Examination of the Newborn Examination Part 2: Top-to-Toe Chris Kingsnorth

Before We Begin

Overview 4 presentations: 1.Introduction and pre-examination 2.Examination part 1: Eyes, heart, hips and testes 3.Examination part 2: Top-to-toe 4.Post-examination

Overview Integrate 4 focuses of NIPE screening (eyes, hips, heart and testes) into top-to-toe examination Practical tips

Overview: Front Head (inc. face and mouth) Eyes Neck and clavicles Limbs and digits CVS (inc. heart, colour and pulses) Respiratory system Abdomen Genitalia + anus Skin Hips CNS (inc. tone, movements and posture) +/- reflexes Cry F General appearance

Overview: Back Spine Heart sounds Lung sounds Skin Tone B

General Principles of Examination Don’t be scared of the baby! Be flexible in order examining based on baby’s behaviour/ state of undress Keep baby warm Involve parents; explain examination and findings If unsure about findings, ask a senior Be prepared to change nappies

General Appearance Start with baby lying on back on flat surface Colour Breathing Behaviour Activity Posture Cry

Skin Colour Texture Birthmarks Rashes Don’t forget to check the back too (you can do this later, when examining the spine)

Skin: Possible Findings Cyanosis Erythema toxicum (Common (50%), not harmful; clears within a few days) Milia (Blocked pores. Common (50%), not harmful; clear within a few weeks) Mongolian blue spot More common in Asian babies. Not harmful. Usually lumbosacral; may occur anywhere. Can look like bruise Always document birthmarks on a body map to avoid future misinterpretation

Head Fontanelles Face Nose Mouth + palate Ears

Head: Possible Findings Cleft palate +/- lipMicrognathiaMicrotia

Eyes NIPE screening focus point Covered in detail in Examination Part 1: Eyes, heart, hips and testes

Neck and Clavicles Size/ proportions Shape Symmetry of structures

Limbs, Hands, Feet and Digits Moving all 4 limbs? Size/ proportions Shape Symmetry Palmar creases Sandal gap Always count digits

Limbs, Hands, Feet and Digits: Possible Findings Sandal gap Single palmar (simian) crease Syndactyly Polydactyly

Heart and CVS NIPE screening focus point Covered in detail in Examination Part 1: Eyes, heart, hips and testes Don’t forget to listen to the heart at the back too (you can do this later, when examining the spine)

Respiratory System Cyanosis? Effort Rate Lung sounds +/- Pulse oximetry Don’t forget to listen at the back too (you can do this later, when examining the spine)

Abdomen Shape and size Palpate: Organomegaly/ masses? Bowel sounds Umbilical cord (esp. for discharge/ redness)

Abdomen: Possible Findings Umbilical infection/ rednessUmbilical hernia Abdominal mass

Genitalia Males: Testes = NIPE screening focus point (Covered in detail in Examination Part 1: Eyes, heart, hips and testes) Females: Shape and size Ambiguous: Seek senior advice

Anus Patent? Passed meconium ≠ patent anus (possibility of enterocutaneous fistula)

CNS Tone Behaviour Movements Posture Newborn reflexes only if concerned

CNS: Possible Findings Other pathologies:

Hips NIPE screening focus point Covered in detail in Examination Part 1: Eyes, heart, hips and testes

Turning the Baby Easiest and safest = roll baby onto side

Spine Inspect + palpate bony structures ‘Divots’ suggesting non-continuity of vertebrae/ absence of spinous process Sinuses/ hairy tuft (possible spina bifida occulta) Meningocele/myelomenigocoele Sacral dimples vs. sinuses; if unsure, ask for senior R/V

Spine: Possible Findings Meningocele/myelomenigocoeleHair tuft

Completing the Examination Redress baby Thank parents Explain any findings/ need for Senior R/V Invite questions

What Now? Download slides + checklist Online MCQ: GB/p/ Examination-of-the-Newborn-- 3--Examination-Part-2---Top-to-toe-quizzeshttps:// GB/p/ Examination-of-the-Newborn-- 3--Examination-Part-2---Top-to-toe-quizzes Request a Podcast/ ask a question Final presentation: Post-examination

Further Information NIPE eLearning package:

References How to roll a baby: URJI URJI Neurological abnormality videos: am/html/newborn_ab.html#01 am/html/newborn_ab.html#01 Neonate skin conditions and images: specific/neonate.html specific/neonate.html

References Cleft lip and palate diagram: content/uploads/2012/05/clp11.png content/uploads/2012/05/clp11.png