History as Part of Examination of Newborn

1. History as Part of Examination of Newborn Promoting multiprofessional education and developmentin Scottish maternity care

2. Objective: To increase knowledge on the importance of: • family history • mother’s medical history • pregnancy history • birth history • post-birth condition to the routine examination of the newborn.

3. Family History Cardiac Hip problems Congenital cataract Renal conditions Haemoglobinopathies Cleft lip and/or palate Hearing problems.

4. Content • family history • mother’s medical history • pregnancy history • birth history • picture quiz • post-birth condition.

5. Mother’s Health • Medical conditions: • Endocrine • Hypertension • Haematological • Psychiatric • Connective tissue disorders, e.g. SLE • Medication • Social circumstances – child protection.

6. Content • family history • mother’s medical history • pregnancy history • birth history • picture quiz • post-birth condition.

7. Mother’s Pregnancy • Past obstetric history and children’s health • Relate antenatal history to stage of fetal development to predict outcome in baby • Results of antenatal screening • Gestation accuracy. • Use case notes and direct questioning.

8. Additional sources of Fetal Compromise • Smoking • Alcohol • Drugs - Prescribed medication - Recreational misuse • Infection.

9. Smoking in Pregnancy • Chronic fetal hypoxia • Carbon monoxide reduces the oxygen carrying capacity of both the mother and fetus • IUGR, approx 188g lighter than non- smokers (Bardy et al 1993) • Fetal, perinatal and neonatal morbidity and mortality.

10. Alcohol in Pregnancy • Fetal Alcohol Syndrome: believed by some to be the third most common cause of mental retardation (Seidel et al 1997). • Variable fetal effects depending on quantities of alcohol.

11. Clinical Features of FAS/FAA

12. Congenital Infections • Group B Streptococcus • Cytomegalovirus (CMV) • Rubella • Toxoplasmosis • Varicella Zoster (Chickenpox) • Listeria • Hepatitis B, C • HIV • Herpes – genital warts.

13. Content • family history • mother’s medical history • pregnancy history • birth history • picture quiz • post-birth condition.

14. Birth History • Fetal condition • Duration of labour • Rupture – delivery interval • Maternal analgesics • Maternal response – pyrexia • Mode of delivery.

15. Neonatal Delivery Effects • Posture and compression effects • Birth injuries • Effects of hypoxia • Effects of maternal medication • Postnatal issues.

16. Linking Condition to History What could be wrong with these babies?

17. Linking Condition to History

18. Linking Condition to History

19. Linking History to Condition • What would you be looking for in the history to explain this picture?

20. Caput Succedaneum • distribution is across suture lines • oedema • pits on pressure • swelling largest at birth • disappears within a few days.

21. Cephalhaematoma • DOES NOT cross suture lines • Can be bilateral • NOT apparent immediately after birth.

22. Other answers you may find in the notes! • Reduced fetal movements, abruption, fetal distress and or meconium staining • Late maternal “sedation” with opiates • Required active resuscitation.

23. Birth and Beyond • Condition at birth – APGAR • Vitamin K • Baby’s behaviour • Temperature • Feeding • Mothering. • Importance of mother’s opinion of baby’s health and progress.

24. Any Questions?

25. Conclusion • Careful review of case notes is essential. • Thorough knowledge of family/maternal health, pregnancy, labour, delivery and subsequent condition of baby is essential prior to newborn examination.