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

2. Before We Begin

3. 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

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

5. 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

6. Overview: Back Spine Heart sounds Lung sounds Skin Tone B

7. 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

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

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

10. 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

11. Head Fontanelles Face Nose Mouth + palate Ears

12. Head: Possible Findings Cleft palate +/- lipMicrognathiaMicrotia

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

14. Neck and Clavicles Size/ proportions Shape Symmetry of structures

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

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

17. 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)

18. 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)

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

20. Abdomen: Possible Findings Umbilical infection/ rednessUmbilical hernia Abdominal mass

21. 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

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

23. CNS Tone Behaviour Movements Posture Newborn reflexes only if concerned

24. CNS: Possible Findings Other pathologies:

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

26. Turning the Baby Easiest and safest = roll baby onto side

27. 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

28. Spine: Possible Findings Meningocele/myelomenigocoeleHair tuft

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

30. What Now? Download slides + checklist Online MCQ: https://www.goconqr.com/en- GB/p/3906445-Examination-of-the-Newborn-- 3--Examination-Part-2---Top-to-toe-quizzeshttps://www.goconqr.com/en- GB/p/3906445-Examination-of-the-Newborn-- 3--Examination-Part-2---Top-to-toe-quizzes Request a Podcast/ ask a question Final presentation: Post-examination

31. Further Information NIPE eLearning package: http://cpd.screening.nhs.uk/nipe-elearning http://cpd.screening.nhs.uk/nipe-elearning

32. References How to roll a baby: https://www.youtube.com/watch?v=kVUeK77 URJI https://www.youtube.com/watch?v=kVUeK77 URJI Neurological abnormality videos: http://library.med.utah.edu/pedineurologicex am/html/newborn_ab.html#01 http://library.med.utah.edu/pedineurologicex am/html/newborn_ab.html#01 Neonate skin conditions and images: http://www.dermnetnz.org/site-age- specific/neonate.html http://www.dermnetnz.org/site-age- specific/neonate.html

33. References Cleft lip and palate diagram: http://www.transformingfaces.org/wp- content/uploads/2012/05/clp11.png http://www.transformingfaces.org/wp- content/uploads/2012/05/clp11.png