Newborn Baby Examination Ellie Duckworth Stage 3 student

Newborn Baby Examination Ellie Duckworth Stage 3 student, University of Cambridge School of Clinical Medicine 2 nd May 2015

Newborn examination • Newborn babies must be examined within 24 hours of birth • Purpose of the examination: • Detect congenital anomalies not already detected at birth • Check for potential problems arising from maternal or familial disease • Checked again at 6 weeks old (usually by GP)

Examination routine • Usually described as examining ‘top to toe’ • In reality, adapt the order of examination to when the baby is settled or crying: • Auscultation first (before removing rest of clothing) • Palate – more visible when the baby is crying, or feel with finger • Sucking reflex – can also help to calm the baby down • Leave most distressing parts until the end e. g. Moro reflex & hip examination

History • Key points in taking a history from the mum: • Pregnancy and mode of delivery • Did they cry straight after birth? Any problems with breathing? • Family history • Congenital heart disease • Hearing problems • Hip dysplasia • Has baby passed urine or meconium yet? • Any problems with breast/bottle feeding?

General observations • Undress down to the nappy • Remember to look at the baby’s back as well • Skin • Colour • Skin lesions • Respiratory effort • Spontaneous movements and posture – symmetrical? • Dysmorphic features

Illustrated textbook of paediatrics (Lissauer) Milia Illustrated textbook of paediatrics (Lissauer) Mongolia n Blue spot Erythem a toxicum (neonata l urticaria) Peripheral cyanosis Illustrated textbook of paediatrics www. nursingcrib. com

Head • Measure head circumference • Fontanelle • Tense • Raised ICP • Meningitis (late sign) • Sunken • Dehydration • 3 rd fontanelle • Downs • Check skull and facial bones for birth injuries www. quickmedical. com

www. abclawcenters. com

Eyes • Check red reflex with ophthalmoscope • Lack of red reflex www. kellogg. umich. edu • Cataracts • Retinoblastoma • Ophthalmic infections Retinoblasto ma

Ears www. gethelponline. org • Shape and size • ‘Low set’ ears • Down’s quizlet. com • Edwards • Di George • Turners • Noonan Edwards Syndrome • Patency of external auditory meatus Di George Syndrome

www. mothering, . co m Mouth www. clapa. com High arched palate • Colour of mucus membrane • Palate • High arched – Marfan’s • Cleft lip/palate newborns. stanford. edu beyondspine. com • Tongue tie Cleft lip • Sucking reflex • Rooting reflex Rooting Tongue tie

Arms & Hands Simianline. handresearch. com • Check neck, shoulders & clavicles for traction birth injury • Count fingers • Shape of fingers – clinodactyly • Palmar creases – multiple or single cai. md. chula. ac. th • Grasp reflex Single palmar crease Clinodacty ly

Erb’s Palsy shoulderdystociainfo. com Illustrated textbook of paediatrics (Lissauer)

Legs & Feet wikipedia • Watch movement of each joint • Check for talipes equinovarus • Count toes hellomrdoctor. com • Shape of toes Talipes equinovarus • Babinski reflex • Grasp reflex Babinski reflex

• Peripheral pulses • Brachial, radial & femoral • Radio-femoral delay • Heart • Apex beat • Heaves or thrills • Auscultation • Lungs • Watch respiratory pattern, rate and depth • Grunting, head nodding, intercostal recession, stridor • Auscultation

Abdomen • Abdominal girth and shape medscape. com • Omphalocoele/gastroschisis • Umbilical stump • Infection (Omphalitis) • Hernia • Palpate for organs, masses or hernia • normal to be able to feel liver and/or spleen in newborns • External genitalia • Undescended testes • Inspect anus for patency Omphalitis

www. cdc. go v Exomphalos/Omphaloco ele www. cdc. gov Gastroschisis

Back • Check for skin lesions • Palpate down the spine • Looking for: • Spina bifida occulta • Pilonidal sinus biology-forums. com

Reflexes wikipedia Moro reflex

Hips Checking for developmental dysplasia of the hip (DDH) Illustrated textbook of paediatrics (Lissauer)

Guthrie test www. mun. ca • Blood sample (heel prick) taken on day 5 -9 of life • In UK, all infants screened for: • Phenylketonuria • Hypothyroidism • Haemoglobinopathies • Cystic fibrosis • MCAD (medium-chain acyl-Co. A dehydrogenase • Others e. g. Maple syrup urine disease namrata. co

Hearing screening • Early detection and intervention of severe hearing impairment • Prevents delay in speech and language development • Evoked optoacoustic emission (EOEA) • Earphone over the ear to emit sound • The sound evokes an echo/emission from the ear if cochlear function is normal • Automated auditory brainstem response (AABR) • If normal test not achieved • Uses computer analysis of EEG waveforms www. homerton. nhs. uk

Vitamin K • Vitamin K deficiency can cause haemorrhagic disease of the newborn • Usually mild symptoms – bruising, haematemesis, melaena, prolonged bleeding around umbilical stump • Can be severe – intracranial haemorrhage • IM injection of vitamin K given to most newborn infants in the UK immediately after birth • Parents can request oral vitamin K but this requires 3 doses over first month of life to achieve adequate liver storage

Questions?