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Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
Newborn examination
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Newborn examination

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how to examine a baby after delivery before discharge to home

how to examine a baby after delivery before discharge to home

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  • 1. NEWBORN SCREENING © DR.RAMESH RAMACHUNDRAN
  • 2. Definition <ul><li>Head to toe physical examination of a newborn to look for any abnormalities or pathology. </li></ul><ul><li>Includes biochemical screening & certain special screening ( ROP, hearing assesment, Echocardiography) </li></ul>
  • 3. <ul><li>Assesment at birth </li></ul><ul><li>Physical examination </li></ul><ul><li>Biochemical screening </li></ul><ul><li>Special screening </li></ul><ul><ul><ul><li>Retinopathy Of Prematurity </li></ul></ul></ul><ul><ul><ul><li>Hearing assesment </li></ul></ul></ul><ul><ul><ul><li>Echocardiography </li></ul></ul></ul>
  • 4. Newborn first exam : Apgar Score 0 1 2 1m 5m 10m 15m 20m Colour Blue or pale Body pink, extremities blue Complete pink Heart rate Absent Slow <100/min >100/min Respiratory effort Absent Slow irregular Good, crying Muscle tone Limp Some flexion Active motion Reflex irritability No response Grimace Cry/active withdrawals TOTAL
  • 5. Physical examination <ul><li>COMPLETE physical examination within 24 hours of birth. </li></ul><ul><li>It is best to examine when the infant is quiet. </li></ul><ul><li>Ensure infant is naked : he/she can be in diapers, but you have to open it. </li></ul><ul><li>Do not forget to wash your hands prior to examination. </li></ul>
  • 6. Measurements… <ul><li>Head circumference : </li></ul><ul><li>- a.k.a Occipitofrontal circumference </li></ul><ul><li>- place measuring tape around front of head, below the </li></ul><ul><li>brow and occipital area. </li></ul><ul><li>- Normal range 32cm-37cm </li></ul><ul><li>Length & Percentile (refer growth chart) </li></ul><ul><li>Weight & Percentile (refer groth chart) </li></ul><ul><li>Assesment of Gestational Age & Percentile </li></ul><ul><ul><ul><li>-Small for Gestational Age </li></ul></ul></ul><ul><ul><ul><li>- Appropriate for Gestational Age </li></ul></ul></ul><ul><ul><ul><li>- Large for gestational age </li></ul></ul></ul>
  • 7. Vital signs <ul><li>Temperature : Rectal </li></ul><ul><li>Respirations : Normal rate is 40-60 </li></ul><ul><li>Blood pressure : Correlates with gestational age, post natal age, birth weight. </li></ul><ul><li>Pulse rate : Awake 120-160bpm, Asleep 70-80bpm </li></ul>
  • 8. <ul><ul><li>Colour </li></ul></ul><ul><ul><li>Plethora (deep rosy red) </li></ul></ul><ul><ul><li>Jaundice </li></ul></ul><ul><ul><li>Pallor </li></ul></ul><ul><ul><li>Cyanosis( central , peripheral , acrocyanosis ) </li></ul></ul><ul><ul><li>“ Blue on pink: or “Pink on blue” </li></ul></ul><ul><ul><li>Harlequin colouration </li></ul></ul><ul><ul><li>Mottling </li></ul></ul><ul><li>Rashes </li></ul><ul><li>Milia </li></ul><ul><li>Erythema toxicum </li></ul><ul><li>Candida albicans rash </li></ul><ul><li>Transient neonatal pustular melanosis </li></ul><ul><li>Acne neonatorum </li></ul>SKIN
  • 9. SKIN <ul><li>Nevi/ Pigmented Lesions </li></ul><ul><li>Macular hemangioma (“stork bites”) </li></ul><ul><li>Port –wine stain (nevus flammeus) </li></ul><ul><li>Mongolian spot </li></ul><ul><li>Cavernous hemangioma </li></ul><ul><li>Strawberry hemangioma </li></ul>
  • 10. HEAD : General, Cuts, Bruises <ul><li>Anterior and posterior fontanelles </li></ul><ul><ul><li>Large anterior fontanelle </li></ul></ul><ul><ul><li>Small anterior fontanelle </li></ul></ul><ul><ul><li>Bulging fontanelle </li></ul></ul><ul><ul><li>Molding </li></ul></ul><ul><ul><li>Caput succedaneum </li></ul></ul><ul><ul><li>Cephalohematoma </li></ul></ul><ul><ul><li>Increased intracranial pressure </li></ul></ul><ul><ul><li>Craniosynostosis </li></ul></ul><ul><ul><li>Craniotabes </li></ul></ul>
