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PaedsY5 Neonatal Medicine > Routine Examination of the Newborn > Flashcards

Routine Examination of the Newborn Flashcards

1
Q

When is routine exam done and by whom?

A

Immediately after birth by midwife, paediatrician or obstetrician

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2
Q

Why is the routine examination done?

A

To check for no major abnormalities such as baby should be pink/ breathing normally

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3
Q

How do you manage if an immediate problem is found?

A
  • Experienced paediatrician must discuss with parents
  • Neonatal unit if v small, preterm or ill
  • Uncertain sex- counsel parents that further investigations are needed
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4
Q

When should a thorough exam be done?

A

within 72 hours of birth with parents/ mother

Baby must be naked

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5
Q

What do you look for on inspection in thorough examination?

A

Tone (Head lag, flexion arm/leg, hold by stomach - floppiness indicates neuro/ chromo/ met/ sepsis issue)

Respiratory effort
Crying (good)
Colour
Obvious abnormalities
Assess movement
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6
Q

What are you looking for on the skull of an infant?

A

Head circumference (normal)

Shape

Cranial sutures

Fontanelle (sunken = dehydrated, bluging = raised ICP)

Moulding/ caput/ cephalohaematoma

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7
Q

What is moulding?

A

abnormal head shape that results from pressure on head during childbirth

(overlap/ close skull bones)

can decrease biparietal diameter by about 1 cm

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8
Q

What is caput succedaneum?

A

Caput succedaneum involves serosanguinous, subcutaneous and
extraperiosteal fluid collection with poorly defined margins caused by the
pressure of the presenting part of the scalp against the dilating cervix during
delivery

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9
Q

How does caput succedaneum look?

A

Swelling/oedema of scalp that appears as a lump or bump on their
head shortly after delivery

Typically forms over the vertex and crosses suture lines

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10
Q

What is a cephalohaematoma?

A

A cephalohaematoma is a haemorrhage
of blood between the skull and the
periosteum (membrane that covers the
outer surface of all bones)

No pressure on the brain

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11
Q

Why do cephalohaematomas occur?

A

Occurs in newborn due to small blood
vessels on the fetal head broken as a
result of minor trauma during birth
process

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12
Q

When do cephalohaematomas arise?

A

The bleeding is gradual and hence,

becomes apparent hours-days after birth

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13
Q

What does cephalohaematoma look like?

A

Increases risk of jaundice in the first days after birth

Bilateral parietal swelling

Takes months to resolve

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14
Q

What are you looking for on the face?

A 
Dysmorphia
Trisomy 21
Milia
Forcep mark on cheeks
Facial nerve damage
Micrognathia (Pierre Robin syndrome)
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15
Q

What are the signs of trisomy 21?

A 
flattened face 
small brachycephalic head
epicanthal folds
flat nasal bridge
small nose and mouth
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16
Q

What is milia?

A

Benign, keratinous cysts appearing as tiny white bumps – should go away in
few days on their own

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17
Q

What are signs of facial nerve damage?

A

Check for eye closure at rest as likely to need eye
lubricant drops to stop dry eye, this will usually resolve spontaneously but
occasionally damage can be permanent

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18
Q

What is micrognathian (Pierre Robin syndrome)?

A

when jaw is undersized; symptom of various
craniofacial conditions; may need respiratory support until growth allows airways to
remain open, trachy in worst affected cases

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19
Q

What should you check in ears in infants?

A

Patent External Auditory canals

Microtia with absent external auditory canals

Low set ears (Trisomy 18)

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20
Q

What should you check for in an infants mouth?

A

Visualise palate

Check reflexes: root and suck

Cleft lip

Cleft palate

Natal tooth

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21
Q

What should you check for in an infants eyes?

A

Red reflexes (cataracts- to stop ambylopia, early surgery)

Sub conjunctival haemorrhage (usually benign and will fade)

Petechiae

Congenital glaucoma/ colobama (Key hole shaped pupil)

22
Q

What should you check for in an infants nose?

A

Babies only breathe through their nose, not mouth (because their soft palate not as
developed, tongue too big and jaw not as developed, and being able to coordinate
breathing and swallowing is too much)

23
Q

What do you look at in the neck of a newborn?

A 
Tone
Length
Webbing (Turner's)
Swelling
Feel for clavicles (ensure no traumatic fracture)
24
Q

What does hypotonia look like in a newborn?

A

arms and legs lying flat against bed, with very little head control when
lifting, will flop forwards when held prone (rag doll like)

25
Q

What are the parts of the limb examination in newborns?

A 
All limb movement
Arms
Hands
Legs
Feet 
Hips
26
Q

How do you examine Arms?

A

Equal movement on both sides
Erb’s and Klumpke’s palsy
Palpate brachial pulse (radial too smol)

27
Q

What is Erb’s and Klumpke’s palsy?

A

Erb’s palsy: due to injury to brachial plexus usually due to shoulder dystocia
during birth; will usually resolve spontaneously within first week or so,
physio referral

▪ Klumpke’s palsy: partial palsy of lower
roots of brachial plexus, can occur due
to traumatic vaginal delivery causing
traction on an abducted arm (e.g.
someone catching themselves by a
branch as they fall from a tree)
28
Q

How do you examine the hands?

A

Check for 5 fingers (polydactyly and syndactyly)

Reflex: Palmar grasp

Check crease (Singly may be Trisomy 21)

29
Q

What are the different types of dactyly?

