NIPE

Question 1

When is a NIPE performed?

Answer 1

Performed within 72hrs

Second examination at 6-8 weeks, usually by a GP to identify abnormalities that develop or become apparent later.

Question 2

What do you look for on inspection?

Answer 2

Pallor: anaemia, congestive cardiac failure
Cyanosis: right to left shunting, hypovolaemia
Jaundice
Posture: hemiparesis, Erb’s palsy
Tone: hypotonic (rag doll, difficulty feeding)- more common in down’s

Question 3

What do you asses in a neonate’s head?

Answer 3

Head circumference:
microcephaly- reduced brain size
macrocephaly- hydrocephalus, cranial vault abnormalities, genetic abnormalities
Shape:
cranial sutures
Cranial moulding
Caput succedaneum, cephalhaematoma, smbgaleal haemorrhages, craniosynostosis
Fontanelle-
tense bulging: raised ICP- hydrocephalus
Sunken- dehydration

Question 4

How do you assess a neonate’s skin?

Answer 4

Colour: pallor, cyanosis, jaundice 
Bruising/lacerations 
Vernix: waxy substance (normal)
Birthmarks: salmon patch, Haemangiomas, port wine stain 
Erythema toxic

Question 5

How do you assess a neonate’s face?

Answer 5

Appearance: dysmorphic features
Asymmetry: facial palsy in instrumental delivery
Trauma (labour)
Nose: latency of nasal passages
Eyes: erythema or discharge, discolouration, position and shape
Red reflex using ophthalmoscope
Ears: skin tags, asymmetry
Mouth and palate: clefts or hard or soft palate. Tongue tie (ankyloglossia)

Question 6

What are the causes of an absent red reflex?

Answer 6

congenital cataracts, retinal detachment, vitreous haemorrhage and retinoblastoma
presence of a white reflex (leukocoria), regardless of whether the red reflex is partly visible suggests the presence of one of the pathologies mentioned previously.
immediate ophthalmology referral.

Question 7

How do you assess the neck and clavicles?

Answer 7

Neck: length, abnormalities like webbing
Neck lumps: cystic hygroma in posterior triangle
Clavicular fracture- bruising, abnormal position of the arm

Question 8

How do you assess the upper limbs?

Answer 8

Symmetry
Fingers: polydactyly
Palms: 2 palmar creases (normal), 1 (downs)
Brachial pulse

Question 9

How do you assess the chest?

Answer 9

Observe: RR (40-60) and work of breathing (grunting, tracheal tug, intercostal recession, head bobbing)
Pectus excavatum, Pectus carinatum
Auscultation:
Lungs
Heart (bottom to top)- bell and diaphragm (HR 120-150)
Pulso oximetry

Question 10

How do you assess the abdomen?

Answer 10

Inspection: distension, umbilicus (stump infection/hernia)
Palpation: liver, spleen, kidneys, bladder (should not be palpable)

Question 11

How do you assess genitalia?

Answer 11

Males:
Position of urethral meatus 
Size (2cm)
Testicular swelling (hydrocele)
Palpate scrotum to feel for both testes (unilateral undescended common)
Female: 
Labia (check not fused)
Clitoris (normal size)
Vaginal discharge (white is normal- exposure to maternal oestrogens)

Question 12

How do you assess the lower limbs?

Answer 12

Asymmetry
Oedema
Ankle deformities- talipes
Number of digits on feet
Assess tone- (decreased in downs)(asymmetrical in intracranial haemorrhage, ischaemic stroke)
Assess movement: upper or lower motor neurone lesion or joint pathology
Assess range of knee movement
Palapate and compare femoral pulses (weak, absent or delayed- coarctation of aorta)

Question 13

How do you assess the hips?

Answer 13

Barlow’s:
performed by adducting the hip (bringing the thigh towards the midline) whilst applying light pressure on the knee with your thumb, directing the force posteriorly.
If dislocatable considered positive
Ortolani’s:
confirm posterior dislocation of the hip joint
Flex the hips and knees of a supine infant to 90°
With your index fingers placing anterior pressure on the greater trochanters, gently and smoothly abduct the infant’s legs using your thumbs.

Question 14

How do you assess the back spine and anus?

Answer 14

Spine:
Scoliosis, hair tufts, nave, sacral pits (neural tube defects, spina bifida)
Anus:
Patency and meconium should be passed in 24 hours

Question 15

How do you assess reflexes?

Answer 15

Palmar grasp reflex: object is placed in the infant’s hand and strokes their palm, the fingers will close and they will grasp it
Sucking reflex: instinctively suck anything that touches the roof of their mouth
Rooting reflex: A newborn infant will turn its head toward anything that strokes its cheek or mouth to aid breastfeeding.(disappears around 4 months)
Stepping reflex: soles of the infant’s feet touch a flat surface they will appear to walk by placing one foot in front of the other
Moro reflex:
Support the infant’s upper back with one hand, then drop back once or twice into your other hand.
Normal Moro reflex involves the extension of the legs and head whilst the arms jerk upwards with the fingers extended. The arms are then brought together and the hands clench into fists, and the infant cries. Asymmetry may be due to hemiparesis, brachial plexus injury or a fractured clavicle.