Paeds examinations

Question 1

How soon must the Newborn Infant Physical Examination (NIPE) be performed and by who?

Answer 1

within 72 hours of birth by a qualified practitioner

Question 2

what is the purpose of the newborn examination?

Answer 2

To screen for congenital abnormalities that will benefit from early intervention
To make referrals for further tests or treatment as appropriate
To provide reassurance to the parents

Question 3

when is a second examination performed on newborns and by who? why?

Answer 3

A second examination is performed at 6-8 weeks of age, usually by GP, to identify abnormalities that develop or become apparent later.

Question 4

If baby is settled when you start, what should you do first? (NIPE)

Answer 4

it’s an opportunistic examination – if the baby is settled listen to their heart first

Question 5

If the baby opens their eyes, what should you check? (NIPE)

Answer 5

it’s an opportunistic examination – if they open their eyes check the fundal reflexes

Question 6

If the baby is crying, what should you look at? (NIPE)

Answer 6

it’s an opportunistic examination – if they’re crying look at the palate!

Question 7

questions to ask the parents while you are examining? (NIPE)

Answer 7

Pregnancy details: date/time, type of delivery, complications, high risk antenatal screening?
Was the baby breech? have they had an ultrasound scan at delivery or 36 weeks (to check hips)?
No abnormalities on antenatal scans?
Family history of congenital conditions

Newborn:
Feeding pattern
Urination
Passing of meconium
Parental concerns

Question 8

what do the different percentiles of weight imply?

Answer 8

Small for gestational age (<10th centile)
Appropriate weight for gestational age (10th-90th centile)
Large for gestational age (>90th centile)

Question 9

if weight plotting shows that a baby is small, what else should be done?

Answer 9

you should also plot head circumference and length to determine whether this is symmetrical (small in all measurements) or asymmetrical (weight disproportionately low, head circumference preserved).

Question 10

describe symmetrically small vs asymmetrically small. what commonly causes each?

Answer 10

symmetrical (small in all measurements) or asymmetrical (weight disproportionately low, head circumference preserved).

Asymmetrical growth restriction is commonly due to placental insufficiency, whilst symmetrical growth restriction is more commonly due to fetal factors such as genetic abnormalities or intrauterine infection