A

Polydactyly: >5
Syndactyly: partly/ wholly united
Clindodactyly: curved finger into plane of palm

30
Q

How do you examine the legs?

A

Equal movement on both sides?

Hemiplegia

Equal length and skin folds

Check femoral pulses – important for cardiac defects

31
Q

How do you examine feet?

A

Check for 5 toes (syndactyly, polysyndactyly, sandal gap)

Reflex: Plantar grasp, Babinski

Positional foot deformities

Bilateral fixed talipes

Pedal oedema (Chromosomal abnormality like Turner’s)

32
Q

How do you deal with hand dactyly?

A

Polydactyly:
• Post axial extra digit: needs specialist plastic surgery referral
• Pre axial extra digit: plastics referral

Syndactyly:
If very severe can cause major functional problems

33
Q

How do you fix foot deformities?

A

o Positional foot deformity (positional talipes): easy to re-position back into a natural
position, physio referral and should resolve with time

o Bilateral fixed talipes (unable to easily position in neutral position): needs
orthopaedic referral and will need surgical correction

34
Q

Hips don’t lie

A

Look for DDH, dislocated hips, stepping reflex and breech legs

35
Q

How do you manage DDH?

A

Early detection of DDH is important as early splinting in abduction reduces
long-term morbidity → specialist orthopaedic opinion should be sought in
DDH

36
Q

What are Barlow and Ortolani’s tests?

A

Barlow’s test (dislocation): pushes the femoral head backwards (toward the
bed) and will dislocate the femoral head posteriorly if the hip joint is
abnormal (shallow or poorly formed) – you may feel a clunk or an abnormal
amount of posterior movement

Ortolani’s test will relocate already dislocated femoral heads back into the
acetabulum with a palpable clunk

37
Q

What are breech legs?

A

When a baby is lying bottom or feet first and must be delivered in this
position, usually benign and will settle over the first week or so, need to check hips
carefully and arrange hip ultrasound

38
Q

What do you look for in the chest?

A

Rate of breathing

Equal chest wall movement

Work of breathing (tracheal tug, intercostal and subcostal recession, head bobbing, nasal flaring, resp rate, grunting)

Recession

Chest shape (e.g. prominent xiphisternum)

39
Q

What do you listen for in the chest?

A

Equal air entry

Normal breath sounds

Heart rate

Heart sounds

Murmur

40
Q

What do you look for in the abdomen?

A

big but soft

Abnormally: Extreme distension, shiny skin, visible veins

Hernias

Diastasis recti

Urate crystals in Nappy

Palpate/ listen: abdominal shape, soft and non tender, liver, spleen and kidney (organomegaly/ palpable mass), bowel sounds, check anus is patent and normally situated

Bile stained vomit is always abnormal

41
Q

What is the commonest hernia?

A

Umbilical hernia: very common, almost always benign and will resolve
spontaneously

42
Q

What do you look for in male genitalia?

A

Normal penis

Both testes in scrotum

Hernias

43
Q

What do you look for in female genitalia?

A

Normal anatomy

Fused genitalia

Size of clitoris (large may be CAH)

Ambiguous genitalia

44
Q

What abnormalities may you discover on inspection of male genitalia - penis?

A

Normal size >2cm

Hypospadias: urethral opening abnormally situated on underside of penile
shaft (can be down at penile base), needs urological/surgical referral and is
STRICT contraindication to circumcision

Chordae: bend in penile shaft, can occur alone or with hypospadias, needs
surgical referral and is contraindication to circumcision until surgical review

45
Q

What abnormalities may you discover on inspection of male genitalia - Scrotum/ Testes?

A

Normal are like peas, can be hard to feel

Bilateral hydrocoeles: check you can get ‘above the mass’ and these will
transilluminate brightly, surgical referral needed although most likely to
spontaneously resolve

Testes not fully descended: in inguinal canal (can often be gently milked into
scrotum), GP should review to check descent

46
Q

What abnormalities may you discover on inspection of male genitalia - Inguinal canal?

A

Bilateral inguinal hernias: unable to feel the top of these masses and
generally do not transilluminate. These can easily strangulate and need
relatively urgent surgical review. Will need herniotomy

47
Q

How do you manage ambiguous genitalia?

A

Medical and social emergency, consultant involvement immediately,
very careful management of family and urgent investigations. Ideally involve local or
regional speciality team right from start.

48
Q

What do you look for when you examine the spine?

A

Straightness

Look and feel all the way down

Check for scoliosis/ marks/ moles etc.

Lesions near base

49
Q

What lesion may be present near the base of the spine and how do you manage them?

A

o Sacral dimple: look for base, usually benign and needs no further action unless
concern about fistula or associated with other abnormalities

o Myelomeningocoele: needs urgent neurosurgical input

o Assess sacrum for hair tufts, sacral pits (signs of underlying neural tube defect e.g.
spina bifida) - very uncommon now due to folate given in pregnancy. Can get normal
pits with no hair surrounding it, and can see where the pit ends — if none of these,
must refer for SPINAL ULTRASOUND

50
Q

What do you look for on the skin?

A

Birth marks

Jaundice

Dry/ peeling skin

Blood vessels

51
Q

What do parents need to be aware of when they leave?

A

Back to sleep and SIDS prevention information

Routine screening (Guthrie test)- PKU, congenital hypothyroid, CF, MCADD, SCD + Hearing

Routine health checks with midwife, HV and GP

Routine childhood immunisation schedule

Breastfeeding support groups

PaedsY5 Neonatal Medicine (8 decks)

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