newborn and development exam

Question 1

when is the newborn exam done?

Answer 1

within first 72 hours of birth

Question 2

when is a second exam done?

Answer 2

by GP at 6-8 weeks of age

Question 3

how do you begin newborn exam?

Answer 3

confirm name, dob, who is with baby, any troubles so far, weight, height/length, head circumference
check gestation weeks
ask parent to undress to nappy

Question 4

general inspection

Answer 4

jaundice
pallor 
cyanosis 
cry
posture 
rashes erythema
any obvious abnormalities

Question 5

next step after GI

Answer 5

tone

check tone in all four limbs for hypotonic limbs which would appear as a rag doll floppiness

Question 6

when is the suckling reflex developed

Answer 6

32-36 weeks but usually by week 35 should have

Question 7

what are you looking for in next?

Answer 7

HEAD

-SIZE micro or macrocelapthy or normal size
SHAPE- cranial moulding 
- caput succedaneum -fluid collection
-cephalaehmatoma - monitor bilibubin
-subgaleal haemorrhages
-craniosynostosis  - premature fuse

FONTANELLE - tense building - raised ICP
sunken-dehydration

Question 8

Then what do you look for?

Answer 8

SKIN
bruising 
rashes 
salmon patch
port wine stain
infantile haemogonia 
Mongolian blue spot
infantine haemgioma

Question 9

then what do you look for on the face

mouth

Answer 9

cleft palate
dysmorphic features- which may indicate genetic abnormalities 
facial nerve palsy- asymetric
trauma
nose-patency

tie tongue
gums

Question 10

eyes

Answer 10

discharge
sclera
position and shape
red reflex 
subconjuctial haemorrhage

Question 11

what can an absent red reflex indicate?

Answer 11

cataract

retinoblastoma

Question 12

ears

Answer 12

pinna
tags and pits
hearing test

Question 13

neck

Answer 13

lENGTH - short, webbing -turner
swelling -cystic hygroma
clavicle fracture

Question 14

upper limbs

Answer 14

symmetry -size and ength
finger - all 5 digits may have polydactyly y
palms - 2 creases per hand
1 crease MAY indicate Down syndrome

Question 15

chest

Answer 15

wall deformities
expansion
lung resp disttress
ascultate
120-150 bpm 
listen for murmurs 
check oxygenation take 2 reading and should be within 3%of one another
cap refill

Question 16

abdomen

Answer 16

hernias
distention
all four quadrants and lightly feel

Question 17

back

Answer 17

look for hair tuft 
sclerosis 
skin patch
sacral pit
naeuvus 
birthmarks

Question 18

anus

Answer 18

patency
meconium first 24 hours
delay - can indicate obstruction of hirschpsrung disease

Question 19

genitalia

Answer 19

position of meatus -in males - can indicate hypospadias
hydrocele -transulliminate
unilateral or undescended testes
bilateral absence

Question 20

lower limb

Answer 20

symmetry
tone
oedema
knee- hyper-extensile
femoral pulses
feet
ankle deformities

Question 21

hips

Answer 21

two test - barlows and ortalani test

Question 22

what are Barlow and ortalani test

Answer 22

The Barlow maneuver is a test used to identify an unstable hip that can be passively dislocated. The infant is placed in a supine position with the hip flexed to 90º and in neutral rotation. The examiner adducts the hip while applying a posterior force on the knee to cause the head of the femur to dislocate posteriorly from the acetabulum. A palpable clunk may be detected as the femoral head exits the acetabulum.
The Ortolani maneuver identifies a dislocated hip that can be reduced. The infant is positioned in the same manner as for the Barlow maneuver, in a supine position with the hip flexed to 90º. From an adducted position, the hip is gently abducted while lifting or pushing the femoral trochanter anteriorly. In a positive finding, there is a palpable clunk as the hip reduces back into position. Hip examination should occur soon after birth and at every visit until the child is walking normally.

Question 23

what are the six reflexes

Answer 23

rooting
sucking
moro
grasp palamar 
tonic neck
stepping

Question 24

what is the rooting reflex

Answer 24

baby turns head to anything stroking corner of mouth in that direction
birth to 4 months to aid with breast feeding

Question 25

the moro reflex is

Answer 25

up to 2 months

startle reflex.

when a baby is startled by a loud sound or movement.

baby throws back his or her head, extends out his or her arms and legs, cries, then pulls the arms and legs back in.

Question 26

palmar grasp reflex

Answer 26

Stroking the palm of a baby’s hand causes the baby to close his or her fingers in a grasp. The grasp reflex lasts until the baby is about 5 to 6 months old. A similar reflex in the toes lasts until 9 to 12 months.

Question 27

stepping reflex

Answer 27

This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his or her feet touching a solid surface. This reflex lasts about 2 months.
usually one foot in front of the other

Question 28

sucking reflex

Answer 28

Rooting helps the baby become ready to suck. When the roof of the baby’s mouth is touched, the baby will begin to suck. This reflex does not begin until about the 32nd week of pregnancy and is not fully developed until about 36 weeks. Premature babies may have a weak or immature sucking ability because of this. Because babies also have a hand-to-mouth reflex that goes with rooting and sucking, they may suck on their fingers or hands.

Question 29

tonic neck reflex

Answer 29

When a baby’s head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. This is often called the fencing position. This reflex lasts until the baby is about 5 to 7 months old.

Question 30

What are four added features for pGALS?

Answer 30

• reach up to sky
• look at ceiling
• insert three fingers in mouth -jaw for TM disease
• asking child to walk on heels, tiptoes and normally.