Examination of the Newborn Flashcards
History: Maternal background
- Age, parity, blood group, VDRL and HIV status.
- Outcome of previous pregnancies.
- Any problems with previous infants
History: Pregnancy
- Booked.
- Duration and fetal growth.
- Illness or complications e.g. diabetes, GPH.
- Drugs, smoking, alcohol.
- Feeding Choice.
History: Labour and Delivery
- Duration of labour.
- Rupture of Membranes, Amniotic Fluid Clear, Meconium.
- Drugs given to mother.
- Method of delivery.
- Time and Date of Delivery.
- Fetal condition.
- Complications.
History: Infant
- Condition at birth – Apgar score.
- Need for resuscitation, Time to spontaneous Respiration.
- Passage of urine and meconium.
- Feeding.
- Problems since delivery e.g. hypothermia, jaundice.
History: Placenta
- Weight.
- Gross abnormalities
When should a brief initial examination be conducted after delivery?
A brief initial examination should be done after delivery to detect major congenital abnormalities or gross disease requiring immediate attention.
When should a complete examination be performed in newborns?
A complete examination should be performed within 24 hours of birth and before discharge home.
What are some key reminders before conducting a newborn examination?
Wash your hands, undress the infant completely, and ensure the infant does not get cold.
Why is it important to examine the infant in the mother’s presence if possible?
Examining the infant in the mother’s presence reassures her and allows for an explanation of any observed issues or concerns.
How should infants be examined?
Infants must be examined gently with warm hands, and the examination should follow a fixed order to ensure nothing is forgotten.
What is the recommended order for conducting a physical examination of a newborn
The physical examination should begin with basic measurements, followed by a general inspection, examination by regions starting at the head and ending at the toes, and finally, assessment of the neurological status.
What are the normal measurements for birth weight in newborn infants?
Birth weight should be 2500g or above and between the 10th and 90th centile for gestational age.
What conditions are considered abnormal in birth weight measurement?
Low birth weight (below 2500g) or being underweight (below 10th centile) or overweight (above 90th centile) for gestational age are considered abnormal.
What are the normal measurements for head circumference in newborn infants?
Head circumference should be between the 10th and 90th centiles for gestational age.
What conditions are considered abnormal in head circumference measurement?
Having a small head (below 10th centile) or a large head (above 90th centile) for gestational age are considered abnormal.
What are the normal measurements for crown-heel length in newborn infants?
Crown-heel length should be between the 10th and 90th centile for gestational age, measured accurately with a measuring box.
What conditions are considered abnormal in crown-heel length measurement?
Being short (below 10th centile) or long (above 90th centile) for gestational age is considered abnormal.
What is the normal range for skin temperature in newborns?
The abdominal wall temperature should be between 36–36.5°C (or axilla 36.5–37°C).
What condition is indicated by a skin temperature below 35°C?
Hypothermia is indicated by a skin temperature below 35°C.
What physical and neurological features are characteristic of a term infant?
Term infants typically exhibit physical and neurological features appropriate for their gestational age, generally considered as being between 37 and 41.9 weeks.
How do premature infants (born before 37 weeks) typically differ in appearance from term infants?
Premature infants may exhibit immature features compared to term infants.
What physical features are characteristic of postterm infants (born at 42 weeks and above)?
Postterm infants may have long nails and are often wasted in appearance.
How would a well-term infant typically appear in terms of wellbeing?
A well-term infant is usually active and alert.
What are signs that an infant may be unwell or lethargic?
Lethargy and appearing ill are signs that an infant may be unwell.
What is considered normal in terms of wasting for a newborn?
Well-nourished soft tissue is considered normal for newborns.
What color is typically seen on the tongue of a healthy newborn?
A healthy newborn typically exhibits a pink tongue.
What are some abnormal colorations that may be observed in newborns?
Abnormal colorations may include cyanosis, pallor, jaundice, or plethora.
Abnormal colorations may include cyanosis, pallor, jaundice, or plethora.
Newborns typically have smooth or mildly dry skin, with vernix and lanugo present.
stork bites
blue naevus
milia
erythema toxicum
salmon patches
What skin conditions or abnormalities may be observed in newborns?
Skin conditions may include meconium staining, petechiae, bruising, large or many pigmented naevi, capillary or cavernous haemangioma, skin infections, or oedema.
What are common features related to the shape of the newborn’s head?
Caput and moulding are common features related to the shape of the newborn’s head.
What abnormalities might be indicated by asymmetry in the shape of the newborn’s head?
Asymmetry in the shape of the newborn’s head might indicate conditions such as anencephaly, hydrocephaly, microcephaly, or encephalocoele.
cephalhaematoma, subaponeurotic bleed
What is the normal condition of the fontanelle in a newborn?
A normal fontanelle in a newborn is open and soft with palpable sutures.
What abnormalities might be indicated by the fontanelle being full or sunken?
A full or sunken anterior fontanelle might indicate abnormalities such as dehydration or a pathological condition affecting intracranial pressure. Large or closed fontanelles might indicate abnormal development.
What is the normal condition of the sutures in a newborn?
Palpable mobile sutures are considered normal in a newborn.
