Neonatology Examination Flashcards
What should be included in the history with the mother before examining the neonate?
Birth term, complications, first child, breast vs bottle, wet and dirty nappies, family hx
When examining the baby, this finding is observed. What is it?
Cleft palate (black opening in the back of the mouth)
What is this finding?
Cutis marmorata or mottled skin
How would you assess nutritional status on a neonate?
Check thighs for subcutaneous fat and weigh the baby (3.5)
What is paradoxical breathing
Abdomen out and chest in (40-60bpm)
what is this finding?
Milia rash. white spots on face mainly around nose and cheeks
what is this finding?
Erythema Toxicum. small papules on erythematous rash. around body
How would you describe a normal pulse (normal for neonate)
the pulse has a rate of 120-160bpm and is strong (vs weak/full/bounding/absent) and regular rhythm (even beats vs irregular)
How is central cyanosis assessed?
open mouth and look for blue
What is included in the cardiology assessment of the newborn?
Central cyanosis
Capillary refill
Femoral Pulse for coarctation of the aorta
Palpate the liver (LIF -> 2cm below costal margin) for hepatomegaly in congenital infections and right sided heart failure
Heart palpation (left lower sternal edge) - should be of minor intensity. major = left-right shunt
Auscultation of 4 cardiac areas for murmurs (and check if louder on right or left)
What are signs of congenital heart disease?
Poor feeding
tachypnea
cyanosis
If you have auscultated the heart and found no murmers. what would you say to the examiner?
I can appreciate heart sounds 1 and 2 in all 4 cardiac areas at grade III (easily audible but without palpable thrill) with no added heart sounds
When examining the neonate’s head you notice the head is asymmetrical with a bulge on the right side. What are your ddx and how would you distinguish them
Caput Succedaneum => Oedema between skin and periosteum, can cross sutures (can cross midline)
Subgaleal hemorrhage => Blood between subgalial anastomoses and periosteum, can cross sutures
Cephalohematoma => Blood between the periosteum and bone, cannot cross midline
When Examining the Head and neck of the baby, list what needs to be done
Inspect the head for asymmetry (plagio/brachycephaly)
Palpate anterior, posterior (checking for 3rd in between) fontanelles as well as metopic, corona, sagittal, and lambdoid sutures for oedema, overlapping sutures (premature fusion)
Measure head circumference 3x (35cm)
Eyes: Dacryocystocele, subconjunctival hemorrhage (normal and self-limiting), and RED REFLEX (checking for (a)symmetrical reflex, white reflex, cataracts (hazy lens)
Ears: Draw imaginary line (low/high set), preauricular skin tag, and microtia
Nose: Check septum if displaced (due to birth), and Choanal atresia
Mouth: If given opportunity, check for microstomia and cleft palate when crying
Neck: Check for masses
Clavicle: Palpate for fractures from birth trauma
When examining the neonate’s head, you note several markings. What is the likely cause?
Assisted delivery via forceps or vacuum
When palpating the head, you notice that there is an interruption or “step” along a suture. What does this indicate?
Overlapping sutures, premature fusion of bone
Craniosynostosis
what is this finding?
dacryocystocele. This is the blockage of the nasolacrimal duct
What is the finding
Preauricular skin tag and microtia
What is choanal atresia
When nasal passages are blocked by tissue or bony septum (90%)
When examining the neonate, you note a mass just lateral to the midline. What is your ddx (5)
Cyst Hygroma (lymph sac)
Sternocleidomastoid tumor
Thyroglossal duct cyst
Branchial cleft cyst
Lymphadenopathy
You are checking the red light reflex and notice there isnt any. What do you suspect?
Cataracts, retinoblastoma
You are attempting the Moro reflex. What do you expect to see?
When the child is startled, the arms will spread in abduction and extension followed by flexion and adduction.
You are inspecting a child and find erythema toxicum. Where is this usually found? How would you manage?
Usually found on the trunk. This will resolve spontaneously
When inspecting a child, you notice that they have club foot.
What is the medical term?
Would this concern you?
Talipes equinovarus
If positional (can be dorsiflexed) then there is no concern but if it is fixed, then it requires orthopedic referral.
What is this finding? Any indications?
Strawberry nevus, no indications unless affecting vision. Then give topical timolol
What is this? What is it associated with?
Iris Coloboma. a/w CHARGE syndrome
What is this?
Cataract
What are some RF for the presence of DDH?
Breach position during birth (legs first)
Macrosomia
Family history of DDH
Female (6x)
You suspect the neonate may be susceptible to a hearing problem. How is Newborn hearing screening performed?
AOAE - Automatic otoacoustic emission (earphone in ear to test cochlear function through echo)
AABR - automated auditory brainstem response (computer analysis of electroencephalogram)
Referral to pediatric audiologist
What is this finding?
What is it associated with?
Cystic hygroma
associated with Trisomy 21, Noonan’s, and Turner’s
What is this finding?
What is it associated with?
Epicanthic folds
Down’s Syndrome
What is this child suffering from? His mother says his head is stuck in that position.
What can this cause?
Congenital Torticollis
This is due to the shortening of the sternocleidomastoid muscle which leads to an ipsilateral head tilt and contralateral rotation of the face and chin
This may lead to the child favoring one side and hence may develop plagiocephaly. Advise the parents to stimulate the opposite side. Surgical referral.
What should be checked when looking at the eye
Symmetry
Distance (hyper/hypotelorism)
Palpebral fissure upslanted in down’s and downslanted in noonan’s
Opthalmoscope: Red light reflexes/white reflex/unequal refraction/cataract
Subconjunctival hemorrhage
Discharge –> conjunctivitis
What is this finding?
What are some RFs? (2)
Give some associated problems (3)
How would you treat?
Cleft Palate
RFs: Maternal use of anticonvulsant therapy, family hx, male gender
Associated problems with feeding and bonding. Recurrent URTI (residue), otitis media (through Eustachian tube)
How would you treat cleft lip/palate
When would you treat a cleft lip?
When would you treat a cleft palate?
How would you follow up this patient?
Refer to cleft lip/palate specialist unit for surgical repair
Cleft lip at 3 months
Cleft palate at 9-12 months to allow for maxillary growth for easier access
Long term follow up due to speech and dental problems
Describe findings seen in the image. What is the most likely diagnosis?
What are other findings you expect to see with this diagnosis?
The baby becomes apneic and is taken to the ED. Why did this happen?
Pierre Robin Sequence:
Micrognathia, midline cleft palate, and posterior displacement of the tongue which may cause airway obstruction as it falls back => sleep apnea
How is Choanal atresia diagnosed?
What is the treatment?
By inability to pass NG tube through either nostril
remember newborns are obligate nose breathers.
tx: Surgical repair
