Role of Nursing Officer on Neonatal examination. Practical aspects of Neonatal care. Abnormal newborn Examination. Birth defects detection by Physical examination

1. Role of Nursing
Officer in
Neonatal
Examination
Ms. JOLLY LIS JOHN
Sister In-Charge,
NICU, SVBCH, Silvassa

2. ROLE OF NURSING
OFFICER
1. GENERAL EXAMINATION
2. ANTHROPOMETRIC MEASUREMENT
3. VITAL SIGNS MONITORING
4. HEAD TO TOE EXAMINATION
5. SYSTEMIC EXAMINATION
10/24/2020
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3. GENERAL EXAMINATION
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4. Posture/attitude
 In term baby- thigh partially abducted at hips and
ankles with flexion of knees and elbows
 In pre term babies limbs are extended or partially
flexed
 Lack of proper postures is seen in
1. Down syndrome
2. Hypothyroidism
3. Neurological or muscle diseases
4. Birth injuries-erbs palsy, # femur neck, #clavicle
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5. Cyanosis
 Mild - normal for few minutes
 Tongue and mucous
membrane should be pink
 Acrocyanosis (Periphery is
bluish & body is pink) –
normal for 2-3 days
 Persistent cyanosis may
suggest
1. Obstructed airway
2. Respiratory disease
3. Cardiac anomalies
4. Neurologic depression
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6. Icterus
After 24 hours of life
 After 24hrs- common
 Within 24hrs- not good
 Looking shortly at the causes of icterus
Within 24 hours of life
 Congenital infection
 Hemolytic pathology
1. Rhesus incompatibility
2. ABO incompatibility
3. G6PD deficiency
4. Spirocytosis
5. Pyruvate kinase deficiency
1. Breast milk jaundice
2. Dehydration
3. Infection especially UTI
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7. Congenital defects
 Look for “abnormal” physical and
physiological findings and mention them in
your notes
 It helps to correlate with the findings of the
investigations in proceeding days
 Even helps to decide further investigations
need to be done
 Also helps us decide the prognosis of the
baby
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8. Anthropometry Measurement
 A study of measurements and proportions of
the human body
 Includes mainly
1. Weight of the baby
2. Length of the baby
3. Head circumference
4. Chest circumference
5. Ponderal index
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9. Weight of the baby
 Normal- 2.5 - 3.8 kg
 While measuring
 Use electric weighing machine
 Accuracy of 5grams
 In naked conditions (most imp-
diapers)
 Loses wt in 1st week of life- 10%
 Regained by 10th day of life
 Upto 3 months gains wt @
30gms/day
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10. Length of the baby
 With infantometer
 In supine position
 Knees should be pressed to get the maximum length
 Normal- 47 to 50cm
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11. Head circumference
 Occipitofrontal
 Normal-35-36 cm
 NEVER to be measured on 1st day
of life
 Due to Moulding and Caput
succedaneum
 Correct measures after 3rd day of
life
Chest circumference
 At the level of nipples
 CC < HC by 3 cm
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12. Vitals Signs
 Must be examined when the baby is calm
 Not crying and between feeds
1. Temperature- in axilla (36.5 to 37.4)
2. Respiration- 30-60/min abdominal
3. Heart rate- 100-160/min
4. Blood pressure- 60/40mm hg
mean BP is more imp in this group
(2/3rd diastolic + 1/3rd systolic)
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13. Head to toe examination
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14. Head
 Moulding – common after NVD
 Caput succedaneum- swelling of the soft
tissues of the scalp due to accumulation of
fluid
 Cephalohematoma-subperiosteal
haemorrhage
 AF-open at birth (1-3cm)
 PF-small, should hardly admit a finger tip
 Look for- bruises, scars, forceps marks
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15.  Macrocephaly- >98th percentile for that age
1. Familial
2. Hydrocephalus
 Microcephaly- <3rd percentile for that age
1. Chromosomal disorder
2. Foetal alcohol syndrome
3. Foetal hydantoin syndrome
4. Metabolic disorders hypothyroidism
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16. Face
Look for dysmorphic face like
 Mongoloid face - downs syndrome
 Potters face – potters syndrome
 Elfin face – william syndrome
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17. Eyes
 Number
 Color of iris
 Microphthalmia
 Buphthalmos-enlargement of eyeball
 Hyper/hypoteloris
 Epicanthus
 Subcongjunctival hemmorage
 Cataract / glaucoma
 Epiphora
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18. Ears
 Size and site
 Shape
 Elastic recoil
 Patency of the external canal
 Malformations
1. Abnormal groves, sinuses, tags
2. Accessory auricles
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19. Nose and Lips
 Nasal flaring - distress
 Nose- patency of each canal to rule out atrsia
Look for flat nasal bridge
 Lips- looks for sucking callosities(mid upper lip), cleft lip.
