Neonatology - NIPE Flashcards
What is the new-born examination for?
Screening for abnormalities in new-borns
When is the new-born examination performed?
Within first 72 hours after birth
Repeated at 6-8 weeks by GP
Before starting the NIPE what should you ask the parents?
- Has the baby passed meconium?
- Is the baby feeding okay?
- Any family history of congenital heart, eye or hip problems?
What does pre-ductal and post-ductal oxygen saturation levels mean?
Oxygen levels before and after the ductus arteriosus
Normal sats are 96% and above
Should not be more than 2% difference
How are pre-ductal and postal ductal saturations measured?
Pre-ductal
- Baby’s right hand
- Right hand receives blood from right subclavian, branch of the brachiocephalic, branches from aorta before ductus arteriosus
Post-ductal
- Either foot
- Blood from descending aorta, comes off after ductus arteriosus
What examination steps should be used for NIPE?
- General appearance
- Head
- Shoulders and arms
- Chest
- Abdomen
- Genitals
- Hips and legs
- Back
- Reflexes
- Skin findings
General appearance?
Colour
Tone
Cry
Head?
General appearance
Size, shape, dysmorphology, caput succedaneum, cephalohaematoma and facial injury
Head circumference AKA
occipital frontal circumference (OCP)
Anterior and posterior fontanelles
Sutures
Overlapping sutures are common and usually resolve as baby grows
Ears
Skin tags, low set ears and asymmetry
Eyes
Slight squints are normal, epicanthic folds -Down’s
Purulent discharge - infection
Red reflex - check for symmetry, more pale in darker babies
Absent with congenital cataracts and retinoblastoma
Mouth
Cleft lip or tongue tie
How can you check for suckling reflex?
Little finger in their mouth to check the suckling and feel the palate all the way back, checking for a cleft palate.
Shoulders and arms?
Shoulder symmetry
Check for clavicle fracture
Arm movements
Check for Erbs palsy
Brachial pulses
Radial pulses
Palmar creases
Single palmar crease -associated with Down’s, can be normal
Digits
Check number of digits and if fingers are straight or curved (clinodactyly)
Sats probe on the right wrist for a pre-ductal reading
Chest?
Oxygen sats - right wrist and foot: 95%
Observe breathing- distress, symmetry and listen for stridor
Heart sounds
Breath sounds
Abdomen
Shape
Concave abdomen can indicate diaphragmatic hernia with abdominal contents in the chest
Umbilical stump
Look for discharge, infection and a periumbilical hernia
Palpate
Organomegaly, hernias or masses
Genitals
Any ambiguity
Palpate testes and scrotum
Check both present and descended, check for hernias or hydroceles
Inspect penis
Hypospadias, epispadias and urination
Anus
Check if it is patent
Ask about meconium and whether the baby has opened the bowel
Legs and hips
Legs and hips
Equal movements, skin creases, tone and talipes
Barlows and Ortolani manoeuvres
Check for clunking, clicking and dislocation of the hips
Count the toes
Back
Inspect and palpate spine
What is talipes?
AKA clubfoot
Ankles are supinated and rolled inwards
Can be positional or structural
What are port wine stains?
Pink patches of skin, normalyl on the face
Caused by capillary abnormalities
Do not fade, typicalyl become darker
Rarely related to Sturge-Weber syndrome
