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Newborn Examination

Newborn Examination. Dr Badr H. Sobaih Adapted from: Rafat Mosalli MD FAAP FRCP. Newborn examination objectives. Indication and importance Precautions prior to exam ! Systematic approach Neonatal reflexes Normal variants. Newborn examination.

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Newborn Examination

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  1. Newborn Examination Dr Badr H. Sobaih Adapted from: RafatMosalliMD FAAP FRCP

  2. Newborn examination objectives • Indication and importance • Precautions prior to exam ! • Systematic approach • Neonatal reflexes • Normal variants

  3. Newborn examination • Earliest possible detection of deviations. • Establishes a baseline for subsequent examinations • Parents assurance and counseling

  4. Newborn examination indications • Immediately after birth • Before discharge from maternity unit • Whenever there is any concern about the infant's progress

  5. Newborn first exam • Apgar score • Heart rate • Respiratory effort • Color • Tone • Reflex irritability

  6. Examination precaution • Hand washing,hand washing ,hand washing • Thermal environment • Light and noise • Brief examination time

  7. General(Growth parameters) • Weight (Naked) • Length(straight) • Head circumference(3 measurements)

  8. Vital Sign • Heart Rate HR 120-160 • Respiratory Rate RR 40-60 • Temperature 36.5-37.5 C • Blood Pressure

  9. General • Well, Distress or not? • skin • Pink is normal • Acro cyanosis is normal • Cyanosis • Bruised part look blue • Jaundice • Common variants skin rash • Erythema toxicum, mongolian spot, Benign Pustular Melanosis

  10. Erythema Toxicum

  11. Erythema Toxicum • Erythematous macules and firm 1-3 mm yellow or white papules or pustules • Etiology obscure • Pustules contain eosinophils and are sterile • Appear in the first 3-4 days of life • Range: Birth to 14 days • Benign and self limited

  12. Erythema Toxicum

  13. DD: Impetigo Neonatorum • Vesicular, pustular, or bullous lesions developing as early as day of life 2-3 up to 2 weeks of life • Lesions occur in moist or opposing surfaces of skin • Unroofed lesions do not form crusts • Treat with antibiotics

  14. Impetigo Neonatorum

  15. Mongolian Spots • 90% of African infants, 81% of Asian, and 9.6% of Caucasian infants • Slate-gray to blue-black lesions • Usually over lumbosacral area and buttocks • Accumulation of melanocytes within the dermis • Generally fade by age 7 years

  16. Mongolian Spots

  17. Benign Pustular Melanosis of the Newborn

  18. Pustular Melanosis

  19. General • Obvious Dimorphism or malformations E:g(Down syndrome ear tag neural tube defect ) • Tone & Movements: Flexion of upper and lower extremities -Asymmetric movement • Brachial plexus and fractured clavicle -Ventral, vertical suspension and head control for tone assessment

  20. General inspection • Vigorous cry is assuring • Weak cry • sepsis, asphyxia, metabolic, narcotic use • Hoarseness • Hypocalcemia, airway injury • High pitch cry • CNS causes, kernicterus

  21. Head and Face • Shape of the head • Fontanels? • Sutures? • Eyes? • Nose? • Mouth,lips,palate? • Ears? • Neck?

  22. Head • Forceps and vacuum marks • Caput succedaneum • Boggy edema in presenting part of head • Cross suture lines • Disappear in few days • Cephalhematoma • Subperiosteal • Weeks to resolve • Dose not cross sutures

  23. Cephalhematoma

  24. Caput Succadaneum

  25. Newborn Scalp Hematomata

  26. Head • Head circumference • Shape :Molding, Brachycephaly: flat occiput • Widening of suture • Fontanelles • Head auscultation: bruits

  27. Infant skull

  28. Craniosynostosis • Definition: premature closure of one or more cranial suture. • Growth of the skull occurs parallel to the suture(s) involved • Early correction optimizes cosmetic appearance • Can be part of syndromes:Crouzon's , Apert's syndrome

  29. Craniosynostosis • Types: • Sagittal synostosis results in scaphocephaly • coronal synostosis results in brachycephaly • coronal, sagittal, and lambdoid synostosis results in acrocephaly • single suture on one side of head can result in plagiocephaly www.uscneurolosurgery.com

  30. Chest and Abdomen

  31. Chest • Distress signs(Grunting,Tachypnea,Nasal flaring,asymetric chest rise,supra-sternal, intercostal, sub costal retraction). • Deformities(Pectus excavatum, carinatum) • Auscultate • Air entry, symmetry • Early crepitation sound is transmitted upper sound • Late inspiratory crepitation

  32. chest • Breast hypertrophy • Milk production • No redness

  33. Heart • HR 100-160 beats/min • Color, perfusion,Central cyanosis • Murmur • Single S1 • Splited S2 • No split ;single ventricle, pulmonary hypertension

  34. Abdomen • Inspection • Scaphoid • Distention • Abdominal wall defect (gastroschisis) • Palpation; babysucking and use warm hands • Kidneys are normaly palpable • Liver 2-3 cm • Spleen palpable • Umbilical vessels • 2 artery, one vein • Hernias ; umbilical and inguinal

  35. Genitalia • Penile size • Hypospadias, epispadias • Testes • 2% crypoorchid • Hydrocele • Female: • Prominent clitoris and minora • Vaginal skin tag • Vaginal discharge /blood • Labial fusion • Anus : Patency and location

  36. Hydrocoeles

  37. Inguinal Hernias

  38. Hip and Extremities • Erb’s palsy: extended arm and internal rotation with limited movement • Humerous fracture • Digital abnormality • Syndactaly, brachdactaly, polydactaly • Single palmar crease • Hip dislocation • Female, breach

  39. Subluxation of the Hip

  40. Subluxation of the Hip

  41. Feet and Back • Feet deformities • Back and spine • abnormal curvature • Sinus tract, tuft of hair

  42. Lumbar hair tuft & haemangioma

  43. CNS • Awakenes and alertness • moving extremities • Flexed body posture • Minimal Head lag • Ventral suspension • Vertical suspension

  44. Neonatal Reflexes

  45. Neonatal reflexes • Also known as developmental, primary, or primitive reflexes. • They consist of autonomic behaviors that do not require higher level brain functioning. They can provide information about lower motor neurons and muscle tone. • They are often protective and disappear as higher level motor functions emerge.

  46. Suck • Onset: ~28weeks GA • Well-established: 32-34 weeks GA • Disappears: around 12 months • Elicited by the examiner stroking the lips of the infant; the infant’s mouth opens and the examiner introduces their gloved finger and sucking starts.

  47. Rooting • Onset: 28 weeks GA • Well-established: 32-34 weeks GA • Disappears: 3-4 months • Elicited by the examiner stroking the cheek or corner of the infant’s mouth. The infant’s head turns toward the stimulus and opens its mouth.

  48. Palmar grasp • Onset: 28 weeks GA • Well-established: 32 weeks GA • Disappears: 2 months • Elicited by the examiner placing his finger on the palmar surface of the infant’s hand and the infant’s hand grasps the finger. Attempts to remove the finger result in the infant tightening the grasp.

  49. Tonic neck (Fencing posture) • Onset: 35 weeks GA • Well-established: 4 weeks PCA • Disappearance: 7 months • Elicited by rotating the infants head from midline to one side. The infant should respond by extending the arm on the side to which the head is turned and flexing the opposite arm. The lower extremities respond similarly.

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