Examination of the newborn mku Year 4 Paediatrics Notes

Examination of the newborn mku Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / PAEDS 4.1 / Agisa -- Slide 1 Examination of the newborn AND NEONATE Slide 2 objective To assess general state of well being To detect any congenital malformations To observe smooth transition to extra-uterine life Slide 3 It is recommended that all babies should be examined within the first 24 hours of life and again before discharge from the hospital,before end of the first week Many parts of examination are similar to the older babies and children. Take detailed history- Antenatal, natal,post natal, family history ASK FOR RECORDS Slide 4 Examination of the newborn baby Minimum prerequisites\nMother & baby Warm room, fresh clean sheet/clothes Thermometer\nWeighing scale Watch with seconds Stethoscope Eyes see what the mind knows Skilled, knowledgeable health professional! EN Teaching Aids: ENC 4 Slide 5 Check list for examination Apgar score-min 1,5,10 4 Limb oxygen saturations Weight,length,head circumference Passage of urine and meconium(urine can delay for up to 48 hours,meconium should be passed within 24 hours) Alertness and wakefulness Skin colour:cyanosis,jaundice Birth marks-Capillary haemangiomas,hyper/hypopigmented patches Sacral development-sacral dimple Skull and fontanelle-capput succadeneum,cephalohematoma,sagittal sutures,fontanelle Eyes-pupillary reflex,can have subconjunctival haemorrages after svd, Mouth and tongue-cleft palate,bifid uvula Slide 7 Check list for examination Neck-brachial cysts,dermoid cysts,thyroglossal cysts Chest-as of older children,breast enlargementwith milk exudates can be normal Abdomen and umbilicus-umbilical stump should contain 2 arteries and one vein Back and spine-check for spina bifida Perineum and genitalia-hypospadias,hydroceles,hernias or undescended testis.patency of the anus.check for any abnormal genitalia in girls,girls can pass some discharge and can have pv bleeding which is normal-due to maternal hormones Neurological assessment-primitivE reflexes,movements,tone,the cry Limbs-digits,palmar crease,talipes Assessment of gestationExamination of hips Screening for genetic disorders Slide 8 Caput succedaneum vs. cephalohematoma Normal vs. Abnormal EN Teaching Aids: ENC 8 Slide 9 The umbilicus: Which one is normal? Normal vs. Abnormal EN Teaching Aids: ENC 9 Slide 10 Umbilicus EN Teaching Aids: ENC 10 Slide 11 Posture The normal resting posture of a term newborn baby: loosely clenched fists flexed arms, hips, and knees\nSmall babies (less than 2.5 kg at birth or born before 37 weeks gestation) the limbs may be extended\nBabies born in the breech position may have fully flexed hips and knees; the feet the mouth; and legs may even reach near the mouth. EN Teaching Aids: ENC 11 Slide 12 The normal resting posture of a baby born breech EN Teaching Aids: ENC 12 Slide 13 ABNORMAL position of arm and hand EN Teaching Aids: ENC 13 Slide 14 Color of the baby Normal vs. Abnormal EN Teaching Aids: ENC 14 Slide 15 Congenital hip dislocation examination Slide 17 Pavlick harness for treating Congenital hip dislocation Slide 18 Infant reflexes Involuntary stereotyped movement responses to a particular stimuli. Dominant movement form during the last 4 months of prenatal life and first 4 months after birth. Occur subcortically (below the level of the higher brain centers) Primitive and postural Slide 19 Most primitive infant reflexes disappear by 4 months of age. They are inhibited by the maturing CNS or intergrated into new movements The absence of one or more of the reflexes may indicate some abnormality of the brain,a local abnormality of the affected limb or a neuromuscular abnormality. Persistence beyond the 4th moth should alert you of a possible developemental delay. Primitive reflexes are critical for human survival Slide 20 Reflexes should be tested carefully and only by trained professionals.\nNeed state of quiet.\nIf baby restless, crying, sleepy, or distracted, may not respond to applied stimulus. Slide 21 Pinpointing the Number of Infant Reflexes Different terminologies used for same reflex by experts Rooting reflex = search reflex; cardinal points reflex Reflexes are often poorly defined and more complex than once thought Palmar grasp vs. traction response Slide 22 Primitive Reflexes Palmar Grasp Sucking Search/rooting Moro/Startle Asymmetric Tonic Neck Symmetric Tonic Neck Plantar Grasp Babinski Palmar Mandibular Palmar Mental Slide 23 Palmar Grasp Slide 24 Sucking Slide 25 rooting/ Search Slide 26 Moro Slide 27 Startle Slide 28 Asymmetric Tonic Neck Slide 29 Symmetric Tonic Neck Slide 30 Plantar Grasp Slide 31 Babinski Slide 32 Palmar Mandibular Slide 33 Palmar Mental Slide 34 Postural Reflexes Stepping Crawling Swimming Head and Body Righting Parachuting Labyrinthine Pull Up Slide 35 Stepping Slide 36 Crawling Slide 37 Swimming Slide 38 Head and Body Righting Slide 39 Postural Reflexes ~ Parachuting Slide 40 Labyrinthine Slide 41 Pull Up Slide 42 Assessment of ges