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New born examination

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Lecture for medical students on new born examination.

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New born examination

  1. 1. What you have to look for…..Lecture for medical undergraduates
  2. 2. ObjectivesAt the end of lecture, the student• should understand the importance of new-born examination.• Should be aware of some normal conditionsthat cause parental anxiety.• Should be able to do a new born examinationsystematically and detect congenital andacquired abnormalities.
  3. 3. Why is it necessary ?1. To detect congenital anomalies.3- 5% of newborns2. To detect some acquired abnormalities.E.g: umbilical sepsis3. Reassure parents when normal findings aredetected.Eg: erythema toxicum
  4. 4. • 4. Identifies familial conditions– DDH• 5. Analysis of findings will identify theproblems specific to regions/ ethnic/age groups– This is particularly important in policymaking & preventive strategies
  5. 5. When would you do it ?• As soon as possible after delivery• Before discharge• At 6/52
  6. 6. Important..• Wash your hands first & dry them• Examination of newbornsrequires patiencegentlenessprocedural flexibility• If the baby is quiet auscultate the heart first• Disturbing manipulations to be done last
  7. 7. New born examination is done from head totoe.Observe the baby• General posture• ColourPinkAcrocyanosisPallor• Appearance of skinVernixLanugo hairNails• ActivityNormal or diminishedTremulous movements
  8. 8. Head* Size and shape to be noted1. Fontanellewidebulging - tensionclosed2. Suturesoverridingwidely separated > 5 mm3. Cephalhaematomableeding under periosteum on the parietal bonesdoes not cross the midline
  9. 9. Cephalhaematoma
  10. 10. 5. Caput succedaneumechymotic, oedematous swelling ofsoft tissuescrosses the midlinedisappears after first few daysHead Contd..
  11. 11. Caput succedaneum
  12. 12. 6. EncephaloceleHead Contd..
  13. 13. Face1. Dysmorphic features– Down’s :epicanthal folds, hypertelorism, low set ears– Other syndromes2. Oedema– face presentation– prolonged labour3. Isolated abnormalities– Mouth: precocious dentition/ cleft lip / palate/ Epstein pearls (selfresolving white inclusion cysts on palate/gums)– Ear abnormalities (deformities, preauricular skin tags)– Eye: cataract – red reflex, conjunctival / retinal haemorrhaege– micrognathia4. Facial nerve palsy
  14. 14. Down’s syndrome
  15. 15. Mid-line defects in trisomy 13
  16. 16. Prominent occiput & low-set ears intrisomy 18
  17. 17. Bilateral cleft lip&complete cleft palate
  18. 18. pre-auricularskin tags
  19. 19. Acute bacterial conjunctivitis
  20. 20. Cataract in Rubella syndrome
  21. 21. Unilateral microcornea &microphthalmos
  22. 22. Unilateral iris coloboma in left eye
  23. 23. Micrognathia
  24. 24. Right facial nerve palsyfollowing birth injury
  25. 25. Neck1. Goitrecorrect technique– slightly extended neck
  26. 26. 2. Sternomastoid tumourafter ~ 1/12 of age.torticollis
  27. 27. 3. Cystic hygroma
  28. 28. Chest• Breastbreast hypertrophymastitis neonatorumsuper numerary nipples• Chest deformities• Observe breathing pattern• Dyspnoea and grunting• Heart : examine both sideslocationheart rateperipheral pulses
  29. 29. Abdomen• Abdominal distension• Scaphoid abdomen• Liver – palpable• Unusual masses
  30. 30. Abdomen contd.• Umbilicusumbilical sepsisomphalocele
  31. 31. later – umbilical hernia
  32. 32. gastrochiasis
  33. 33. Abdomen Contd..• Bladder exstrophy• Cloacal exstrophy
  34. 34. Groin• Femoral pulses– to exclude coarctation• Hip examination– to exclude CDH
  35. 35. Ortolani manoeuvreabducting the femur– palpable clunk
  36. 36. Asymmetrical thigh creasesinunilateral dislocation of hip
  37. 37. Genitalia• Ambiguous genitalia• Undescended testes• Hypospadias• Hydrocele• Imperforated anus• Inguinal hernia
  38. 38. Ambiguous genitalia
  39. 39. Hypospadias
  40. 40. Imperforated anus
  41. 41. Hydrocele
  42. 42. Inguinal hernia
  43. 43. High imperforated anuscommunicates into vagina
  44. 44. Imperforate hymen
  45. 45. Limbs• Observe for spontaneous or stimulated activity• Polydactyly• Syndactyly• Nerve damage• Talipes (Club foot): CTEV• Other abnormalities• Erb’s palsy• Amniotic band defects
  46. 46. Turner syndromeLow hairlineAbnormal earsNeck webbingMicrognathiaShield chest withwidespread nipples
  47. 47. Lymphoedema in hands & feet- Turner syndrome
  48. 48. Rocker-bottom feet (protruding calcanei) intrisomy 18
  49. 49. Overlapping fingers intrisomy 18
  50. 50. Polydactyly
  51. 51. Syndactyly
  52. 52. Lobster claw hand
  53. 53. Amniotic band defects
  54. 54. Talipes equino varus
  55. 55. Erb’s palsy
  56. 56. Spine• Kyphoscoliosis• Feel for defects• Tuft of hair-Spina bifida occulta
  57. 57. Back / spine contd….• Meningomyelocele
  58. 58. Skin• Pustules
  59. 59. Skin Contd..• Milia- Sweat retention vesicles
  60. 60. • Thrush- oral- nappy rash – satellite lesionsSkin Contd..
  61. 61. Skin Contd..• Mongolian bluespots
  62. 62. Skin contd..• Haemangioma
  63. 63. Skin Contd..• Amoniacal dermatitis
  64. 64. • Erythema toxicumSkin contd..
  65. 65. • Seborrhoeic dermatitisSkin contd..
  66. 66. Skin contd..• Sweat rash
  67. 67. Skin contd..• Cutis marmorata
  68. 68. Skin contd..• Stork bite
  69. 69. Anthropometric measurements• Length– infantometer
  70. 70. • Weight
  71. 71. • OFC
  72. 72. New born reflexes• Rooting
  73. 73. • Sucking
  74. 74. • Grasp
  75. 75. • Moro– gradually disappear by 4/12
  76. 76. • Asymmetrical tonicneck reflex- Appear at 2- 4/12- Disappear by 6/12
  77. 77. You CAN’T miss1. Red reflex: Cataract2. Femoral pulse: coarctation of aorta3. DDH• As missing any of the above in new borne examination doesmuch harm than missing anything else.
  78. 78. Summary•New born examination is important in all babies toexclude congenital abnormalities & acquired infections.•All babies should be examined before discharge.•Thorough examination should be done from head to toe.•If abnormalities were detected, can take early actions tocorrect them. Eg: DDH,CTEV•Parents can be reassured if normal variations werefound. Eg: Erythema toxicum

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