Y2 NIPE Flashcards
Which are the five steps of the neonatal examination?
Preparation Observation Examination Explanation Documentation
Scalp
Bruising/swelling
Head
sutures and fontanelles, size, asymmetry/shape
Face
Characteristics for T21 etc. Cleft lip, Asymmetry
Mouth
Cleft lip, Teeth, Cysts, Cleft Palate, Macroglossia
Ears
Skin creases, Deformity/absence, pre-auricular skin tags, ?position
Eyes
Absence, Asymmetry, Red reflexes, Corneal opacities, Coloboma
Neck
Extra skin folds, Asymmetry, dimples, Swelling
Hands and feet
Asymmetry/Absence, skin creases, swelling.
Digits
Too few/too many, appearance of nails, Appearance of digits, Webbing.
Skin
Aplasia cutis, Birthmarks, Cuts and bruises, Pigmentation
Chest
Shape, Nipple position and number
Cardiovascular system
Heart position, Heaves and thrills, Heart sounds and murmurs (five spots), peripheral pulses
Respiratory system
Respiratory effort, Breath sounds
Abdomen
Distension, shape, Organomegaly, Tenderness
Umbilicus
Condition of cord and surrounding skin
Male genitalia
Testes, shape and size of penis, position of meatus, Urine stream.
Female genitalia
Appearance, Withdrawal bleeding.
Anus
Patency, Position, passage of meconium.
Groin
Swelling
Hips
Stability
Spine
Deformity, overlying marks/defects
CNS
Symmetry of reflexes, Appropriateness of reflexes, Ability to suck, Tone, Posture.
Size
Weight, Length, Head circumference.
What aspects need to be considered when looking in the case notes before undertaking a NIPE examination?
- Family history
- Past medical history
- Past obstetric history
- Present obstetric history
- Details of birth
- Wellbeing of baby at birth and following (APGAR etc)
What maternal aspects need to be considered before a NIPE?
Substance misuse Diabetes Hypertension Medication Cardiac conditions STIs Family history GBS present RhD status
What fetal aspects need to be considered before a NIPE?
SGA IUGR Macrosomia Congenital abnormalities Multiple pregnancy
What intrapartum aspects need to be considered before a NIPE?
Gestational age Abnormal FHR pattern Shoulder dystocia PROM Presence of meconium APH Operative delivery and why Maternal fever/sepsis
What equipment is needed to perform a NIPE ?
Stethoscope, Ophthalmoscope, Spatula, Tape measure, ?pulse oximeter
What is the normal weight of a newborn?
Around 3,5 kg
What is the average length of a newborn?
Around 50 cm
What are Petechiae?
Petechiae are pinpoint, round spots that appear on the skin as a result of bleeding. The bleeding causes the petechiae to appear red, brown or purple. Petechiae (puh-TEE-kee-ee) commonly appear in clusters and may look like a rash. Usually flat to the touch, petechiae don’t lose color when you press on them. Can be a sign of low platelets, or congenital rubella/ congenital syphilis.
What is the normal head circumference of a newborn?
32-36 cm in a term baby
After how long after birth should “normal” swelling of the fontanels go away?
around 24 hrs
How can you see the difference between caput and cephalohematoma?
Caput- indistinct border, CH- clear edge
Caput- present since birth, CH- appears after birth and increases for 2-3 days
Caput-swelling cross suture lines, CH, swelling does NOT cross suture lines
Caput- disappears within days, CH- can take weeks to resolve
What are risk factors for cephalohematoma? Why are they critical to note?
Cephalohematoma occurs twice as often in males as in females, for unknown reasons. It is more common in primagravidas, in large infants, following instrument-assisted deliveries (with vacuum or forceps), following prolonged difficult labour, when cephalopelvic disproportion exists, when the head is in a deviant position (occipital posterior, occipital transverse), or when a scalp electrode has been placed. They can hide skull fracture, intracranial bleeding or a blood clotting disorder.
What could ear dimples/tags/abnormal position indicate and what should be done about it?
Chromosomal abnormalities/ syndromes, referral to neonatal staff
What is Talipes equinovarus?
Talipes equinovarus or club foot is the most common foot deformity in the UK occurring in 1:1000 births. The foot is plantar flexed (turned downwards and inwards the midline of the baby) and it can be structural or fixed. Newborn males are twice more likely to have this condition than females and in 50% of cases both feet are effected. The cause is unknown but can be associated with down’s syndrome or spina bifida therefore referral is required. Positional talipes is when the feet can easily be corrected with gentle manipulation and is caused due to constricted uterine space.
How and why do we palpate the liver?
to ensure not enlarged over 1cm below the costal margin(may be present in congestive heart failure).
normal respiratory rate for a newborn is?
40-60 breaths/minute
Which reflexes are tested in the NIPE?
Moro Rooting Sucking and swallowing Palmar/Plantar Grasp Walking and stepping Crawling
Questions regarding activity, behaviour cry and tone indirectly assess
Respiratory, cardiovascular, skeletomuscular, neurological
Questions regarding color and temperature indirectly assess
Respiratory, cardiovascular, metabolic, immunological
Questions regarding urinary output indirectly assess
renal, immunological
Questions regarding feeding and stools indirectly assess
gastrointestinal and immunological
Questions regarding skin integrety/ rashes/ spots indirectly assess
immunological
