Neonatal check

Question 1

Order of examination

Answer 1

Hx: maternal + newborn
head to toe
General appearance
Head, face, neck
arms shoulders hands
chest - cardio + resp
abdomen
genitourinary
Lower limbs + femoral pulses
Back
Neuro: reflexes

Question 2

what are the primitive reflexes - when do the appear/disappear?

Answer 2

Rooting: 
sucking
grasping
stepping- 
moro: from birth - 3 months

Also non primitive:
parachute + others

Question 3

4 domains examined in terms of milestones

Answer 3

Gross motor
Fine motor/vision
Hearing and speech
Personal/Social/Behavioural

Question 4

Questions to ask in Hx before baby check

Answer 4

Maternal:
Med/surg Hx, OBstetric, Social Hx

Newborn
Pregnany
labour: Method of delivery ROM?, infections, GBS+ve, induced, GA
Birth: assisted delivery? weight at birth, APGAR, RESUS?
Progress: GA, treatments, investigations, passed stool/urine, NNST, feeding, observations

growth details:
any medications currently?

Question 5

General appearance red flags:

Answer 5

dysmorphia
wt loss
jaundice*
billous vomiting *
central cyanosis*

*= urgent investigation

Question 6

Head, face, neck red flags

Answer 6

enlarge/bulgind/sunken fontanelles*
subgaleal Hx*
micro/macroscephaly
non patent nares*
cephalhaematoma
caput
fused sutures
absent red reflex
dull cornea
pupil irregular

*=urgent Ix

Question 7

Upper limbs: Shoulder, Arms, hands RED FLAGS

Answer 7

limb hypotonia, contractures

palmar crease pattern

Question 8

Chest RED FLAGS

Answer 8

resp distress*
apnoea*
weak/absent pulse*
positive pulse oximetry*
abnormal HR, rhytmgh, regularity
Murmurs

Question 9

Abdomen red flags

Answer 9

organomegaly*
gastroschisis/exomphalos*
bilateral undescended testes*
inguinal hernia

Question 10

GU RED FLAGS

Answer 10

no urine/meconium in

Question 11

Hips, Legs and Feet RED FLAGS

Answer 11

risk factors for hip dysplasia ( What are they?)
positive/abnormal Barlows or Ortolanis
contractures/hypotonia
fixed talipes
development hip dysplasia

Question 12

Back RED FLAGS

Answer 12

curvature of spine
non intact spin
tufts of hair, dimple along spine –> Spina bifida

Question 13

Neuro RED FLAGS

Answer 13

Seizures*
Altered LOC*
weak/irritable/absent cry
absent reflexes
no response to consoling

Question 14

Discharge planning: what do you need to cover?

Answer 14

Vitals: Observations, feeding, output
Discuss:
- Routine tests: NNST, hearing challenge
- GP care plan, midwife or child health nurse
- Health promotion: feeding+growth, jaundice, SIDS, injury prevention, immunisation
- infant personal health record
- referral and follow up (5-7 days) and 6 weeks (GP)

Question 15

Timing of Exam?

Answer 15

immediately after delivery
full+detailed assessment within 48 hours
at 5-7 days
6 weeks

Question 16

Equipment needed for neonatal checkup

Answer 16

stethoscope
opthalmoscope
pencil torch
tongue depressor
pulse oximetry
documentation!