Newborn examination

Question 1

Newborn & infant physical examination (NIPE) = a screening test to pick conditions that can be treated early on for better outcomes

=> Performed within 72 hours of birth

Answer 1

Focus on examining:
=> Hips
=> Testes in boys
=> Eyes
=> Heart
=> General physical exam

Question 2

NIPE starts with a detailed hx:

1. Antenatal: scans, problems, maternal health
2. Delivery: gestation, type, presentation?breech
3. Postnatal: teeing, pooing, feeding
4. Family hx: heart, hips, eyes

Answer 2

Measurements:

1. Head circumference
2. Weight

=> To check whether baby is SGA or not / appropriate investigation if SGA

Question 3

HEART:

1. Listening for murmurs
2. Reviewing any saturation readings

Answer 3

EYES:

1. Looking for red reflex
   => if absent (white) = cataract
   => if diminished / abnormal = retinoblastoma

Question 4

HIPS:

1. Check for hips dysplasia
2. Barlow manoeuvre to check for hip dysplasia

=> hold the baby and push the hips backwards towards the bed and dislocate the hips
=> +ve result = hip dysplasia

3. Ortalini manœuvre if hips dislocated already

=> move hips outwards relocates the hip

Congenital dysplasia of hip early recognition => apply Pavlik Harness

*sometimes need surgery for correction

Answer 4

Barlow manoeuvres attempt to identify a dislocatable hip by adduction of the flexed hip with gentle posterior force

Ortolani manoeuvres attempt to relocate a dislocated hip by abduction of the flexed hip with gentle anterior force

Question 5

GENITALIA

1. Both testes down in the scrotum = normal
2. Unilateral undescended testis - review at 4-6 months
   => if persisting then refer
3. Bilateral undescended testes - more worrying, suggestive of a sexual developmental issue => refer early to endocrine team

Answer 5

BLOOD SPOT TEST

1. Taken at 5 day of age

2. Conditions tested for:
=> Neonatal hypothyroidism
=> Cystic fibrosis
=> Sickle cell disease
=> Phenylketonuria 
=> Medium chain acyl-coA dehydrogenase deficiency
=> Homocystinuria 
=> Maple syrup urine disease
=> Isovaleric acidaemia 
=> Glutaric aciduria type 1

*Early detection improves outcomes significantly

Question 6

The purpose of newborn examination:

=> To screen for congenital abnormalities that will benefit from early intervention

=> To make referrals for further tests or treatment as appropriate

=> To provide reassurance to the parents

Answer 6

A second examination is performed at 6-8 weeks of age, usually by GP, to identify abnormalities that develop or become apparent later.