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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Newborn examination Presentation Transcript

  • 1. NEWBORN SCREENING © DR.RAMESH RAMACHUNDRAN
  • 2. Definition
    • Head to toe physical examination of a newborn to look for any abnormalities or pathology.
    • Includes biochemical screening & certain special screening ( ROP, hearing assesment, Echocardiography)
  • 3.
    • Assesment at birth
    • Physical examination
    • Biochemical screening
    • Special screening
        • Retinopathy Of Prematurity
        • Hearing assesment
        • Echocardiography
  • 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
    • COMPLETE physical examination within 24 hours of birth.
    • It is best to examine when the infant is quiet.
    • Ensure infant is naked : he/she can be in diapers, but you have to open it.
    • Do not forget to wash your hands prior to examination.
  • 6. Measurements…
    • Head circumference :
    • - a.k.a Occipitofrontal circumference
    • - place measuring tape around front of head, below the
    • brow and occipital area.
    • - Normal range 32cm-37cm
    • Length & Percentile (refer growth chart)
    • Weight & Percentile (refer groth chart)
    • Assesment of Gestational Age & Percentile
        • -Small for Gestational Age
        • - Appropriate for Gestational Age
        • - Large for gestational age
  • 7. Vital signs
    • Temperature : Rectal
    • Respirations : Normal rate is 40-60
    • Blood pressure : Correlates with gestational age, post natal age, birth weight.
    • Pulse rate : Awake 120-160bpm, Asleep 70-80bpm
  • 8.
      • Colour
      • Plethora (deep rosy red)
      • Jaundice
      • Pallor
      • Cyanosis( central , peripheral , acrocyanosis )
      • “ Blue on pink: or “Pink on blue”
      • Harlequin colouration
      • Mottling
    • Rashes
    • Milia
    • Erythema toxicum
    • Candida albicans rash
    • Transient neonatal pustular melanosis
    • Acne neonatorum
    SKIN
  • 9. SKIN
    • Nevi/ Pigmented Lesions
    • Macular hemangioma (“stork bites”)
    • Port –wine stain (nevus flammeus)
    • Mongolian spot
    • Cavernous hemangioma
    • Strawberry hemangioma
  • 10. HEAD : General, Cuts, Bruises
    • Anterior and posterior fontanelles
      • Large anterior fontanelle
      • Small anterior fontanelle
      • Bulging fontanelle
      • Molding
      • Caput succedaneum
      • Cephalohematoma
      • Increased intracranial pressure
      • Craniosynostosis
      • Craniotabes
  • 11. Neck & Facial Features
    • 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.
    • Neck : Note shape, range of motion, and any webbing; palpate for masses
      • Brachial palsy
      • Erb’s palsy
      • Fractured clavicle
    • Ears : Unusual shape, low set ears, periauricular skin tags (papillomas), hairy ears.
  • 12.
    • 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
    • Nose : Size and Shape;
    • Note placement of the septum
    • Formation of the nasal bridge;
    • Verify patency ( Flat nasal bridge , Deviated septum , Choanal atresia , Nasal pit )
    • Mouth : Hard & soft palate for evidence of cleft palate
    • : Neonatal tooth (predeciduos,true deciduos)
    • : Macroglossia
    • : Oral thrush
    • : Smooth philtrum
    Neck & Facial Features
  • 13. Chest
    • Observation : respiratory rate, chest symmetrical, sternal/intercostal /subcostal recession, nasal flaring, grunting, stridor
    • Breath sounds : Equality bilaterally, presence of any additional sound.
    • Pectus excavatum : sternum that is altered in shape.
    • Breast in newborn : May be abnormally enlarged (3-4cm) due to effects of maternal estrogens.
  • 14. Heart :
    • Observation : heart rate, rhythm, quality of heart sounds, active precordium
    • Position of heart : may be determined by auscultation
    • Presence of murmur
    • Palpate the pulses (femoral) & define whether its normal, weak or absent.
    • Check for perfusion
    • Signs of congestive heart failure : gallop, tachycardia & abnormal pulses
  • 15. Abdomen
    • Observation : scaphoid abdomen, omphalocele, gastroschisis
    • Palpation : Check for distension, tenderness or masses. Palpate liver, spleen, kidneys and groin and note any masses
    • Auscultation : Listen for bowel sound
    • Inspect anus for position and verify patency
  • 16. Umbilicus
    • Should have 2 arteries 1 vein.
