Newborn examination + common abnormalities Flashcards
When is the neonatal exmaination (NIPE - newborn and infant physical examinatino) performed?
in first 72 hours
What is the best approach to the NIPE?
head to toe
What are 4 reasons to perform the routine NIPE?
- Detect congenital abnormalities not already identified at birth e.g. eye abnormalities, congenital heart disease, undescended testis or developmental dysplasia of the hip (DDH)
- Check for potential problems arising from maternal disease or familial disorders
- Provide opportunity for parents to discuss any questions about their baby and to reassure them
- Opportunity to provide health education
What are 17 parts to the newborn examination?
- General observation of baby’s appearance, posture, movements
- Head circumference measured, note centile
- Fontanelle and sutures palpated
- Face observed - syndrome
- Plethoric/pale - check haematocrit
- Jaundice - if <24h requires further evaluation
- Eyes - red reflex
- Palate - cleft palate, submucous cleft (palpate)
- Breathing and chest wall movement
- Heart auscultation
- Abdomen palpation
- Femoral pulses palpated
- Genitalia and anus - confirm patency of anus, check testes in scrotum
- Muscle tone - hold trunk to see if head support
- Whole of back and spine - midline defects
- Primitive reflexes - grasp and Moro
- Hips - DDH, Barlow and Ortolani
What should be done prior to the routine newborn examination?
Check obstetric and neonatal notes to identify relevant information
When is the newborn examination repeated in the UK?
6-8 weeks of age by GP
What should be done if a tense fontanelle is detected when the baby is not crying?
may be raised ICP, cranial ultrasound should be performed to check for hydrocephalus
also late sign of meningitis
What are 3 causes of absent red reflex in the newborn?
- Cataracts
- Retinoblastoma
- Corneal opacity
What should you do to check for cleft palate?
visually inspect with light including posteriorly to exclude posterior cleft palate, and palpate to detect indentation of posterior palate from submucous cleft
What is the normal heart rate of the newborn?
110-160 (may drop to 85 in sleep)
What is the normal place where you should be able to feel the liver in the newborn?
1-2cm below the costal margin
What is usually the cause of abnormal masses in the abdomen in the newborn examination?
usually renal
What can cause reduced pulse pressure of the femoral pulses? How can this be confirmed?
coarctation of the aorta - measuring blood pressure in the arms and legs
What can cause pulse pressure of the femoral pulses to increase?
patent ductus arteriosus
What do the checks for developmental dysplasia of the hip involve?
- Barlow manoevre
- femoral head dislocated posterior out of acetabulum (checking for instability)
- Ortolani
- dislocated femoral head relocated back into acetabulum (checking for dislocation)
What does newborn hearing screening involve?
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)
What is biochemical newborn screening (previously called the Guthrie test) and when is it performed?
blood sample, usually heel prick, taken when feeding has been established on days 5-7 of life
What 9 conditions does biochemical newborn screening test for?
- congenital hypothyroidism
- haemoglobinopathies (sickle cell and thalassaemia)
- cystic fibrosis
- phenylketonia
- MCAD (medium-chain acyl-coenzyme A dehydrogenase deficiency)
- Maple syrup urine disease
- isovaleric acidaemia
- glutaric aciduria type 1
- homocytstinuria
What does the blood test screening for CF involve?
measuring seurm immunoreactive trypsin - raised if pancreatic duct obstruction
What are 16 examples of congenital anomalies that may be found in the newborn examination which resolve spontaneously?
- Peripheral cyanosis of hands and feet
- Traumatic cyanosis
- Swollen eyelids and distortion of shape of head
- Subconjunctival haemorrhages
- Small white pearls along midline of palate (Epstein pearls)
- Cysts of the gums (epulis) or floor of mouth (ranula)
- Breast enlargement -in babies of either sex, milk discharge
- White vaginal discharge or small withdrawal bleed/ prolapse of ring of vaginal mucosa
- Capillary haemangioma/ stork bites
- Neonatal urticaria (erythema toxicum)
- Milia
- Mongolian blue spots
- Umbilical hernia
- Positional talipes
- Caput succedaneum
- Cephalhaematoma
What are positional talipes?
foot can be fully dorsiflexed to touch the front of the lower leg; in true talipes equinovarus this is not possible
What are 8 exampes of significant abnormalities which may be detected on routine examination of the newborn?
- Port-wine stain (naevus flammeus)
- Strawberry naevus (cavernous haemangioma)
- Natal teeth consisting of front lower incisors
- Extra digits
- Heart murmur - most resolve in first few days, some congenital heart disease
- Midline abnormality over spine or skull
- Palpable and large bladder
- Talipes equinovarus
