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Flashcards in Baby checks Deck (28):
1

History

Maternal
-Obstetric
-medical
-surgical
-family/social

Present pregnancy
-maternal: antenatal, medical etc
-fetal
-investigations

Newborn
-Labour: gestation, gender type, infection, fetal distress
-Birth: delivery, APGAR, growth parameters, resuscitation
-Prognosis since birth: concerns, feeding, observations, stool/urine, medications, immunisations

2

Approach to examination

Generally appearance
Growth
Chest->respiratory and cardiac: easier when quiet
Head, face, neck
Shoulders, arms and hands
Abdomen
Genitourinary
Hips, leg, feet
Back
Neurological
Discuss, document, refer

Parent present

3

What to discuss with parents

Purpose
Process
Timing
Limitations
Parental concerns

4

When to perform checks

Initial immediately after birth
Detailed assessment within 48 hours, always prior to discharge
F/U at 5-7 days and 6 weeks

If unwell/immature, as clinically indicated

5

Environment for examination (5)

Lighting, warmth
Correct identifiction
Infection control
Privacy

6

Equiptment required

Warmer
Stethoscope
Opthalmoscope
Tongue depressor
Pensil Light
Tape measure, scales, centile charts
Pulse oximetry
Documentation->infant personal health record, medical health record

7

Components to assess at general appearance

Skin colour, integrity, perfusion
Alertness
Activity, ROM
Posture
Tone

8

Growth status components

HC
Length
Weight

Check 3 times for HC

9

Head, face, neck components

• Head shape, size
• Scalp, fontanelles, sutures
• Eye size, position structure
• Nose, position, structure
• Ear position, structure
• Mouth, palate, teeth, gums
tongue, frenulum
• Jaw size
Neck
Clavicles

10

Shoulders, arms and hand components

Length
Proportion
Symmetry
Structure
Number of digits

11

Chest components

• Size, shape, symmetry,
movement
• Breast tissue, nipples
• Heart sounds, rate, pulses
• Breath sounds, resp rate
• Pulse oximetry (optional)

12

Abdomen components

Size, shape, symmetry
Palpate liver, spleen, kidneys
Umbilicus

13

GU components

Male- penis, foreskin, testes
Females- clitoris, labia, hymen
FEMORAL PULSES
Anal position, patency
Passage of urine and stool

14

Hip, legs, feet comopnent

Ortolani, Barlows
Leg length, proportions, symmetry, digits

15

Back component

Spinal column, skin
Symmetry of scapulae and buttocks

16

Neurological component

Behaviour
Position
Muscle tone, spontaneous movements
Cry
Reflexes->Moror, suck, grasp

17

Risks of DDH (4)

Female
First born
Feet first
Family history

18

Further investigations required if findings on growth and appearance- include the urgent and reasons

Dysmorphic- syndromes
Excessive weight loss- breast fed baby may lose up to 10% body weight in first few days
Petechiae not a result of mode of delivery->thrombocytopenia, coagulation, vascular disorders (autoimmune, infections etc)
Pallor
Hemangioma->may rarely cause high output CF

*Billious vomiting
*Jaundice

19

Further investigations required if findings on head and neck

Macro/microcephaly
Caput/cephalohematoma
Fused sutures
Facial palsy/assymmetry
Hazy/dull cornea
Absent red reflex->retinoblastoma, congenital cataracts
Unequal pupils/dilated/constricted
Purulent conjunctivitis
Dacryocyst->nasolacrimal duct obstruction= infection and epiphora
Cleft lip/palate
Unresponsive to noise
Ear drainage
Small receeding chin/micrognathia
Neck masses/swelling/webbing
Swelling over or fractured clavicle

*Enlarged/buldging/sunken fontanelle
*Subgaleal hemorrhage->+association with head injury
*Non patent nares

20

Further investigations required if findings on upper limbs

Limb hypotonia, contractures or palsy
Palmar crease pattern

21

Further investigations required if findings on chest

Abnormal HR, rhythm, regularity
Heart murmurs

*Respiratory distress
*Apnoeic episodes
*Weak or absent pulses
*Positive pulse oximetry

22

Further investigations required if findings on abdomen

Inguinal hernia

23

Further investigations required if findings on GU

Hypospadias
Penile chordee
Micropenis

*No urine/meconium in 24 hours
*Ambiguous genitalia
*Testicular torsion

24

Further investigations required if findings on Hips, legs and feet

Risk factors for hip dysplasia
+Barlows/Ortolani
Contracture, hypotonia
Fixed talipes
DHD

25

Further investigations required if findings on back

Curvature of spine
Non-intact spine
Tufts of hair/dimple along the spine

26

Further investigations required if findings on neurological

Weak/absent cry
Absent reflexes
No response to consoling
Inappropriate carer response to crying

*Seizures
*ALOC

27

Discaharge requirements

Review discharge requirements->observations, feeding, output

Discuss:
1. Routine tests->Hearing, hepatitis B, NNST
2. Support agencies-->GP, Child/community health, lactation support, 13 health
3. Health promotion
-Feeding and growth
-Jaundice
-SUDI (sudden unexpected death in infancy), injury prevention
-Immunisation
-Signs of illness
4. Infant personal health record
5. Referral and follow-up->routine at 5-7 days and 6 weeks

28

Aspects of health promotion

Feeding and growth
Jaundice
SUDI, injury prevention
Immunisation
Signs of illness

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