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

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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)

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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

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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?

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

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Peripheral cyanosis Milia Mongolian Blue spot Erythema toxicum (neonatal urticaria) www.nursingcrib.com Illustrated textbook of paediatrics (Lissauer)

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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

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www.abclawcenters.com

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

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

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Mouth Colour of mucus membrane Palate High arched Marfans Cleft lip/palate Tongue tie Sucking reflex Rooting reflex High arched palate Cleft lip Tongue tie Rooting reflex www.mothering,.com www.clapa.com newborns.stanford.edu beyondspine.com

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

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Erbs Palsy Illustrated textbook of paediatrics (Lissauer) shoulderdystociainfo.com

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

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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

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Abdomen Abdominal girth and shape 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 medscape.com

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Exomphalos/OmphalocoeleGastroschisis www.cdc.gov

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

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Reflexes wikipedia Moro reflex

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

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Guthrie test 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-CoA dehydrogenase Others e.g. Maple syrup urine disease www.mun.ca namrata.co

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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

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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

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Questions?