Newborn check

Question 1

Apgar score

Answer 1

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.

Question 2

Skin signs to look for on GI

Answer 2

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.

Question 3

What to look for on GI

Answer 3

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

Question 4

Things to look for only normal born examination of Head

Answer 4

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

Question 5

Things to look for only normal born examination of Face

Answer 5

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

Question 6

Things to look for only normal born examination of Neck

Answer 6

structure symmetry of movement, ranges of movement. look for SCM collie, # collar bone

Question 7

Things to look for only normal born examination of Clavicles, Arms and hands

Answer 7

fractures, Length, proportions, symmetry and digits

Question 8

Things to look for only normal born examination of Chest

Answer 8

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

Question 9

Things to look for only normal born examination of Abdomen

Answer 9

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

Question 10

Things to look for only normal born examination of Genitourinary

Answer 10

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

Question 11

Things to look for only normal born examination of Hips. legs and feet

Answer 11

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])

Question 12

Things to look for only normal born examination of Back

Answer 12

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

Question 13

Things to look for only normal born examination of Neurological

Answer 13

Assess posture, behaviour, spontaneous movements, muscle tone, cry,
Reflexes - Moro, rooting, suck, grasp, stepping/walking.

Question 14

Common Syndromes to be aware of

Answer 14

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

Question 15

Discharge planning after newborn birth

Answer 15

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

Question 16

Red Flags on newborn examination

Answer 16

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

Question 17

Dysplasia of hips

Answer 17

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.