NEWBORN EXAMINATION by HC111207235434

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									 Spencer Gulf Rural Health School



Paediatrics and Child Health
      2010 Program




                WORK SHEET 2

               EXAMINATION OF NEONATE
EXAMINATION GOALS

       Identify physical abnormalities
       Ensure extra-uterine adaptation
       Parental assurance/questions
       Identify family needs
       Health Education
EXAMINATION TIMES

          At birth
          Day 1-2
          Discharge
          Week 1-2
          End of Neonatal Period
AT BIRTH…
 Ensure transistion – I/U to E/U.

 Confirm Gestation & Growth.

 1st physical examination.

 Familiarise with mother [serology,
  meds.etc.]
DAY 1-2
 Confirm transistion complete

 ? Feeding efficiency

 ? Jaundice [DCT?]

 Family history complete?
DISCHARGE
 Feeding & Growth check

 Repeat exam. [hips, eyes, pulses]

 Colour

 Family plans ?
WEEK 1 - 2

  ? Regain birthweight
    ( gaining wt by day 4 and regained
     birth wt at 2 weeks


  Routine ?

  Breastfeeding ?
End of Neonatal Period
 Feeding & Weight?

 Routines

 Physical Exam. [%’les, Heart, Eyes]

 ? Immunisations
EXAM. COMPONENTS

         Observation
         Measurements
         Gestational Age
         Physical
         Neurological
         Body Systems
PHYSICAL EXAMINATION

“HANDS to HEAD”
“HEART to HIPS”

“HEAD to TOE”
“ROLE OVER”
HEAD


          Shape
          Fontanelles
          Sutures
          Hair
HEAD SHAPE
 NORMAL          ABNORMAL
                      Cephalhaemotoma
  Moulded            Hydrocephalus
                      Microcephaly
  Caput              Plagiocephaly
   succedaneum        Scaphocephaly
Plagiocephaly
FONTANELLES/SUTURES
 NORMAL           ABNORMAL

  Flat,concave        Bulging
  Anterior            Small [<1cm]
  Posterior           Large [>4cms.
  Open, ridged        Immobile
   sutures
  Mobile
HAIR
 NORMAL         ABNORMAL

  Soft            Low hairline

  One colour      Coarse

                   Coloured tufts
EYES
        Position
        Conjunctiva
        Pupils
        Eyelids, Palpebral
         fissure
        Lens
        Vision
CONJUNCTIVA/SCLERA
 NORMAL           ABNORMAL

  Pale pink           Inflammed
  Haemorrhages        Coloured d/c
  Watery d/c          Oedematous
                       Excessive
                        lacrimation
PUPILS/LENS
 NORMAL                 ABNORMAL
    Clear                   Opaque
    Round                   Patchy red reflex
    Red reflex              Irregular
    Equally reactive        Non parallel
    Parallel
? VISION


          Blinks to bright light
          Squints
          “Looks”
          Parallel movements
EARS
 NORMAL              ABNORMAL
  Equal size,            Unequal
   curvature              Deformations
  Patent meatus          Low set
  Above eye              No reaction
  Reacts to sound        Tags, sinuses
NOSE
        Shape

        Patency

          Breathes with mouth closed

          No discharge
MOUTH
 Lips        Teeth/Gums

 Movement    Mucous
               Membranes
 Palate
              Saliva
 Tongue
LIPS & TONGUE
 NORMAL            ABNORMAL

    Cupid’s Bow        Cleft, thin border
    Symmetrical        Small orifice
    Contained          Protruding
    Mobile             Tethered
                         [frenulum]
PALATE
 NORMAL                     ABNORMAL

    Intact – hard & soft      Cleft
    Gentle arch               Bifid Uvula
    Epstein’s pearls          Immobile
    Mobile soft palate
NECK
 NORMAL                 ABNORMAL