What abnormalities might be indicated by wide, fused, or markedly overlapping sutures?
Wide, fused, or markedly overlapping sutures might indicate abnormalities in skull development.
What is the expected variation in hair among newborns?
Newborns typically exhibit wide familial variation in hair.
What might a low posterior hairline suggest in a newborn?
A low posterior hairline might suggest certain genetic conditions or abnormalities.
What is the normal positioning of the eyes in a newborn?
In a newborn, there should be one eye space between the eyes.
What abnormalities might be indicated by hypertelorism or hypotelorism?
Hypertelorism or hypotelorism might indicate abnormalities in the spacing between the eyes.
What is the normal size expectation for the eyes in a newborn?
Normal eyes in a newborn should exhibit a typical size.
What abnormalities might be indicated by microphthalmia or macrocornea?
Microphthalmia or macrocornea might indicate abnormalities related to the size of the eyes, such as glaucoma.
What are common findings related to the eyelids in a newborn?
Mild oedema is common in newborn eyelids.
What abnormalities might be indicated by marked oedema, ptosis, or bruising of the eyelids?
Marked oedema, ptosis, or bruising of the eyelids might indicate trauma or underlying pathology.
What might narrow palpebral fissures suggest in a newborn?
Narrow palpebral fissures might suggest fetal alcohol syndrome (FAS) or other abnormalities.
Normal Conjuctivae
may have small subconjuctival haemorrhages
What are potential abnormalities related to the conjunctivae in a newborn?
Abnormalities might include pale or plethroic, conjunctivitis, or excessive tearing due to nasolacrimal duct obstruction.
What are normal expectations regarding the cornea, iris, and lens in a newborn?
The cornea should be clear, the pupil regular, and a red reflex should be present.
What condition might be indicated by choanal atresia?
Choanal atresia, a congenital condition where the back of the nasal passage (choana) is blocked, might be indicated by difficulty passing a feeding catheter or observing dry secretions blocking the nostrils.
What might a flattened nose suggest in a newborn?
A flattened nose in a newborn might suggest oligohydramnios, a condition characterized by low levels of amniotic fluid.
What is expected regarding the patency of the nostrils in a newborn?
Both nostrils should be patent, allowing for easy passage of a feeding catheter.
What abnormalities might be indicated by an opaque cornea, irregular pupil, cataracts, absence of red reflex, fixed squint, or abnormal eye movements?
These abnormalities might indicate issues such as corneal opacity, cataracts, or neurological problems affecting eye movement.
What is the typical shape of the nose in a newborn?
In a newborn, the nose is typically small with upturned nostrils.
What might be observed on the lips of a newborn?
Sucking blisters may be observed on the lips of a newborn.
Abnormal lips
Cleft lips
What might be observed on the palate of a newborn?
Epstein’s pearls
What characteristics might indicate fetal alcohol syndrome (FAS) in the lips?
In FAS, the lips may exhibit a long smooth upper lip, absence of a philtrum, and a thin pink border.
Abnormal palate of a newborn
high arched or cleft palate may be observed in a newborn.
What is considered normal regarding the appearance of the tongue in a newborn?
A normal tongue in a newborn is pink in color.
What abnormalities might be indicated by a cyanosed, pale, or large tongue (macroglossia)?
These abnormalities might indicate issues such as poor oxygenation, anemia, or conditions like macroglossia.
In what condition might the tongue be posteriorly placed?
In Pierre-Robin anomaly, the tongue may be posteriorly placed, leading to potential airway obstruction.
What is the normal dental condition at birth?
Newborns typically have no teeth at birth.
What might adventitious or primary teeth suggest in a newborn?
These teeth might suggest abnormalities or conditions affecting dental development.
What normalities might be observed on the gums of a newborn?
small cysts
What abnormalities might be observed on the gums of a newborn?
epulis may be observed on the gums of a newborn.
normal mucous membranes
pink and shiny
What conditions might affect the mucous membranes in a newborn?
Thrush or ulcers may affect the mucous membranes in a newborn.
When might excessive saliva production be observed in a newborn?
Excessive saliva production may be observed in newborns with poor swallowing or esophageal atresia.
How does the size of the jaw in a newborn compare to that of an older child?
The jaw in a newborn is typically smaller than that of an older child.
when do newborns typically have micrognathia
Pierre Robin anomaly
What is the typical position of the pinnae (outer ears) in a newborn?
In a newborn, the pinnae are typically vertical at term.
What might be indicated by ears that are rotated backward with poorly formed upper pinnae (low set)?
Ears that are rotated backward with poorly formed upper pinnae might suggest abnormalities in ear development or placement.
What is considered normal regarding the appearance of the ears in a newborn?
Familial characteristics are considered normal in the appearance of the ears in a newborn.
What might be indicated by the presence of a pre-auricular skin tag or sinus?
A pre-auricular skin tag or sinus might indicate a minor congenital anomaly, which is often benign.
What abnormalities might be observed in the ears of a newborn?
Malformed ears or hairy ears in infants of diabetic mothers (IDM) might be observed.
What does “IDM” stand for?
“IDM” stands for infants of diabetic mothers.
What is the typical shape of the neck in a newborn?
The neck in a newborn is usually short.