Newborn Check Flashcards
1
Q
What should you look for on general inspection of a newborn?
A
- Responsiveness, consciousness
- Colour
- normal infant appears pink
- Acrocyanosis, a bluish appearance of hands, feet and perioral area is common in the first few days after delivery
- Pallor may indicate anaemia
- Jaundiced appearance may be due to hyperbilirubinaemia: risk of bilirubin encephalopathy
- Tone and posture
- If cephalic presentation, usually flexed posture
- If breech presentation, legs usually extended
- Movement
- range, spontaneity, symmetry
- Breathing
- Paradoxical movements (abdomen moving outwards and chest wall moving inwards during inspiration) are normal
- Look for signs of respiratory distress (RR should be timed over 1 minute)
- Determination of gender
- Identification of obvious deformations or malformations (e.g. syndromic features)
2
Q
What must you check before actually examining the newborn?
A
- Body measurements: weight, length, head circumference
- Vital signs esp. T>38
3
Q
Outline the examination of the head of a newborn.
A
- Inspect for size, shape and symmetry
- Palpate anterior and posterior fontanelles
- Palpate sutures
- Molding (asymmetry)
- Cephalohaematoma (swelling confined to suture lines)
- Subgaleal haemorrhage (swelling not confined to suture lines)
- Premature fusion (craniosynostosis)
4
Q
Outline the examination of the face of a newborn.
A
- Must check size, shape and symmetry for all features
- Eyes
- Red reflex (concerned about)
- Inspection of pupil for unequal size, dilatation, constriction, clear appearance (cataracts)
- Nose
- Patency of nares
- Mouth
- Cleft lip/palate
- Mouth drooping
- Tongue-tie
- Palpate hard palate with little finger
- Sucking reflex
- (Gag reflex)
5
Q
Outline the examination of the ears of a newborn.
A
- Position: top third of pinna should be at or above a horizontal line from inner and outer canthus and < 15° rotation with respect to the tragus
- Response to noise
- Drainage from ear
6
Q
What should we examine in the neck of a newborn, and how?
A
Look for swellings with neck extended
7
Q
Outline the examination of the chest of a newborn.
A
• Assess work of breathing: • Respiratory distress in a neonate: ○ Tachpnoea (RR > 60) ○ Recession ○ Expiratory grunt ○ Nasal flaring ○ Cyanosis
- Apnoea (pause in respiration > 20s)
- Palpate clavicles (may be broken if shoulder dystocia)
- Look at spacing of nipples (may be widened in some syndromes such as Turner’s)
- Auscultation of lungs and heart (HR, murmurs, breath sounds)
- Pulse
8
Q
Outline the examination of the abdomen of a newborn.
A
- General inspection, looking for masses, deformities, distension
- Look for gastroschisis (protruding intestines from abdominal wall) and omphalocoele (abdominal organs protruding into base of umbilicus)
- Inspect umbilicus for erythema, infected appearance
- Palpate for liver - usually 1-3 cm below the costal margin
- Palpate for spleen - not usually palpable
- Auscultate for bowel sounds
9
Q
Outline the genitourinary examination of a newborn.
A
- Males
- Testicular descent
- Testicular size and symmetry
- Look for hypospadias
- Females
- Size of clitoris, labia
- Vaginal discharge is normal
- Look for ambiguous genitalia
- Check if urine has been passed within 24 hours of birth
- Assess patency of anus
- Check if meconium has been passed within 24 hours of birth
10
Q
Outline the limb examination of a newborn.
A
- Count number of fingers and toes
- Check palmar crease
- Single palmar crease associated with T21
- Assess tone
- Brachial and femoral pulses (also look for radio-femoral delay)
- Symmetry of hip creases
- Hip manoeuvres (pistol grip) - can feel femoral pulses at same time
11
Q
Outline the hip manoeuvres.
A
- Barlow test:
• One hand stabilises pelvis, other hand grasps other side knee (hand at greater trochanter)
• Flex knee to 90 degrees
• Adduct hip 10-20 degrees, apply posterior force (in/down)
• If subluxing, ‘gliding sensation of posterior movement’ will be felt from femoral head rubbing against edge of acetabulum
• If dislocating, ‘gliding sensation’ followed by distinct loss of resistance
○ Confirm by relaxing pressure/Ortolani manouvre - Ortolani manouevre:
• Used to reduce a dislocated hip
• Both hips and knees flexed to 90 degrees
• Thumb grasps inside of knees, other fingers on greater trochanter
• As hip is abducted, other fingers try to lift femoral head back into acetabulum - anterior force (out and up)
• If reduced, ‘clunk’ sensation felt
12
Q
Outline the back examination of a newborn.
A
- Inspection for symmetry of scapulae and buttocks
* Palpation down spine
13
Q
What are the major reflexes in a newborn?
A
- Eye blink reflex
- Sucking reflex
- Rooting reflex
- Grasp reflex
- Tonic head reflex
- Stepping reflex
- Plantar reflex
- Moro reflex
14
Q
Rooting reflex:
- Stimulation
- Response
- Age of disappearance
- Function
A
- Stroke cheek near corner of mouth
- Head turns towards source of stimulation
- 3 weeks (then becomes voluntary)
- Helps infant find nipple
15
Q
Eye blink reflex:
- Stimulation
- Response
- Age of disappearance
- Function
A
- Shine light at eyes/clap near head
- Closes eyes
- Permanent
- Protects from strong stimulation