  • 11. Neck & Facial Features <ul><li>Face : Look for obvious abnormalities.Note the general shape of the nose, mouth and chin. Presence of syndromic features is often diagnosed clinically throughout experience. </li></ul><ul><li>Neck : Note shape, range of motion, and any webbing; palpate for masses </li></ul><ul><ul><li>Brachial palsy </li></ul></ul><ul><ul><li>Erb’s palsy </li></ul></ul><ul><ul><li>Fractured clavicle </li></ul></ul><ul><li>Ears : Unusual shape, low set ears, periauricular skin tags (papillomas), hairy ears. </li></ul>
  • 12. <ul><li>Eyes : Observe shape, size and position of eyes. Note integrity and color of iris and sclera. Ophthalmoscopic examination to assess pupillary size and red retinal reflex </li></ul><ul><li>Nose : Size and Shape; </li></ul><ul><li>Note placement of the septum </li></ul><ul><li>Formation of the nasal bridge; </li></ul><ul><li>Verify patency ( Flat nasal bridge , Deviated septum , Choanal atresia , Nasal pit ) </li></ul><ul><li>Mouth : Hard & soft palate for evidence of cleft palate </li></ul><ul><li>: Neonatal tooth (predeciduos,true deciduos) </li></ul><ul><li>: Macroglossia </li></ul><ul><li>: Oral thrush </li></ul><ul><li> : Smooth philtrum </li></ul>Neck & Facial Features
  • 13. Chest <ul><li>Observation : respiratory rate, chest symmetrical, sternal/intercostal /subcostal recession, nasal flaring, grunting, stridor </li></ul><ul><li>Breath sounds : Equality bilaterally, presence of any additional sound. </li></ul><ul><li>Pectus excavatum : sternum that is altered in shape. </li></ul><ul><li>Breast in newborn : May be abnormally enlarged (3-4cm) due to effects of maternal estrogens. </li></ul>
  • 14. Heart : <ul><li>Observation : heart rate, rhythm, quality of heart sounds, active precordium </li></ul><ul><li>Position of heart : may be determined by auscultation </li></ul><ul><li>Presence of murmur </li></ul><ul><li>Palpate the pulses (femoral) & define whether its normal, weak or absent. </li></ul><ul><li>Check for perfusion </li></ul><ul><li>Signs of congestive heart failure : gallop, tachycardia & abnormal pulses </li></ul>
  • 15. Abdomen <ul><li>Observation : scaphoid abdomen, omphalocele, gastroschisis </li></ul><ul><li>Palpation : Check for distension, tenderness or masses. Palpate liver, spleen, kidneys and groin and note any masses </li></ul><ul><li>Auscultation : Listen for bowel sound </li></ul><ul><li>Inspect anus for position and verify patency </li></ul>
  • 16. Umbilicus <ul><li>Should have 2 arteries 1 vein. </li></ul><ul><li>Inspect for discharge, redness or edema around base of the cord </li></ul><ul><li>Appearance : should be translucent. A greenish yellowish colour suggest meconium staining </li></ul>
  • 17. Genitalia : Any infant with ambiguos genitalia should not undergo gender assignment until a formal endocrinology evaluation <ul><li>Male </li></ul><ul><li>Length : > 2cm </li></ul><ul><li>Determine site of meatus </li></ul><ul><li>Palpate bilateral testicles </li></ul><ul><li>Examine for inguinal hernia </li></ul><ul><li>Look for hypospadias, epispadias, chordae. </li></ul><ul><li>Observe colour of scrotum </li></ul><ul><li>Phimosos-foreskin cannot be retracted </li></ul><ul><li>Cryptotorchidism-testes not descended </li></ul><ul><li>Female </li></ul><ul><li>Inspect for size and location of the labia, clitoris, meatus, and vaginal opening </li></ul><ul><li>Pseudomenses </li></ul><ul><li>Vaginal tag a small appendage or flap on the mucous membranes; common neonatal variation that usually disappears in a few weeks </li></ul>
  • 18. Extremities : Examine the arms & legs paying close attention to the digits <ul><li>Syndactyly </li></ul><ul><li>Polydactyly </li></ul><ul><li>Oligodactyly </li></ul><ul><li>Congenital Talipes Equinovarus (CTEV) </li></ul><ul><li>Metarsus Varus </li></ul>