    • Inspect for discharge, redness or edema around base of the cord
    • Appearance : should be translucent. A greenish yellowish colour suggest meconium staining
  • 17. Genitalia : Any infant with ambiguos genitalia should not undergo gender assignment until a formal endocrinology evaluation
    • Male
    • Length : > 2cm
    • Determine site of meatus
    • Palpate bilateral testicles
    • Examine for inguinal hernia
    • Look for hypospadias, epispadias, chordae.
    • Observe colour of scrotum
    • Phimosos-foreskin cannot be retracted
    • Cryptotorchidism-testes not descended
    • Female
    • Inspect for size and location of the labia, clitoris, meatus, and vaginal opening
    • Pseudomenses
    • Vaginal tag a small appendage or flap on the mucous membranes; common neonatal variation that usually disappears in a few weeks
  • 18. Extremities : Examine the arms & legs paying close attention to the digits
    • Syndactyly
    • Polydactyly
    • Oligodactyly
    • Congenital Talipes Equinovarus (CTEV)
    • Metarsus Varus
  • 19. Trunk & Spine
    • Observe curvature and integrity
    • 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.
    • A sacral or pilonidal dimple may indicate a small meningocele or other anomaly.
    • Spina bifida – defect in closure of the neural tube that is associated with malformations of the vertebrae & spinal cord
  • 20. Hips
    • Congenital hip dislocation ( Ortolani & Barlow Maneuvers)
      • Assymetry of the skin folds on the dorsal surface
      • Shortening of the affected leg
  • 21. Nervous System : Observe for any abnormal movement/ excessive irritability
    • Muscle tone
      • Hypotonia : Floppiness
      • Hypertonia : Extended arms&legs, hyperextension of back & tightly clenched fists.
    • Reflexes
      • Rooting reflex
      • Glabellar reflex
      • Grasp reflex
      • Neck righting reflex
      • Moro’s reflex
  • 22. Biochemical screening
    • Simple laboratory investigation to diagnose congenital metabolic disorder that may lead to mental retardation and even death if left untreated.
    • The goal of this screening is to give all newborns a chance to live a normal life.
    • It provides the opportunity for early treatment of diseases that are diagnosed before symptoms appear
    • Malaysia : G6PD deficiency & Congenital Hypothyroidism
  • 23. G6PD deficiency
    • G6PD deficiency is one of the most common genetic diseases affecting an estimated 400 000 000 people worldwide.
    • All newborn screened for G6PD and in case of deficiency should be explained to both parents.
    • Test : Beutler fluorescent spot test : rapid & cheap test that identifies NADPH produced by G6PD under UV light.
  • 24. Congenital Hypothyroidism
    • Significant decrease in, or absence of thyroid function present at birth.
    • Approximately 1 in 4000 newborn infants has a severe deficiency of thyroid function, while even more have mild or partial degrees.
    • If untreated for several months after birth, severe congenital hypothyroidism can lead to growth failure and permanent mental retardation.
  • 25. Screening for ROP : is a disorder of the developing retina of low birth weight preterm infants that potentially leads to blindness.
    • Infants with a birth weight of less than 1500 g
    • Gestational age of 32 weeks or less
    • Infants who required oxygen supply
  • 26. Hearing Assesment
    • 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.
  • 27.
    • Family History of Hearing Loss
    • Perinatal Infection
    • Craniofacial Anomalies
    • Very Low Birth Weight
    • Hyperbilirubinemia (>340mmol/L)
    • Bacterial Meningitis
    • Ototoxic Medications
    • Syndrome Associated with Hearing Loss
    • Prolonged Ventilation
    • Severe Asphyxia at Birth
    • Admission to NICU
    Hearing Assesment
  • 28. ECHOCARDIOGRAPHY
    • GDM ON S/C INSULIN
    • GDM ON DIET CONTROL
    • ANY CLINICALLY HEARD MURMUR
    • LARGE FOR GESTATION AGE
    • NEWBORN WITH MACROSMIC FEATURES
    • SYNDROMIC NEWBORN (DOWN’S SYNDROME,
  • 29. JAUNDICE
  • 30. PALLOR
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