NIPE

Question 1

What is the normal respiratory rate for a neonate?

Answer 1

40-60 breaths per minute.

Question 2

What is the normal heart rate for a neonate?

Answer 2

100-160bpm

Question 3

What cardiac risk factors can affect the development of the fetal heart?

Answer 3

First degree family history of congenital heart disease
Fetal trisomy
Maternal exposure to viruses eg rubella during early pregnancy
Maternal type 1 diabetes

Question 4

You feel a distinct strong grace when palpating over the point of maximum impulse with the side of your hand, what does this indicate?

Answer 4

Right ventricular hypertrophy

Question 5

What cardiac condition can cause hepatomegaly?

Answer 5

Congestive heart failure

Question 6

What would you do before carrying out the NIPE?

Answer 6

Introduce self to parents, explain the purpose, scope, and limitations of the NIPE and what it will involve
Obtain consent
Identify any risk factors
Ask parents if they have observed any episodes of the newborn becoming breathless or experiencing a colour change either at rest or when feeding.
ask parents if the neonate has normal feeding behaviours, level of alertness and muscle tone.
Decontaminate hands and apply PPE according to the risk assessment
Prepares a suitable environment for the examination and gather equipment.

Question 7

What are you observing when looking at the heart on the NIPE?

Answer 7

Check for symmetrical movement of the chest
place hand over neonates chest to feel for the point of maximum impulse.
Palpates for the presence of thrills.
Place side of hand over PMI to asses for presence of heaves.
place paediatric stethoscope over the apex beat and count the heart rate for 1 minute while simultaneously palpating the brachial pulse
Auscultate aortic area for 30 seconds
Auscultate pulmonic area for 30 seconds
Auscultate the tricuspid area for 30
seconds
Auscultate the mitral area for 30 seconds
Auscultate the coarctation area for 30 seconds
Resp rate for one minute
Palpate both brachial pulses and check that they are in equal rhythm, rate or volume.
Palpate the left femoral and the right brachial pulses simultaneously to check that they are equal in rate, rhythm and volume.
Palpate the liver

Question 8

What do you do after you’ve done the NIPE?

Answer 8

Document the outcome according to local policy and escalate any concerns
Explain the findings of the NIPE to the parents and explain that a second one will take place at 6-8wks

Question 9

What does a heave feel like?

Answer 9

A lifting feeling or a kick under your hand
Place hand on its side
Indicates right ventricular hypertrophy

Question 10

What does a thrill feel like?

Answer 10

Vibration - abnormally large beating of the heart
Indicates a heart murmur
Place hand flat

Question 11

What is coarctation?

Answer 11

A birth defect in which a part of the aorta is narrower than usual.

Question 12

What are heart murmurs caused by?

Answer 12

Narrow valve/vessel
Leaky valve
High flow of blood

Question 13

What type of murmurs are common in newborns?

Answer 13

Systolic murmurs and continuous murmurs
Diastolic murmurs are not common in newborns

Question 14

When should an infant with suspected heart abnormality be seen following the NIPE?

Answer 14

Seen by a paediatrician with expertise in cardiology in the early neonatal period, urgency depends on suspected condition and clinical condition of the baby.

Question 15

Types of congenital heart defects?

Answer 15

Cyanotic - decreased pulmonary blood flow (atresia, transposition of the great arteries, tetralogy of fallot)

Acyanotic - increased pulmonary blood flow
PDA - patent ductus arteriosus
ASD - atrial septal defect
VSD - ventricular septal defect

Obstruction to outflow - coarctation of the aorta.

Question 16

What are the signs and symptoms that suggest critical or major congenital heart abnormalities?

Answer 16

Chest Recession
nasal flaring.
Central cyanosis
Heaves and thrills
Presence of cardiac murmurs or extra heart sounds.

Question 17

What is systole?

Answer 17

S1
Occurs when the atrioventricular valves close after blood enters the ventricles, represents the start of systole.

Question 18

What is diastole?

Answer 18

S2
Aortic and pulmonary valves close after blood has left the ventricles to enter the systemic and pulmonary circulation systems at the end of systole.

Question 19

What can make it difficult to discern which is S1 and which is S2?

Answer 19

Rapid heart rate

Question 20

Biology behind respiratory system

Answer 20

From 32wks increasing amounts of surfactant produced - reduces surface tension, prevents collapsing of alveoli on expiration.
Lining of alveoli becomes thinner increasing surface area for gas exchange
Lethucin:sphinogomyelin ratio indicates maturity of respiratory system
The ratio is decreased in pre eclampsia, prematurity, narcotic addiction, maternal diabetes.

Question 21

First step of checking the hips?

Answer 21

gently extend both legs to check that the legs are the same length

Question 22

What is the galeazzi maneouvre?

Answer 22

flex the newborns legs at both the knees and hips so that the backs of their ankles are touching their buttocks
Asses the level of the knees - if one hip is dislocated the knee on the affected
side will seem lower
If knees are on different levels this is a sign of developmental dysplasia

Question 23

What is the ortalani maneouvre?

Answer 23

Is it dislocated? Are we able to relocate an already dislocated femoral head back into the acetabulum
Place thumb along inner aspect of the thigh while lining fingers with the greater trochanter on the outer aspect of the thigh
Flex the leg

Question 24

What is the Barlow manoeuvre?

Answer 24

is it dislocatable?
support the leg in a flexed position slightly ubduct the leg towards the umbilicus and apply pressure downward

Question 25

What happens if the test is screen positive?

Answer 25

Urgent referral for senior paediatrician review, hip ultrasound within 4-6 wks of birth if born >34wks gestation
Or between 38+0 and 40 wks for those born <34wks

Question 26

What are hip risk factors on the NIPE?

Answer 26

First degree family history of hip problems in early life
Breech presentation at or after 36wks of pregnancy irrespective of presentation at birth or mode of delivery
breech presentation at time of birth between 28wks and term
Multiple pregnancy

Question 27

What is developmental dysplasia of the hips?

Answer 27

Used when referring to patients who are born with dislocation or instability of hip which then may result in hip dysplasia

Dysplasia - abnormal growth/development

Question 28

What type of joints are the hips?

Answer 28

A ball and socket joint
acetabulum (socket) in the pelvis
Femoral head (ball)

Question 29

What ligaments are involved in hip movement?

Answer 29

Illiofemoral ligament
Ischiofemoral ligament
Pubofemoral ligament

Question 30

What is the embryology of hip development?

Answer 30

Primitive limb buds form as early as 3 weeks after fertilisation
Acetabulum forms from the mesoderm around the end of the fourth week
there’s a shallow socket on the outer aspect of the developing innominate bone.
As the bones grow and develop the socket depeens due to pressure exerted by the femoral head.

Question 31

When does limb bud differentiation take place?

Answer 31

Limb bud differentiation and hip joint cleavage occurs by the 8th week, during this time there is separation of the fetal tissue by a cleft which causes the formation of the femoral head and acetabulum.

Question 32

When does limb rotation happen?

Answer 32

8th week

Question 33

How does dysplasia occur?

Answer 33

If the femoral head is not in line with the acetabulum during the growth of the fetus.