 Philtrum- size (long/short), midline cleft
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20. Oral cavity
 Epstein pearls small greyish white swelling on either side of
midline- normal
 High arched palate
 Cleft palate
 Sub mucous cleft
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21. Tongue and teeth
 Tongue tie-normal
 Size and position of tongue
 Glossoptosis-airway
obstruction
 Protruding tongue-
hypothyrodism
 Natal teeth- mostly seen on
lower incisors region
 Fall in few days
 Extraction is not advised
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22. Neck
 Normal range of movement is more than that in adults
 Swelling in the neck
 Crepitus-fracture clavicle due to difficult delivery
 Sternocliedo mastoid tumour
 Torticollis
 Shortening or webbed neck- turners syndrome
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23. Chest and Abdomen
 Look at respiration- in laboured respiration subcoastal and/or intercaostal
retractions
 Nipples- position numbers gap
 Widening of nipples –turner syndrome
 Abdomen- scaphoid in IUGR
 Distended- rule out abdominal mass-USG
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24. Umbilical cord and umbilicus
 Cut transverse surface of the cord- look for 2 artery and
1 vein
 Single artery- related with many anomalies
 Staining – meconium stained liquor
 Cord falls in 7-10 days
 Look for-
1. Erytheyema or serous discharge-sepsis
2. Bleeding hemorrhagic diseases
3. Greenish- meckels diverticulam
 Omphalocele
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25. Genitals-female
 Female genitals
 Urethral opening
 Clitoris and labia minor –prominent in term babies
 Clitoral enlargement with hyperpigmentation- investigate
for androgen access
 Thick white discharge-normal
 Bleeding- maternal hormone withdrawal
 Small vaginal skin tags- common in breech presentation
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26. Genitals male
 Penis
1. Phimosis
2. Hypospadias
3. Epispadias
4. Chordae
 Scrotum and testis-
 Hydrocele
 Term babies rugea are more
 Testis should be bilaterally palpable
 Check for undescended testis/retractile testis
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27. Back
 Exam carefully
 Vertebral column
 Spina bifida occulta
 Meningocele
 Meningomyelocele
 Pilonidal sinus
 Tuft of hair
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28. Extremities
 Hips- check range of movement, dislocation, hip
joint is unstable for few days after life
 Look for CDH-barlows and ortolani test
 Limbs achondroplasia arm recoil is good in term
babies
 Edema of limbs- turner syndrome
 Wrist sign- positive in marfan syndrone
 Digits look for-polydactyly, syndactyly
 Palms and soles-look for creases
 Nails-long in post terms absent in ectodermal
dysplasia
 Club foot should be checked for and differentiated
from pressure effect
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29. Skin
 Vernixcaseosa-secreted by foetal
sebaceous gland. Provides insulation
hence should not be removed unless
meconium stained
 Erythema toxicum yellowish pustules
common in terms
 Harlaquin color change- normal
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30.  Dry and racking skin- post date
 Mongolian spot- well demarcated bluish
area of pigmentation over buttocks, back
which disappears within 1 year
 Lanugo- fine, soft, immature hair
 Salmon patches(nevus simplex)- reddish
macule due to capillary malformation
seen on forehead, nape of neck, eyelids,
nose, upper lips
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31. Systemic examination
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32. Cardiovascular system
 Note-
1. Rate
2. Rhythm
3. Heart sounds
4. Apex beat
 Auscultate murmurs-
1. systolic murmurs heard normally
2. Gallop sound- failure
 Always palpate femoral pulse- absent in coarctation of aorta
 Blood pressure should be measured in all 4 limbs
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33. Respiratory system
 Diaphragmatic type of respiration
 Barrel shaped chest-meconium aspiration syndrome
 Respiratory- movement of thoracic cage is limited because of
more horizontally placed ribs.
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34. Nervous system
 Motor system examination
 Includes- tone
power
reflex
 Tone and power
 Depends on neuromuscular integrity
 is noted by spontaneous movement of the baby.
 Tone improves caudocranially
 By 32 wks- tone of lower limb improves knees and hip flexion
 Bt 36 wks-tone of upper limb improves elbow flexion is noted
 Put to sit test is used to check neck muscles
 Ventral suspension to check trunk muscles
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35.  Higher functions
 Note the level of alertness
 Six behavioral states are present
1. Deep sleep
2. Light sleep
3. Drowsiness
4. Quiet alertness
5. Active alertness
6. Cry
 Irritability is majorly due to
1. Hunger
2. Soiled diapers
3. Colics
4. Infections
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36. Neonatal reflexes
 Rooting and sucking- birth upto 4 months of life
 Moro’s reflex (startle reflex)- birth upto 4-5 months
 Tonic neck reflex(fencing) birth to 4-5 months
 Grasp reflex- upto 5-6 months
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37. THANK YOU!
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