  • 19. Trunk & Spine <ul><li>Observe curvature and integrity </li></ul><ul><li>Check for any gross defects of the spine. An abnormal pigmentation/ hairy patches over the lower back should increase the suspicion that an underlying vetebral abnormality exists. </li></ul><ul><li>A sacral or pilonidal dimple may indicate a small meningocele or other anomaly. </li></ul><ul><li>Spina bifida – defect in closure of the neural tube that is associated with malformations of the vertebrae & spinal cord </li></ul>
  • 20. Hips <ul><li>Congenital hip dislocation ( Ortolani & Barlow Maneuvers) </li></ul><ul><ul><li>Assymetry of the skin folds on the dorsal surface </li></ul></ul><ul><ul><li>Shortening of the affected leg </li></ul></ul>
  • 21. Nervous System : Observe for any abnormal movement/ excessive irritability <ul><li>Muscle tone </li></ul><ul><ul><li>Hypotonia : Floppiness </li></ul></ul><ul><ul><li>Hypertonia : Extended arms&legs, hyperextension of back & tightly clenched fists. </li></ul></ul><ul><li>Reflexes </li></ul><ul><ul><li>Rooting reflex </li></ul></ul><ul><ul><li>Glabellar reflex </li></ul></ul><ul><ul><li>Grasp reflex </li></ul></ul><ul><ul><li>Neck righting reflex </li></ul></ul><ul><ul><li>Moro’s reflex </li></ul></ul>
  • 22. Biochemical screening <ul><li>Simple laboratory investigation to diagnose congenital metabolic disorder that may lead to mental retardation and even death if left untreated. </li></ul><ul><li>The goal of this screening is to give all newborns a chance to live a normal life. </li></ul><ul><li>It provides the opportunity for early treatment of diseases that are diagnosed before symptoms appear </li></ul><ul><li>Malaysia : G6PD deficiency & Congenital Hypothyroidism </li></ul>
  • 23. G6PD deficiency <ul><li>G6PD deficiency is one of the most common genetic diseases affecting an estimated 400 000 000 people worldwide. </li></ul><ul><li>All newborn screened for G6PD and in case of deficiency should be explained to both parents. </li></ul><ul><li>Test : Beutler fluorescent spot test : rapid & cheap test that identifies NADPH produced by G6PD under UV light. </li></ul>
  • 24. Congenital Hypothyroidism <ul><li>Significant decrease in, or absence of thyroid function present at birth. </li></ul><ul><li>Approximately 1 in 4000 newborn infants has a severe deficiency of thyroid function, while even more have mild or partial degrees. </li></ul><ul><li>If untreated for several months after birth, severe congenital hypothyroidism can lead to growth failure and permanent mental retardation. </li></ul>
  • 25. Screening for ROP : is a disorder of the developing retina of low birth weight preterm infants that potentially leads to blindness. <ul><li>Infants with a birth weight of less than 1500 g </li></ul><ul><li>Gestational age of 32 weeks or less </li></ul><ul><li>Infants who required oxygen supply </li></ul>
  • 26. Hearing Assesment <ul><li>Early identification of hearing loss and appropriate intervention within the first 6 months of life has been demonstrated to prevent many of these adverse consequences and facilitate language acquisition. </li></ul>
  • 27. <ul><li>Family History of Hearing Loss </li></ul><ul><li>Perinatal Infection </li></ul><ul><li>Craniofacial Anomalies </li></ul><ul><li>Very Low Birth Weight </li></ul><ul><li>Hyperbilirubinemia (>340mmol/L) </li></ul><ul><li>Bacterial Meningitis </li></ul><ul><li>Ototoxic Medications </li></ul><ul><li>Syndrome Associated with Hearing Loss </li></ul><ul><li>Prolonged Ventilation </li></ul><ul><li>Severe Asphyxia at Birth </li></ul><ul><li>Admission to NICU </li></ul>Hearing Assesment
  • 28. ECHOCARDIOGRAPHY <ul><li>GDM ON S/C INSULIN </li></ul><ul><li>GDM ON DIET CONTROL </li></ul><ul><li>ANY CLINICALLY HEARD MURMUR </li></ul><ul><li>LARGE FOR GESTATION AGE </li></ul><ul><li>NEWBORN WITH MACROSMIC FEATURES </li></ul><ul><li>SYNDROMIC NEWBORN (DOWN’S SYNDROME, </li></ul>
  • 29. JAUNDICE
  • 30. PALLOR
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