1. Newborn baby check
Isabel Ng

2. Introduction WIPER Gloves Questions:
Ask parents if they have noticed any problems/worries
How was the pregnancy and labour
Has the baby been feeding, crying, wet+dirty nappies?
Family history of eye, hip or heart problems
Weigh baby and plot on growth chart

3. Inspection Skin Rousability and alertness General tone Stepping reflex
Posture – flexed position normal
Baby’s cry
General proportions and maturity

4. Head
Circumference
3 separate measures, take largest and plot, tape facing DOWN
Shape, dysmorphic features
Birth injuries
Fontanelles – tense/sunken
Eyes – shape, infections?, corneal opacities, red reflex
Ears – shape, position, patency of external auditory meatus
Nose – nose-bridge, press gently, could reveal jaundice
Mouth – colour of mucous membranes, observe palate, check suckling and rooting reflex, feel palate with little finger
Top – bottom: head circumference (note tape should be face down), cleft lip, tongue tie

5. Upper limbs Palmar creases
Check neck, shoulders, clavicles for traction birth injury
Erb’s palsy
Number of fingers and shape
Shape and movement of arms
Brachial and radial pulses
Palmar grasp
Top – bottom: normal palmar creases, shoulder dystocia, erb’s palsy

6. Thorax Respiratory effort and rate
Palpate praecordium and apex beat ( bpm normal in term babies)
Central capillary refill
Auscultate heart and lungs

7. Abdomen Observe girth and shape
Any masses/organomegaly/hernias? (expect liver to be 1-2cm below costal margin, spleen tip and left kidney may be palpable)
Umbilicus health – surrounding skin, hernias?
Inspect genitalia and anus – patent orifices, hypospadias, palpate testes
Observe nappy

8. Back Look at skin Spinal curvature and symmetry
Inspect vertebral column for neural tube defects – palpate
Pilonidal sinus/dimples/hair?

9. Lower limbs Femoral pulses and radio-femoral delay
Feet: Talipes, number of toes, skin colour, shape
Babinski and grasp reflexes
Barlow
Middle finger on greater trochanter, thumb around distal medial femur.
flex and adduct hip, femoral head gently pushed down, if hip is dislocatable, femoral head will be posteriorly dislocated
Ortolani
Abduct hip and apply upward leverage, if hip was dislocated with Barlow’s manoeuvre, it will return with “clunk” into acetabulum
Moro reflex

10. Remember Keep baby warm Talk to parents through the examination
If baby crying – take opportunity to observe mouth and palate
Find opportune moments to listen to heart and lungs
Minimise time without nappy
After newborn baby check, follow-up any abnormalities, baby has newborn hearing screening (4-5 weeks), baby is checked again at 6-week check at GP’s.

11. Exams… Station with several components Check head circumference
Barlow and Ortolani manoeuvres
Examine baby’s eyes
Viva on abnormal findings

12. Leukocoria Causes: Congenital cataracts Retinopathy of prematurity
Retinoblastoma
Urgent referral to ophthalmologist
Genetic screening, laser/surgical removal/correction
Top image: normal red reflex; bottom image: leukocoria

13. Developmental dysplasia of the hip
Dynamic ultrasound screen if positive barlow and ortolani or family history of 1st deg relative or breech presentation >=36weeks pregnancy or at delivery
Refer to orthopaedics
Many resolve by 6 weeks
<6months: bracing, splinting and Pavlik harness
>6months or failed bracing: closed reduction or surgery
Complications: premature degenerative joint disease and back pain long-term disability  hip replacement
Image: Pavlik harness – keeps hips and knees flexed and hips abducted

14. Spina bifida Refer to neurosurgeons USS/MRI
Possible need for surgical closure/removal of cord tethering

15. Talipes equinovarus Foot inverted and supinated
May be positional talipes – try to manoeuvre feet
Conservative: strapping, passive manipulation and boots - Ponseti and French functional method
XR, USS to monitor during manipulation
If conservative management fails, surgery at >6 months old – tendon release (Achilles tenotomy)
Clockwise from top: Talipes equinovarus; Ponseti method of correction; French method of correction

16. Skin changes Mongolian spots Naevus flammeus – capillary malformations
Stork bites/angel’s kiss/port wine stains
Strawberry naevus/haemangioma
Erythema toxicum
Clockwise from top: Mongolian spots; Port wine stain; Stork bite; Angel’s kiss; Infantile haemangioma; Erythema toxicum neonatorum

17. Down syndrome General: Hypotonia Hyperflexibility Head:
Epicanthal folds on inner corners of eyes
Oblique palpebral fissures
Brushfield spots
Flat nasal bridge
Enlarged tongue, high-arched palate
Brachycephaly
Neck: loose skin on nape of neck
Hands:
Single palmar crease
Clinodactyly (curved fingers)
Feet:
“Sandal gap” – extra space between big toe and second toe
Congenital heart defects
Duodenal atresia
Clockwise from top: Facial dysmorphia; Brushfield spots; Simian line (single palmar crease) and clinodactyly of little finger; Sandal gap

18. Newborn bloodspot screening
Taken at day 5 or in exceptional cases day 5-8
MC PHIGS MC
Maple syrup urine disease
Cystic fibrosis
Phenylketouria
Homocystinuria
Isovaleric acidaemia
Glutaric aciduria type I
Sickle cell disease
MCAD – medcium chain acyl-coA dehydrogenase deficiency
Congenital hypothyroidism

19. Paediatric immunisations
Isabel Ng

20. 8 weeks 12 weeks Name of Vaccine Protects against Site
5 in 1 DTaP/IPV/Hib
Diphtheria, tetanus, whooping cough (pertussis), polio, Haemophilus influenzae type B
IM Thigh
PCV
Strep pneumoniae
Rotavirus vaccine
Rotavirus
Oral
MenB
Meningitis B
12 weeks
Name of Vaccine
Protects against
Site
5 in 1 DTaP/IPV/Hib
(Dose 2)
Diphtheria, tetanus, whooping cough (pertussis), polio, Haemophilus influenzae type B
IM Thigh
Rotavirus vaccine (Dose 2)
Rotavirus
Oral
MenC
Meningitis C

21. 16 weeks 12 – 13 months Name of Vaccine Protects against Site
5 in 1 DTaP/IPV/Hib (Dose 3)
Diphtheria, tetanus, whooping cough (pertussis), polio, Haemophilus influenzae type B
IM Thigh
PCV (Dose 2)
Strep pneumoniae
MenB (Dose 2)
Meningitis B
12 – 13 months
Name of Vaccine
Protects against
Site
Hib/MenC booster
H. Influenzae type B, Meningitis C
IM Thigh
MMR
Measles Mumps Rubella
PCV (Dose 3)
Strep pneumoniae
MenB (Dose 3)
Meningitis B

22. 2 – 6 years (annually) 3 years 4 months Name of Vaccine
Protects against
Site
Flu vaccine
Influenza virus
Nasal spray
3 years 4 months
Name of Vaccine
Protects against
Site
4 – in – 1 dTaP/IPV or DTaP/IPV
Diphtheria, tetanus, pertussis, polio
IM Deltoid
MMR (Dose 2)
Measles Mumps Rubella

23. Girls 12-13 years 14 years Name of Vaccine Protects against Site
Gardasil
HPV 6, 11, 16, 18
IM Deltoid
14 years
Name of Vaccine
Protects against
Site
3 – in – 1 booster
Tetanus, diphtheria, polio
IM Deltoid
Men ACWY booster
Meningitis A, C, W and Y

24. Thank you and good luck!