Hypotonic infant ?
Arms extended along the body.
Legs flat in frog position.
Head and trunk unstable.
Difficult to pick up.
What do you assess in head and neck ?
General head :
- size and shape of skull
- palpate anterior and posterior fontanelle
- symmetry
Eyes :
- Ocular alignment : straight, slanting
- hypertelorism : abnormal distance between eyes
- Epicanthic fold
- width of palpebral fissures
- transparency of the lens
- red light reflex
Nose :
- position
- patency of nostrils
Mouth :
- symmetry
- color
- palpate soft and hard palate
- sucking reflex
Ears :
- shape and position
- auricula appendage and pre-auricular fistulas
What do you assess in the chest ?
Inspect :
- symmetry and shape
- signs of increased respiratory effort : nasal flaring, IC recession, thoracic breathing
- audible breathing sounds
Percuss and auscultate lungs :
- use pediatric stethoscope
- symmetry of breath sound, presence of adventitous sounds
Palpate and auscultate heart :
- check for thrill on the left thorax
- assess possible murmur : type, timing in cycle, loudness, PMI, radiation
Blood pressure
Check if both clavicle are intact : infant will turn the head toward unaffected shoulder and move arm less
What do you assess in the abdomen ?
Normal abdomen should bulge slightly due to underdeveloped abdominal muscle.
Check umbilical cord
Auscultate for peristalsis
Palpation :
- abnormal resistance
- size of liver : 1-3 cm below costal arch
- swelling in the groin
- femoral pulse
What do you assess in the limbs ?
Inspect :
- hand crease : present and normal
- spontaneous movement
- count fingers and toes
Hip examination :
- increase risk of hip dysplasia if : breech birth, multiple birth, positive family history
- skin fold and gluteal fold
What primitive reflex do you check ? (9)
Grasp reflexes :
- plantar : toe curling when finger under them
- palmar : place finger inside hand, it will close
Rooting reflex :
- cheek stroked, head turns toward direction of stroke
Sucking reflex :
- touch the top of the mouth and attempt to suck
Step reflex :
- infant upright, feet touching a surface, leg movement like walking
Moro reflex :
- move trunk and head backward suddenly, they will extend then flex their arms again
Startle reflex :
- loud noise or unexpected movement, extension of arms then flexion
Babinski reflex :
- stroke bottom of foot, dorsiflexion and spreading
Crawling reflex :
- on the stomach, apply pressure on foot, tries to push against hand
Tonic neck reflex :
- turn head to the side, leg/arm of that side extend, the opposite flex
Characteristics of Down syndrome infant ?
Small head, flat occipital and profile.
One palmar crease.
Up slanting eyes
Epicanthic folds
Low muscle tone
Short broad, neck with excess skin
