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 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

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

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

Screening Examinations

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)

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

Eyes +ve Results @ Newborn check @ 8 Week 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

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 fetal anomaly scan

Heart Screen +ve findings Tachypnoea at 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

Heart Response to +ve finding @ New born examination @ 8 Week Check Discuss with appropriate expert Urgency will depend on circumstances Measure pre and post ductal arterial O2 sats (pulse oximetry) within 4 hours @ 8 Week Check Discuss with appropriate expert at the time of the examination

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

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

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

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 Cryptorchidism is 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

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

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 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)

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