Y2 NIPE

Question 1

Which are the five steps of the neonatal examination?

Answer 1

Preparation
Observation
Examination
Explanation
Documentation

Question 2

Scalp

Answer 2

Bruising/swelling

Question 3

Head

Answer 3

sutures and fontanelles, size, asymmetry/shape

Question 4

Face

Answer 4

Characteristics for T21 etc. Cleft lip, Asymmetry

Question 5

Mouth

Answer 5

Cleft lip, Teeth, Cysts, Cleft Palate, Macroglossia

Question 6

Ears

Answer 6

Skin creases, Deformity/absence, pre-auricular skin tags, ?position

Question 7

Eyes

Answer 7

Absence, Asymmetry, Red reflexes, Corneal opacities, Coloboma

Question 8

Neck

Answer 8

Extra skin folds, Asymmetry, dimples, Swelling

Question 9

Hands and feet

Answer 9

Asymmetry/Absence, skin creases, swelling.

Question 10

Digits

Answer 10

Too few/too many, appearance of nails, Appearance of digits, Webbing.

Question 11

Skin

Answer 11

Aplasia cutis, Birthmarks, Cuts and bruises, Pigmentation

Question 12

Chest

Answer 12

Shape, Nipple position and number

Question 13

Cardiovascular system

Answer 13

Heart position, Heaves and thrills, Heart sounds and murmurs (five spots), peripheral pulses

Question 14

Respiratory system

Answer 14

Respiratory effort, Breath sounds

Question 15

Abdomen

Answer 15

Distension, shape, Organomegaly, Tenderness

Question 16

Umbilicus

Answer 16

Condition of cord and surrounding skin

Question 17

Male genitalia

Answer 17

Testes, shape and size of penis, position of meatus, Urine stream.

Question 18

Female genitalia

Answer 18

Appearance, Withdrawal bleeding.

Question 19

Anus

Answer 19

Patency, Position, passage of meconium.

Question 20

Groin

Answer 20

Swelling

Question 21

Hips

Answer 21

Stability

Question 22

Spine

Answer 22

Deformity, overlying marks/defects

Question 23

CNS

Answer 23

Symmetry of reflexes, Appropriateness of reflexes, Ability to suck, Tone, Posture.

Question 24

Size

Answer 24

Weight, Length, Head circumference.

Question 25

What aspects need to be considered when looking in the case notes before undertaking a NIPE examination?

Answer 25

- Family history - Past medical history - Past obstetric history - Present obstetric history - Details of birth - Wellbeing of baby at birth and following (APGAR etc)

Question 26

What maternal aspects need to be considered before a NIPE?

Answer 26

``` Substance misuse Diabetes Hypertension Medication Cardiac conditions STIs Family history GBS present RhD status ```

Question 27

What fetal aspects need to be considered before a NIPE?

Answer 27

``` SGA IUGR Macrosomia Congenital abnormalities Multiple pregnancy ```

Question 28

What intrapartum aspects need to be considered before a NIPE?

Answer 28

``` Gestational age Abnormal FHR pattern Shoulder dystocia PROM Presence of meconium APH Operative delivery and why Maternal fever/sepsis ```

Question 29

What equipment is needed to perform a NIPE ?

Answer 29

Stethoscope, Ophthalmoscope, Spatula, Tape measure, ?pulse oximeter

Question 30

What is the normal weight of a newborn?

Answer 30

Around 3,5 kg

Question 31

What is the average length of a newborn?

Answer 31

Around 50 cm

Question 32

What are Petechiae?

Answer 32

Petechiae are pinpoint, round spots that appear on the skin as a result of bleeding. The bleeding causes the petechiae to appear red, brown or purple. Petechiae (puh-TEE-kee-ee) commonly appear in clusters and may look like a rash. Usually flat to the touch, petechiae don't lose color when you press on them. Can be a sign of low platelets, or congenital rubella/ congenital syphilis.

Question 33

What is the normal head circumference of a newborn?

Answer 33

32-36 cm in a term baby

Question 34

After how long after birth should "normal" swelling of the fontanels go away?

Answer 34

around 24 hrs

Question 35

How can you see the difference between caput and cephalohematoma?

Answer 35

Caput- indistinct border, CH- clear edge Caput- present since birth, CH- appears after birth and increases for 2-3 days Caput-swelling cross suture lines, CH, swelling does NOT cross suture lines Caput- disappears within days, CH- can take weeks to resolve

Question 36

What are risk factors for cephalohematoma? Why are they critical to note?

Answer 36

Cephalohematoma occurs twice as often in males as in females, for unknown reasons. It is more common in primagravidas, in large infants, following instrument-assisted deliveries (with vacuum or forceps), following prolonged difficult labour, when cephalopelvic disproportion exists, when the head is in a deviant position (occipital posterior, occipital transverse), or when a scalp electrode has been placed. They can hide skull fracture, intracranial bleeding or a blood clotting disorder.

Question 37

What could ear dimples/tags/abnormal position indicate and what should be done about it?

Answer 37

Chromosomal abnormalities/ syndromes, referral to neonatal staff

Question 38

What is Talipes equinovarus?

Answer 38

Talipes equinovarus or club foot is the most common foot deformity in the UK occurring in 1:1000 births. The foot is plantar flexed (turned downwards and inwards the midline of the baby) and it can be structural or fixed. Newborn males are twice more likely to have this condition than females and in 50% of cases both feet are effected. The cause is unknown but can be associated with down’s syndrome or spina bifida therefore referral is required. Positional talipes is when the feet can easily be corrected with gentle manipulation and is caused due to constricted uterine space.

Question 39

How and why do we palpate the liver?

Answer 39

to ensure not enlarged over 1cm below the costal margin(may be present in congestive heart failure).

Question 40

normal respiratory rate for a newborn is?

Answer 40

40-60 breaths/minute

Question 41

Which reflexes are tested in the NIPE?

Answer 41

``` Moro Rooting Sucking and swallowing Palmar/Plantar Grasp Walking and stepping Crawling ```

Question 42

Questions regarding activity, behaviour cry and tone indirectly assess

Answer 42

Respiratory, cardiovascular, skeletomuscular, neurological

Question 43

Questions regarding color and temperature indirectly assess

Answer 43

Respiratory, cardiovascular, metabolic, immunological

Question 44

Questions regarding urinary output indirectly assess

Answer 44

renal, immunological

Question 45

Questions regarding feeding and stools indirectly assess

Answer 45

gastrointestinal and immunological

Question 46

Questions regarding skin integrety/ rashes/ spots indirectly assess

Answer 46

immunological