NIPE Flashcards
(31 cards)
What is used as a screening tool for newborns?
It is used to pick up abnormalities in the newborn baby.
What happens as a result of screening abnormalities?
Referrals are sent to specialities that may need to follow up the baby.
When is the examination performed?
The examination is performed within the first 72 hours after birth and is repeated at 6 – 8 weeks by their GP.
Who performs the initial examination?
The initial check can be performed by a trained midwife or paediatric doctor. For home births, the GP may visit to perform the baby check.
What questions would you ask the parents before starting the examination?
Has the baby passed meconium? Is the baby feeding ok? Is there a family history of congenital heart, eye or hips problems?
What two oxygen saturations need to be measured?
Pre-ductal and post-ductal oxygen saturations need to be checked. Normal saturations are 96% or above, with no more than a 2% difference between them.
Where is the ductus arteriosus located and what is its role?
The ductus arteriosus is located along the arch of the aorta and connects the aorta with the pulmonary artery. It allows blood from the deoxygenated right-sided circulation to mix with the oxygenated left-sided circulation.
When is the ductus arteriosus needed?
It is needed for certain congenital heart conditions that are duct-dependent. If it closes, there can be a rapid deterioration in symptoms.
- duct depended conditions may be picked up by measuring the difference in pre and post ductal saturations
Where are the pre-ductal and post-ductal saturations measured?
- Pre-ductal saturations are measured in the baby’s right hand - the R hand receives blood from the R subclavian artery, a branch of brachiocephalic artery which branches from the aorta before the ductus arteriosus
- post-ductal saturations are measured in either foot - feet receive blood travelling from the descending aorta, which occurs after the ductus arteriosus
What should you look for on a general examination?
Colour (pink is good), tone, and cry.
What should you assess on the head?
- General appearance: size, shape,dysmorphology,caput succedaneum,cephalohaematomaand anyfacial injury
- Head circumference: known as theoccipital frontal circumference(OCP)
- Anteriorandposterior fontanelles
- Sutures: overlapping sutures are common and usually resolve as the baby grows
- Ears: skin tags, low set ears and asymmetry
- Eyes: slightsquintsare normal, epicanthic folds can indicate Down’s, purulent discharge could indicate infection
- Red reflexusing anophthalmoscope: check for symmetry. It is often more pale in darker skinned babies. It is absent withcongenital cataractsandretinoblastoma.
- Mouth: cleft lip or tongue tie
- Put your little finger in their mouth to check thesuckling reflectand feel thepalateall the way back, checking for a cleft palate.
What should you assess on the shoulders and arms?
- Shoulder symmetry: check for a clavicle fracture
- Arm movements: check for an Erbs palsy
- Brachial pulses
- Radial pulses
- Palmar creases: a single palmar crease is associated with Down’s, but can be normal
- Digits: check the number of digits and if the fingers are straight or curved (clinodactyly)
- Use asats probeon the right wrist for apre-ductal reading
What should you do on the chest examination?
- Oxygen saturationsin the right wrist and a feet: 95% and above is normal
- Observe breathing: look for respiration distress, symmetry and listen for stridor
- Heart sounds: listen for murmurs, heart sounds, heart rate and identify which side the heart is on heart
- Breath sounds: listen for symmetry, good air entry and added sounds
What should you assess on the abdomen?
- Observe the shape: a concave abdomen may indicatediaphragmatic herniawith abdominal contents in the chest
- Umbilical stump: look for discharge, infection and a periumbilical hernia
- Palpatefor organomegaly, hernias or masses
What should you assess in the genitals?
- Observefor the sex, ambiguity and any obvious abnormalities
- Palpate testes and scrotum: check both are present and descended, check for hernias or hydroceles
- Inspect the penisfor hypospadias, epispadias and urination
- Inspect the anusto check if it is patent
- Ask about meconiumand whether the baby has opened the bowel
What should you do with the legs?
- Observe the legs and hipsfor equal movements, skin creases, tone and talipes
- Barlows and Ortolani manoeuvres: check for clunking, clicking and dislocation of the hips
- Count the toes
What should you assess in the back?
Inspect and palpate the spine: look for curvature, spina bifida and a pilonidal sinus
What reflexes do you need to test?
- Moro reflex: when rapidly tipped backwards the arms and legs will extend
- Suckling reflex: placing a finger in the mouth will prompt them to suck
- Rooting reflex: tickling the cheek will cause them to turn towards the stimulus
- Grasp reflex: placing a finger in the palm will cause them to grasp
- Stepping reflex: when held upright and the feet touch a surface they will make a stepping motion
What skin findings may you find?
Haemangiomas, port wine stains, Mongolian blue spot, cradle cap, desquamation, erythema toxicum, milia, acne, naevus simplex, moles, and transient pustular melanosis.
What does positional talipes require?
Referral to a physiotherapist for exercises; it will resolve with time.
What does structural talipes require?
Structural talipesinvolves the bones of the foot and ankle and requires referral to an orthopaedic surgeon.
What does undescended testes require?
Monitoring and referral to a urologist.
What do skin findings need?
Skin findings generally do not require any action; many will fade with time.
What do haemangiomas near the eyes, mouth, or airway require?
Referral for treatment with beta blockers; otherwise, they can be monitored.
