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NIPE Flashcards

1
Q

When is the new-born assessment carried out?

A

Within 72 hours of birth

Repeated at 6-8 weeks

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2
Q

What is the purpose of the new-born assessment?

A

Screen for congenital abnormalities

Make referrals for further tests as necessary

Provide reassurance to parents

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3
Q

Where should the new-born assessment take place?

A

Private area
Baby on changing mat
Parents present
Natural light

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4
Q

What preparation needs to be done?

A

Wash hands
Introduce self
Explain and gain consent

Ask parents to undress baby down to nappy

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5
Q

What questions should you ask the parents?

A

Maternal history

  • delivery date/time
  • method of delivery
  • risk factors for neonatal infections
  • any abnormalities on antenatal scans
  • family history

New-born history

  • feeding pattern
  • passed meconium?
  • urination
  • parental concerns
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6
Q

What is the significance of the baby being breech at 36 weeks or earlier?

A

Increased risk of developmental dysplasia of the hip

Refer for ultrasound

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7
Q

What measurements should be take and plotted?

A

Weight
Length
Fronto-occiptal circumference

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8
Q

What are you looking for on general inspection?

A

Colour

  • pallor
  • cyanosis
  • jaundice
  • rashes

Cry

Posture

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9
Q

What should you be assessing as you exam the infant?

A

Tone

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10
Q

How are hypotonic infants said to feel?

A

Like a rag doll

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11
Q

What do you assess with the head?

A

Size
- measure + plot circumference

Shape

  • shape of head
  • inspect sutures

Fontanelles
- anterior fontanelle

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12
Q

What is microcephaly?

A

Head that is smaller than expected

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13
Q

What can microcephaly indicate?

A

Reduced brain size

Atrophy

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14
Q

What is macrocephaly?

A

Head that is larger than expected

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15
Q

What can macrocephaly indicate?

A

Hydrocephalus
Cranial vault abnormalities
Genetic abnormalities

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16
Q

What is caput succedaneum?

A

Diffuse subcutaneous fluid collection with poorly defined margins (crossing suture lines)

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17
Q

What causes caput succedaneum?

A

Pressure on presenting part of the brain during delivery

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18
Q

When does caput succedaneum resolve?

A

First few days

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19
Q

What is cephalhaematoma?

A

Subperiosteal haematoma that does not cross suture lines

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20
Q

What should be monitored if presence of cephalhaematoma?

A

Bilirubin

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21
Q

What is a subgaleal haemorrhage?

A

Haemorrhage aponeurosis of the scalp and periosteum

Forms large fluctuant collection which crosses suture lines

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22
Q

What is craniosynostosis?

A

Condition in which one or more the sutures fuses prematurely

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23
Q

What is the result of craniosynostosis?

A

Raised ICP
Damage to intracranial structures

Surgical intervention required

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24
Q

What does a tense bulging fontanelle suggest?

A

Raised ICP

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25
What does a sunken fontanelle suggest?
Dehydration
26
What should be looked for on the skin?
Colour Bruising/lacerations (documented Birthmarks/other marks Vernix
27
What is a Mongolian spot?
Benign flat birthmark with irregular shape usually over sacrum
28
What is nevus simplex also known as?
Stork bite | Salmon patch
29
What is a nevus simplex?
Congenital capillary malformation most commonly on the eyelid/glabella/back of neck
30
When does nevus simplex normally resolve be?
First year
31
What is naevus flammeus?
Vascular malformation that does not regress
32
What is naevus flammeus also known as?
Port wine stain
33
What is looked for on the face?
Appearance Asymmetry Trauma Nasal patency
34
What is looked for in the eyes?
Erythema Discharge Sclera inspection Position + shape Red reflex Subconjunctival haemorrhages
35
How do you assess for the red reflex?
Use ophthalmoscope
36
What does an absence of the red reflex suggest?
Congenital cataracts | Retinoblastoma
37
What is looked for in the ears?
Pinna symmetry + shape Ear position
38
What is looked for in the mouth?
Cleft palate - use torch + tongue depressor Evidence of tongue-tie
39
What is looked for in the neck?
Length of neck Neck webbing Neck swellings Clavicular fracture
40
What is looked for in the upper limbs?
Symmetry Count fingers Inspect palms - 2 palmar creases Palpate brachial pulses
41
What does one single palmar crease indicate?
Down's syndrome
42
What is looked for in the chest?
Chest wall deformities Chest wall expansion Ausculate - heart sounds - air entry Pre + post ductal pulse oximetry
43
What should be looked for in the abdomen?
Abdominal distension Hernias - inguinal - umbilical Palpate - liver - spleen - kidneys - bladder Umbilicus
44
What is looked for in the genitalia?
Any ambiguity
45
What is looked for in male genitalia?
Position of meatus Size of penis Hydrocele Palpate scrotum for 2 testes
46
What is looked for in female genitalia?
Inspect labia | Inspect clitoris
47
What is assessed in the anus?
Patency | Position
48
What is looked for in the lower limbs?
Symmetry Tone Movement Palpate femoral pulses Count toes
49
What tests are conducted on the hips?
Barlow's test | Ortolani's test
50
What is Barlow's test?
Adduct the hips while applying light force to the knees pushing them posteriorly
51
What is a positive Barlow's finding?
Dislocation of the hip Positive = bad
52
Why is Ortolani's test done?
Confirm posterior dislocation of the hip joint
53
What is Ortolani's test?
Flex hips + knees Place anterior pressure on greater trochanters and abduct the hips
54
What is a positive Ortolani's finding?
'Clunk' hears as hip relocates
55
What is looked for in the spine?
``` Scoliosis Hair tufts Naevus Abnormal skin patches Birthmarks Sacral pits ```
56
What reflexes are tested?
``` Palmar grasp reflex Suckling reflex Rooting reflex Stepping reflex Moro reflex ```
57
What is the palmar grasp reflex?
When an object is placed in an infants hand, fingers will grasp it in the palm
58
What is the sucking reflex?
Child will suck anything that touches the roof their mouth
59
What is the rooting reflex?
Child will turn its head towards anything that strokes it cheek or mouth
60
What is the stepping reflex?
When the soles of their feet touch a flat surface, they will appear to walk
61
What is the moro reflex?
Warn parents first Support the infants upper back with one hand, then drop back once or twice onto other hand Legs + head extend, arms jerk up with fingers extended Arms then brought together and hands clench into fists and infant cries
62
How do you complete the new-born examination?
Thank parents Share results with parents Offer to help redress child Wash hands Document findings

Paediatrics (40 decks)

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