Newborn examination + common abnormalities

Question 1

When is the neonatal exmaination (NIPE - newborn and infant physical examinatino) performed?

Answer 1

in first 72 hours

Question 2

What is the best approach to the NIPE?

Answer 2

head to toe

Question 3

What are 4 reasons to perform the routine NIPE?

Answer 3

1. Detect congenital abnormalities not already identified at birth e.g. eye abnormalities, congenital heart disease, undescended testis or developmental dysplasia of the hip (DDH)
2. Check for potential problems arising from maternal disease or familial disorders
3. Provide opportunity for parents to discuss any questions about their baby and to reassure them
4. Opportunity to provide health education

Question 4

What are 17 parts to the newborn examination?

Answer 4

1. General observation of baby’s appearance, posture, movements
2. Head circumference measured, note centile
3. Fontanelle and sutures palpated
4. Face observed - syndrome
5. Plethoric/pale - check haematocrit
6. Jaundice - if <24h requires further evaluation
7. Eyes - red reflex
8. Palate - cleft palate, submucous cleft (palpate)
9. Breathing and chest wall movement
10. Heart auscultation
11. Abdomen palpation
12. Femoral pulses palpated
13. Genitalia and anus - confirm patency of anus, check testes in scrotum
14. Muscle tone - hold trunk to see if head support
15. Whole of back and spine - midline defects
16. Primitive reflexes - grasp and Moro
17. Hips - DDH, Barlow and Ortolani

Question 5

What should be done prior to the routine newborn examination?

Answer 5

Check obstetric and neonatal notes to identify relevant information

Question 6

When is the newborn examination repeated in the UK?

Answer 6

6-8 weeks of age by GP

Question 7

What should be done if a tense fontanelle is detected when the baby is not crying?

Answer 7

may be raised ICP, cranial ultrasound should be performed to check for hydrocephalus

also late sign of meningitis

Question 8

What are 3 causes of absent red reflex in the newborn?

Answer 8

1. Cataracts
2. Retinoblastoma
3. Corneal opacity

Question 9

What should you do to check for cleft palate?

Answer 9

visually inspect with light including posteriorly to exclude posterior cleft palate, and palpate to detect indentation of posterior palate from submucous cleft

Question 10

What is the normal heart rate of the newborn?

Answer 10

110-160 (may drop to 85 in sleep)

Question 11

What is the normal place where you should be able to feel the liver in the newborn?

Answer 11

1-2cm below the costal margin

Question 12

What is usually the cause of abnormal masses in the abdomen in the newborn examination?

Answer 12

usually renal

Question 13

What can cause reduced pulse pressure of the femoral pulses? How can this be confirmed?

Answer 13

coarctation of the aorta - measuring blood pressure in the arms and legs

Question 14

What can cause pulse pressure of the femoral pulses to increase?

Answer 14

patent ductus arteriosus

Question 15

What do the checks for developmental dysplasia of the hip involve?

Answer 15

• Barlow manoevre
  
  • femoral head dislocated posterior out of acetabulum (checking for instability)
• Ortolani
  
  • dislocated femoral head relocated back into acetabulum (checking for dislocation)

Question 16

What does newborn hearing screening involve?

Answer 16

OAE (otoacoustic emission) testing - earphone placed over ear and sound emitted, which evokes echo or emission frmo ear if cochlear function normal

(if abnormal, referred for ABR - auditory brainstem response audiometry)

Question 17

What is biochemical newborn screening (previously called the Guthrie test) and when is it performed?

Answer 17

blood sample, usually heel prick, taken when feeding has been established on days 5-7 of life

Question 18

What 9 conditions does biochemical newborn screening test for?

Answer 18

1. congenital hypothyroidism
2. haemoglobinopathies (sickle cell and thalassaemia)
3. cystic fibrosis
4. phenylketonia
5. MCAD (medium-chain acyl-coenzyme A dehydrogenase deficiency)
6. Maple syrup urine disease
7. isovaleric acidaemia
8. glutaric aciduria type 1
9. homocytstinuria

Question 19

What does the blood test screening for CF involve?

Answer 19

measuring seurm immunoreactive trypsin - raised if pancreatic duct obstruction

Question 20

What are 16 examples of congenital anomalies that may be found in the newborn examination which resolve spontaneously?

Answer 20

1. Peripheral cyanosis of hands and feet
2. Traumatic cyanosis
3. Swollen eyelids and distortion of shape of head
4. Subconjunctival haemorrhages
5. Small white pearls along midline of palate (Epstein pearls)
6. Cysts of the gums (epulis) or floor of mouth (ranula)
7. Breast enlargement -in babies of either sex, milk discharge
8. White vaginal discharge or small withdrawal bleed/ prolapse of ring of vaginal mucosa
9. Capillary haemangioma/ stork bites
10. Neonatal urticaria (erythema toxicum)
11. Milia
12. Mongolian blue spots
13. Umbilical hernia
14. Positional talipes
15. Caput succedaneum
16. Cephalhaematoma

Question 21

What are positional talipes?

Answer 21

foot can be fully dorsiflexed to touch the front of the lower leg; in true talipes equinovarus this is not possible

Question 22

What are 8 exampes of significant abnormalities which may be detected on routine examination of the newborn?

Answer 22

1. Port-wine stain (naevus flammeus)
2. Strawberry naevus (cavernous haemangioma)
3. Natal teeth consisting of front lower incisors
4. Extra digits
5. Heart murmur - most resolve in first few days, some congenital heart disease
6. Midline abnormality over spine or skull
7. Palpable and large bladder
8. Talipes equinovarus