examination of the newborn examination part 2: top-to-toe chris kingsnorth
TRANSCRIPT
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Examination of the NewbornExamination Part 2: Top-to-Toe
Chris Kingsnorth
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Before We Begin
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Overview
• 4 presentations:
1. Introduction and pre-examination2. Examination part 1: Eyes, heart, hips
and testes3. Examination part 2: Top-to-toe4. Post-examination
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Overview
• Integrate 4 focuses of NIPE screening (eyes, hips, heart and testes) into top-to-toe examination
• Practical tips
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Overview: FrontHead (inc. face and mouth)
Eyes
Neck and clavicles
Limbs and digits
CVS (inc. heart, colour and pulses)
Respiratory systemAbdomen
Genitalia + anus
Skin
Hips
CNS (inc. tone, movements and
posture) +/- reflexes Cry
F
General appearance
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Overview: Back
Spine
Heart soundsLung sounds
Skin
Tone
B
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General Principles of Examination
• Don’t be scared of the baby!• Be flexible in order examining based on baby’s
behaviour/ state of undress• Keep baby warm• Involve parents; explain examination and
findings• If unsure about findings, ask a senior• Be prepared to change nappies
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General Appearance
Start with baby lying on back on flat surface
•Colour•Breathing•Behaviour•Activity•Posture•Cry
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Skin
• Colour• Texture• Birthmarks• Rashes Don’t forget to check the
back too (you can do this later, when examining
the spine)
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Skin: Possible Findings
Cyanosis Erythema toxicum (Common (50%), not harmful;
clears within a few days)
Milia(Blocked pores. Common (50%), not harmful; clear within a few
weeks)
Mongolian blue spotMore common in Asian babies. Not harmful. Usually lumbosacral; may
occur anywhere. Can look like bruise
Always document birthmarks on a body map to avoid future
misinterpretation
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Head
• Fontanelles• Face• Nose• Mouth + palate• Ears
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Head: Possible Findings
Cleft palate +/- lip Micrognathia Microtia
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Eyes
• NIPE screening focus point• Covered in detail in Examination Part 1: Eyes,
heart, hips and testes
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Neck and Clavicles
• Size/ proportions• Shape • Symmetry of structures
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Limbs, Hands, Feet and Digits
• Moving all 4 limbs?• Size/ proportions• Shape • Symmetry • Palmar creases• Sandal gap
Always count digits
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Limbs, Hands, Feet and Digits: Possible Findings
Sandal gap Single palmar (simian) crease Syndactyly
Polydactyly
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Heart and CVS
• NIPE screening focus point• Covered in detail in Examination Part 1: Eyes,
heart, hips and testes
Don’t forget to listen to the heart at the back too
(you can do this later, when examining the
spine)
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Respiratory System
• Cyanosis?• Effort• Rate• Lung sounds• +/- Pulse oximetry
Don’t forget to listen at the back too (you can do
this later, when examining the spine)
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Abdomen
• Shape and size• Palpate: Organomegaly/ masses?• Bowel sounds• Umbilical cord (esp. for discharge/ redness)
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Abdomen: Possible Findings
Umbilical infection/ redness Umbilical hernia
Abdominal mass
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Genitalia
Males: Testes = NIPE screening focus point (Covered in detail in Examination Part 1: Eyes, heart, hips and testes)
Females: Shape and size
Ambiguous: Seek senior advice
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Anus
• Patent?• Passed meconium ≠ patent anus (possibility of
enterocutaneous fistula)
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CNS
• Tone• Behaviour• Movements• Posture• Newborn reflexes only if concerned
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CNS: Possible Findings
Other pathologies:
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Hips
• NIPE screening focus point• Covered in detail in Examination Part 1: Eyes,
heart, hips and testes
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Turning the Baby
Easiest and safest = roll baby onto side
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Spine
• Inspect + palpate bony structures• ‘Divots’ suggesting non-continuity of
vertebrae/ absence of spinous process• Sinuses/ hairy tuft (possible spina bifida
occulta)• Meningocele/myelomenigocoele
Sacral dimples vs. sinuses; if unsure, ask for senior R/V
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Spine: Possible Findings
Meningocele/myelomenigocoele Hair tuft
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Completing the Examination
• Redress baby• Thank parents• Explain any findings/ need for Senior R/V• Invite questions
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What Now?
• Download slides + checklist• Online MCQ:
https://www.goconqr.com/en-GB/p/3906445-Examination-of-the-Newborn--3--Examination-Part-2---Top-to-toe-quizzes
• Request a Podcast/ ask a question• Final presentation: Post-examination
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Further Information
NIPE eLearning package: http://cpd.screening.nhs.uk/nipe-elearning
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References
• How to roll a baby: https://www.youtube.com/watch?v=kVUeK77URJI
• Neurological abnormality videos: http://library.med.utah.edu/pedineurologicexam/html/newborn_ab.html#01
• Neonate skin conditions and images: http://www.dermnetnz.org/site-age-specific/neonate.html
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References
• Cleft lip and palate diagram: http://www.transformingfaces.org/wp-content/uploads/2012/05/clp11.png