    Length                  Webbed
    Ear to Shoulder         Excessive tissue
    Chin to Shoulder        Torticollis
    Symmetrical             Sinus
THORAX
 NORMAL                   ABNORMAL

  Symmetrical               Asymmetrical
  Flat Sternum              Carinatum/excavat
  Straight clavicles         um
  Breast mid-               Clavicular
   clavicular                 lump/pain
  Effortless breathing      Accessory nipple
                             Dyspnoea
HEART
 NORMAL                 ABNORMAL

  Apex 4th I’costal,      Apex displaced
   mcl                     Prominent
  Quiet praecordium        praecordium
  110-160 b/m             <110, >160 b/m
  HR regular              HR irregular
  2 heart sounds          Extra sound/s
LUNGS/BREATHING
 NORMAL                    ABNORMAL

    RR <60b/m                  RR >60b/m
    Irregular breathing        Apnoea + cyanosis
    Effortless                 Dyspnoea
    Silent                     Noisy
ABDOMEN
 NORMAL                 ABNORMAL

    Gently convex           Distended/Scaphoid
    Symmetrical             Asymmetrical
    Liver  1 finger        Mass palpable
    Clear W. jelly          Coloured W. jelly
    2 aa’s, 1 vein          Umbilical “mass”
    Dry umbilicus           Umbilical discharge
GROINS
 NORMAL              ABNORMAL

  Symmetrical          Inguinal mass
   creases
                        Impalpable pulses
  Palpable pulses
GENITALIA
 MALE                     FEMALE

   2 scrotal testicles        Patent hymen
   Symmetrical                Separate labia
    scrotum                    Mucosal tag
   Penile shaft -             Mucoid discharge
    straight                   Obvious clitoris
   Distal urethral
    meatus
ANUS

        Patent

        Posterior position

        Puckered
SPINE
 NORMAL                 ABNORMAL

  Straight, mobile        Bent, rigid

  Mongolian patch/es      Patch/tuft of hair

  Evenly hairy            L/S sinus

  Sacral pit              Mass
LIMBS
 ARMS & HANDS            LEGS & FEET
   Equal size              Equal size
   Full R.O.M.             Full R.O.M.
   Normal tone             Normal tone
   Symmetrical             Symmetrical
    movem’t                  movem’t
   10 separate digits      10 [separate] digits
   Multiple creases        Multiple creases
   Complete nails          Complete nails
HIPS


        Range of Movement

        Clicks & Crunches

        Ortlani/Barlow Manouveres
Developmental dysplasia
of the hip

This condition was previously called congenital
   dislocation of the hip (CDH); however,
   developmental dysplasia of the hip (DDH) is
   now the preferred term as it implies that
   some of these hip problems may develop
   after birth.

DDH is the most common musculoskeletal
  abnormality in neonates. The incidence of
  this condition in Australia and North
  America is 7 per 1000 live births.
DDH
classified clinically as follows:
         stable
         subluxable
         dislocatable
         dislocated, reducible
         dislocated, irreducible
         teratological.
   risk factors for DDH
         (with the degree of increased risk) are:
              breech presentation (10×)
              female baby (4×)
              oligohydramnios (4×)
              big baby >4 kg (2×)
              firstborn baby (2×)
              family history.
   When diagnosed and treated from birth, it is possible to produce a normal hip joint after a few months
    treatment in an abduction splint. However, if the diagnosis is not made until after the child begins to
    walk, the treatment is long and tedious and often ends with an imperfect joint
Barlow and Ortolani
 A. The test Barlow is positive if the
  hip can be manually dislocated.
 B The Ortolani test is positive if the
  hip is lying in a dislocated position
  and is manually reducible
GENERAL
 State & state    Skin
  change
                       Colour
 Posture &            Thickness
  movement             Birthmarks
                       Rashes
 Cry                  hair

 reflexes
Summary
Newborn Examination
   Systematic
   Thorough
   Be aware of the environment
   Let parents watch
   Repeat examination
   Ask about social and other issues

								
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