Newborn check Flashcards
Apgar score
Score 0 1 2
HR Absent 100
RR Absent Irreg Strong cry
Tone Limp Some Good flexion
Suction None Grimace Cough or sneeze
Colour White Blue periphery Pink
Normal score at 1 min 7-10
If 0-3 at 1 min = resuscitation or death.
Skin signs to look for on GI
Normal: Skin colour, integrity, anomalies - +/- vernix, post dates = dry skin.
Jaundice, Cyanosis (Acrocyanosis normal), Pallor,
Rashes - erythema toxicum (normal), Millia, Millaria
Birthmarks
Capillary haemangioma - Lumpy bright red lesion, Proliferation of blood vessels, enlarges until 2-4 yr then regresses.
Capillary malformation - Sharply circumscribed pink to purple lesion, abn dilation of normal dermal capillary, May be Sturge-Wber syndrome with an underlying meningeal haemangioma, intracranial calcification and fits. Doesn’t resolve but some may improve with laser therapy
Mongolian blue spot - Common in racial groups with pigmented skin, fade during early yrs.
Pigmentation disorders
Pigmented naevus
Cafe an lait - genetic conditions, neurofibromatosis, McCune-Albright syndrome. Linked with neuro and skeletal problems
Depigmentation - genetic disorders - tuberous sclerosis -> brain abnormalitis, epilepsy, learning difficulties.
What to look for on GI
Skin changes
Baby’s alertness, posture, activity (symetrical), range of spontaneous movements, muscle tone (flexed)
Size - <2.5 kg is low birth weight, >4kg Large
Maturity - Ballard score - made of neurological and physical signs
Quality of cry - abnormal cry in syndrome. e.g. Cornelia de Lange syndrome – like a bleating lamb, Cri-du-chat syndrome- like a cat
Growth Charts
Things to look for only normal born examination of Head
Head - Shape, size, scalp, fontanelles (soft, flat and pulsatile, close at 18 m), sutures,
Cephalhaematoma (parietal swelling that does not cross suture lines), Chignon from ventouse suction cup. Caput succedaneum.
Wormian bones (extra bones in the sutures).
Small head - Hypothyroidism
Craniosynostosis premature fusion of sutures
Things to look for only normal born examination of Face
Dysmorphic features - low set or simple ear (Down’s), inner epicanthic folds, Mongolian or anti-Mongolian slant of eyes, Symmetry of face and mouth, accessory auricles and pre-auricular pits, micrognathia,
Eyes - size, structure, position in relation to nasal bridge, cataracts, red reflex, sclera Jaundice, Coloboma (defect in pupil).
Nose - position and symmetry of the nares and septum, Patent
ears-position, patancy, structure,
mouth-palate, tongue, jaw size, central cyanosis, neonatal teeth
Things to look for only normal born examination of Neck
structure symmetry of movement, ranges of movement. look for SCM collie, # collar bone
Things to look for only normal born examination of Clavicles, Arms and hands
fractures, Length, proportions, symmetry and digits
Things to look for only normal born examination of Chest
Size, shape, symmetry, movement, breast tissue, nipples,
CVS - HS, HR, pulses (brachial, femoral), rhythm, Apex beat, Heart murmur, Heart failure (tachypnoea and hepatomegaly)
Resp - BS, RR, effort with respiration, symmetry of chest movement
Things to look for only normal born examination of Abdomen
Size, shape, symmetry, palpate organs-liver, spleen, kidneys, umbilicus (signs of infection and 3 vessels)
Abdominal distension or bile-stained vomiting suggest bowel obstruction. Hernia - umbilical, periumbilical, inguinal, surgery
Palpable kidneys - Hydronephrosis. Palpable <1day old.
Anterior abdominal wall defects - gastroschisis or exomphalos
Things to look for only normal born examination of Genitourinary
Genitalia -male - penis, foreskin, testes. Hypospadias, cryptorchidism.
Female - Clitoris, labia, hymen. Ambiguous genitalia: If both testes are impalpable, consider whether the baby could be a virilized female, due to congenital adrenal hypoplasia
Anal position, patency. Imperforate anus may indicate fistula to bladder or vagina
Passage of urine, stool
Things to look for only normal born examination of Hips. legs and feet
Ortolani and Barlow’s manoeuvres to assess stability and congenital dislocation of hips
Assess leg length, proportions, symmetry and digits.
abnormalities - Talipes equinovarus (Club foot), Polydactyly or syndactyly (fused digits), Single palmar creases and sandal gap between toes (Down’s). Contractures occur in oligohydramnios or congenital muscular disorder. Absent radii (VACTERL association [Vertebral defect, Anal atresia, cardiac defect, tracheoesophageal fistula or/or Oesophageal atresia, renal and radial anomalies and Limb defects])
Things to look for only normal born examination of Back
Spinal column, skin. Symmetry of scapulae and buttocks,
Spina bifida or post encephalocele. Midline naevus, lipoma or deep sacral pit can suggest an underlying spinal abnormality
Things to look for only normal born examination of Neurological
Assess posture, behaviour, spontaneous movements, muscle tone, cry,
Reflexes - Moro, rooting, suck, grasp, stepping/walking.
Common Syndromes to be aware of
Trisomy 21 - Down’s syndrome
Trisomy 13 - Patau’s syndrome - midline defects, cleft lip and palate, cutis aplasia, holoprosencephaly, polydactyly, Heart defect - VSD, PDA, ASD
Trisomy 18 - Edwards’ syndrome - IUGR, Polyhydramnios, rocker- bottom feet, clenched hands, prominent occiput, heart defects - VSD, PDA, ASD, apnoea.
Turner syndrome - 45XO -
Noonan’s syndrome - Lymphedema - phenotypically similar to turner’s both occurs in both sexes. Short stature, oedema, pulmonary stenosis.
VATER and VACTERL association - Vertebral defect, Anal atresia, cardiac defect, tracheoesophageal fistula or/or Oesophageal atresia, renal and radial anomalies and Limb defects.
CHARGE - Coloboma, heart defects, choanal atresia, retarded growth and development, genital hypoplasia and ear anomalies.
Pierre Robin sequence - (sequence is where one abnormality lead to another)
causes posterior displacement of the tongue which prevents the palate forming correctly = Cleft palate
Discharge planning after newborn birth
Discuss with parents routine screening tests - NNST and Healthy hearing Health care - Role of GP, Community midwife, child health nurse, Risk of injury, 6 wk baby check. Education Immunisation SIDS - Safe infant sleeping passive smoking tummy time
Red Flags on newborn examination
Spina bifida - major cause of disability, Folic acid reduces incidence
Anencephaly - Cranial part of the neural tube does not exist and the brain cortex does not develop. Fetal
Meylomeningocele - open lesion where the spinal cord is covered by a thin membrane of meninges. Severe weakness of lower limbs with bladder and anal denervation and an associated hydrocephalus. Survivors have severe disability.
Meningocele - spinal cord in intact but there is an exposed sac of meninges which can rupture, with the risk of meningitis.
Spina bifida occulta - hidden neural tube defect where the vertebral bodies fail to fuse posteriorly. Some degree may be present in 5-10% of normal infants the only clue may be a tuft of hair, naves, lipoma, or deep sacral pit in the midline over the lower back. Needs a spinal USS
Dysplasia of hips
occur in 1% of infants. Due to shallow acetabulum leading to hip joint being dislocatable or dislocated.
Risk factors = Breech position, FmHx, Female sex, and impaired limb movement
Association with Talipes
Baby with risk factors or abnormal examination = USS before 12 weeks
Tx - wearing harness or splint to hold the joint in flexion and abduction for several months.
