1. Newborn.pptx

NEWBORN EXAMINATION PAEDIATRICS Learning Objectives • To learn how to approach newborn • To apply birth (natal) history while approaching newborn history taking and examination • To recall steps by steps examination of newborn • To distinguish benign neonatal conditions • To understand neonatal re...

NEWBORN EXAMINATION PAEDIATRICS Learning Objectives • To learn how to approach newborn • To apply birth (natal) history while approaching newborn history taking and examination • To recall steps by steps examination of newborn • To distinguish benign neonatal conditions • To understand neonatal reflexes and clinical significance • To learn new Ballard Score and its application in gestational age Normal or Concern A term neonate born in good condition, developed respiratory distress in the first hour of life. No risk factors for sepsis such as maternal pyrexia or prolonged rupture of membranes. Baby becomes cyanotic at rest but regains colour when cries. 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) 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 Examination at birth: Assess Ask: Birth History (Pre, Natal, Post) Check o Weight the baby o Temperature Record Weight and Height Measurement • Preparing and weighing the baby  Remove all clothing  Wait till the baby stops moving  Weigh naked  Read and record  Return the baby to the mother MEASUREMENT HEAD Inspect and palpate • Bruising • Edema, • Molding/shape, • Sutures • Fontanelles Overlapping of skull bones – MOULDING Can reduce the diameter of skull temporarily Within 24 hours, oedema and moulding show improvement. SWELLING OVER HEAD Cephalohematoma (Sub periosteal bleed) Caput Succedaneum Soft tissue swelling NECK AND CLAVICLES • Range of motion – short neck but should have full range of motion • Asymmetry • Masses - Lateral or midline, cystic or solid • Crepitus NECK Congenital Goiter EYES • Symmetry • Set/shape • Discharge – slight yellow discharge is normal • Erythema – RED FLAG • Red light reflexes or orange yellow in dark skinned neonates Normal or Abnormal? Leucocoria Ear, Nose, Mouth • Ear- set/shape, preauricular pits/tags • Nasal – shape, patency, polyp Nasal congestion is normal • Palate and lips – intact, colour, • Gum • Tongue – freely mobile Cleft lip and Palate Preauricular Pit Chest • Shape of thorax - deformity • Position of nipples – midclavicular lines. Small breast bud is normal • Breathing – Respiratory distress. Listen Grunting – Respiratory distress Cry Auscultation Heart rate – 120 -160/mins Murmurs Breathsounds ABDOMEN AND UMBILICUS • • • • • • Shape of abdomen Liver – 1-2 cm below the right costal margin. Spleen – should not be palpable Kidneys – usually by non ballotable Umbilical cord – dry, swelling Umbilical arteries – 2 arteries and 1 vein • Listen to Bowel sounds Which one is abnormal? GENETILIA • Labia – Maturation by gestation • Hymen – orifice visible or not Mucoid discharge and slight bleeding - normal • Penis – straight • Testicles – check in the scrotum • Anus - check the patency TRUNK AND BACK • Back - symmetry, deformities • Spine – palpable along the length (Neck to sacrum) • Skin lesions and hair at back – FURTHER INVEXTIGATION • Masses or lumps Spina Bifida Occulta Normal or Abnormal? EXTREMITIES • Fingers and toes – counted, malformations • Arms and legs - mobility, posture (birth injury) and tone • Deformity • Stability PRIMITIVE REFLEXES • Evaluate the developmental status and the integrity of the neurological system • Indication of the baby’s gestational age (prematurely born) SUCKING REFLEX • Elicited by placing a clean gloved finger, bottle or dummy in the mouth and the tongue • Stimulus in the mouth - elicit a sucking reflex • Weak in preterm baby (well established 32-34 weeks) MORO REFLEX • Tested on a padded surface e.g. on crib cushion or foam mat • Held at a 45 degree angle to the supporting surface. • The head is then lifted up slightly. • Allow the head to suddenly fall a couple of centimetres before immediately supporting the head again MORO REFLEX PALMER GRASP • When a finger/or other stimulus into the palm of the child’s hand • Fingers flex and the child firmly grasps the hand. • Hand will relax and open directly after reaction occurred PLANTAR GRASP SURVIVAL AT THE LIMIT OF VIABILITY BY GA Which one is Benign? Which one is Normal? CONCERN! A 12-hour-old term baby has 1) Weight of 4.4 kg 2) Hb of 15.8 g/dL 3) Heart rate of 71/min 4) OFC of 37 cm 5) Respiratory rate of 50/min Hump at back A newborn baby is born with a midline lumbrosacral cystic lesion. Occipitofrontal circumference was above the 90th percentile. The next best step is: • A. Cranial ultrasound • B. Renal tract ultrasound • C. Surgical closure of the back • D. Ventricular tap Bleeding in newborn A 7-day-old term boy is admitted to hospital with bruising and bleeding from the umbilical stump. He had been born at home and was not given vitamin K after birth. The full blood count is normal, but prothrombin time and activated partial thromboplastin time are elevated. What is the BEST treatment for the baby? A. Intramuscular vitamin K only B. Intravenous vitamin K only C. Intravenous vitamin K plus fresh frozen plasma D. Intramuscular vitamin K plus fresh frozen plasma References • • • Kliegman RM (ed.). Nelson Textbook of pediatrics.20th ed. Elsevier; 2016. Gomella TR (ed.). Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. 7th ed. McGraw-Hill education. 2013. Ballard JL. New Ballard Score Maturational Assessment of Gestational Age. Available from: http://www.ballardscore.com/