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The Baby Check

The Baby Check. Newborn and Infant Examination. Newborn examination - undertaken no later than 72 hours after birth . The physical examination is repeated at approximately 6-8 weeks of age  The examinations tailored to patients needs Must review relevant issues: Family history

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The Baby Check

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  1. The Baby Check

  2. Newborn and Infant Examination • Newborn examination - undertaken no later than 72 hours after birth. • The physical examination is repeated at approximately 6-8 weeks of age  • The examinations tailored to patients needs • Must review relevant issues: • Family history • Mother's pregnancy, the birth • Antenatal screening outcomes • When baby 1st PU and BO • The baby's development, feeding patterns, weight, alertness and general wellbeing • Any aspects of their baby that might be worrying the parent

  3. New born and Infant examination • Top to toe examination • Also involves 4 screening examination • Eyes • Heart • Hips • Testes

  4. Newborn and Infant Examination • Appearance including colour, breathing, behaviour, activity and posture • Head (including fontanelles) • face, nose, mouth including palate, ears, neck and general symmetry of head and facial features. • Measure and plot head circumference • Eyes - opacities and red reflex • Neck and clavicles, limbs, hands, feet and digits; assess proportions and symmetry • Heart • position, heart rate, rhythm and sounds, murmurs and femoral pulse volume • Lungs • effort, rate and lung sounds • Abdomen • shape and palpate to identify any organomegaly; also check condition of umbilical cord • Genitalia and anus • completeness and patency and undescended testes in males • Spine • inspect and palpate bony structures and check integrity of the skin • Skin • note colour and texture as well as any birthmarks or rashes • Central nervous system • observe tone, behaviour, movements and posture. Elicit newborn reflexes • Hips • symmetry of the limbs and skin folds (perform Barlow and Ortolani’s manoeuvres) NICE Guideline CG37 - 2006

  5. Screening Examinations

  6. Eyes • About 200 children a year are born in the UK with congenital cataract in one or both eyes • Only one fifth of these 200 have a family history of cataracts • Cataract is the largest treatable cause of visual loss in childhood in the UK • Associated risk factors include: • low birth weight <1500g • low gestational age <32 weeks • family history of any eye disorder of childhood onset including congenital cataract, glaucoma and retinoblastoma • maternal infections during pregnancy e.g. Rubella, toxoplasmosis, herpes simplex virus (HSV)

  7. Eyes • Screen +ve • The absence of any reflex suggests presence of a congenital cataract • A white reflex (leukocoria) is suggestive of tumour of the eye (retinoblastoma) • Other abnormal findings include: • abnormalities of the iris • small or absent eye

  8. Eyes • +ve Results • @ Newborn check • Refer for expert consultation • To be seen by 2 weeks of age • @ 8 Week Check • Refer for expert opinion • To be seen by 11 weeks of age

  9. Heart • Congenital cardiac defects are a leading cause of infant death • Critical or serious congenital cardiac malformations are found in • approximately 6-8 in 1,000 newborn babies • Associated risk factors include: • family history of congenital heart disease • maternal conditions such as diabetes, systemic lupus erythematosus(SLE) • exposure to rubella during the first trimester of pregnancy, • Some medications taken during pregnancy e.g. Lithium • Syndromes Down’s, Noonan’s and Marfan’s • A proportion of major cardiac lesions may be identified during the fetalanomaly scan

  10. Heart • Screen +ve findings • Tachypnoeaat rest • Episodes of apnoea lasting longer than 20 seconds or associated with colour change • Increased work of breathing. • Central cyanosis • Visible pulsations over the precordium, heaves, thrills • Presence of murmurs/extra heart sounds • significant murmurs are usually loud • heard over a wide area • have a harsh quality • associated with other abnormal findings • benign murmurs are typically short, soft, systolic, localised to the left sternal border, have no added • Absent or weak femoral pulses

  11. Heart • Response to +ve finding • @ New born examination • Discuss with appropriate expert • Urgency will depend on circumstances • Measure pre and post ductal arterial O2sats(pulse oximetry) within 4 hours • @ 8 Week Check • Discuss with appropriate expert at the time of the examination

  12. Hips Approximately 1-2 in 1000 babies have a hip problem that requires treatment • Major associated risk factors include: • a first degree family history of hip problems in early life • breech presentation at 36 weeks of pregnancy, irrespective of presentation at delivery and mode of delivery • breech delivery if earlier than 36 weeks • Multiple births, if any of the above risk factors are present, all babies should be referred for • Undetected DDH or delayed treatment may result in significant morbidity • Early diagnosis and intervention improve health outcomes and reduce the need for surgical intervention

  13. Hips • Screen +ve test • Difference in leg length • Knees at different levels when hips and knees are bilaterally flexed • Difficulty in abducting the hip to 90 degrees • Palpable ‘clunk’ when undertaking either the Ortolani or Barlow manoeuvres

  14. Hips • Response to +ve Screening test • @ New born Exam • Abnormal examination • Refer for • urgent ultrasound • expert clinical consultation • To be seen by 2 weeks of age • Normal examination but has risk factors • Refer for Uss Hip – completed by 6 weeks of age

  15. Testes • Cryptorchidism affects approximately 2-6% of male babies born at Term • Associated risk factors include: • a first degree family history (father or sibling) of cryptorchidism • low birth weight • small for gestational age or pre-term delivery • Cryptorchidismis significant as it is associated with: • a significant increase in the risk of testicular cancer (primarily seminoma) • reduced fertility when compared with descended testes • May also be associated with other urogenital problems such as hypospadias and testicular torsion • Early diagnosis and intervention improves fertility and may aid earlier identification of testicular cancer

  16. Testes • The absence of one or both testes in the scrotal sac is a screen positive finding • Bilateral undescended testes in the newborn may be associated with an underlying endocrine disorders

  17. Testes • @ New Born Check • If Bilateral undescended testes • To be seen by a senior paediatrician within 24 hours of the examination • If Unilateral undescended testis • Review at 6-8 week examination • @ 6-8 week check • If Bilateral undescended testes • To be seen by a senior paediatrician within 2 weeks • If Persistent unilateral undescended testis • GP to review between 24-30weeks of age • Testis still absent -Refer to surgeon (Should be seen no later than 13 months)

  18. References • NHS E-Learning module – Video + Reference sheets • http://newbornphysical.screening.nhs.uk/elearning

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