new born examination
DESCRIPTION
Lecture for medical students on new born examination.TRANSCRIPT
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New born ExaminationNew born Examination
What you have to look for…..
Lecture for medical undergraduates
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ObjectivesAt the end of lecture, the student • should understand the importance of new-
born examination.
• Should be aware of some normal conditions that cause parental anxiety.
• Should be able to do a new born examination systematically and detect congenital and acquired abnormalities.
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Why is it necessary ?
1. To detect congenital anomalies.
3- 5% of newborns
2. To detect some acquired abnormalities.
E.g: umbilical sepsis
3. Reassure parents when normal findings are
detected.
Eg: erythema toxicum
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• 4. Identifies familial conditions– DDH
• 5. Analysis of findings will identify the problems specific to regions/ ethnic/ age groups– This is particularly important in policy
making & preventive strategies
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When would you do it ?
• As soon as possible after delivery
• Before discharge
• At 6/52
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Important..• Wash your hands first & dry them
• Examination of newborns
requires patience
gentleness
procedural flexibility
• If the baby is quiet auscultate the heart first
• Disturbing manipulations to be done last
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New born examination is done from head to toe.
Observe the baby
• General posture
• Colour
Pink
Acrocyanosis
Pallor
• Appearance of skin
Vernix
Lanugo hair
Nails
• Activity
Normal or diminished
Tremulous movements
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Head* Size and shape to be noted
1. Fontanellewidebulging - tensionclosed
2. Suturesoverridingwidely separated > 5 mm
3. Cephalhaematoma bleeding under periosteum on the parietal bones does not cross the midline
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Cephalhaematoma
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5. Caput succedaneum
echymotic, oedematous swelling of
soft tissues
crosses the midline
disappears after first few days
Head Contd..
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Caput succedaneum
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6. Encephalocele
Head Contd..
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Face1. Dysmorphic features
– Down’s :epicanthal folds, hypertelorism, low set ears– Other syndromes
2. Oedema – face presentation– prolonged labour
3. Isolated abnormalities– Mouth: precocious dentition/ cleft lip / palate/ Epstein pearls (self
resolving white inclusion cysts on palate/gums)– Ear abnormalities (deformities, preauricular skin tags)– Eye: cataract – red reflex, conjunctival / retinal haemorrhaege– micrognathia
4. Facial nerve palsy
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Down’s syndrome
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Mid-line defects in trisomy 13
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Prominent occiput & low-set ears in trisomy 18
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Bilateral cleft lip
&
complete cleft palate
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pre-auricular skin tags
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Acute bacterial conjunctivitis
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Cataract in Rubella syndrome
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Unilateral microcornea & microphthalmos
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Unilateral iris coloboma in left eye
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Micrognathia
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Right facial nerve palsy following birth injury
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Neck
1. Goitre
correct technique
– slightly extended neck
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2. Sternomastoid tumour
after ~ 1/12 of age.
torticollis
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3. Cystic hygroma
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Chest• Breast
breast hypertrophy
mastitis neonatorum
super numerary nipples
• Chest deformities
• Observe breathing pattern
• Dyspnoea and grunting
• Heart : examine both sides
location
heart rate
peripheral pulses
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Abdomen
• Abdominal distension
• Scaphoid abdomen
• Liver – palpable
• Unusual masses
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Abdomen contd.
• Umbilicus
umbilical sepsis
omphalocele
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later – umbilical hernia
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gastrochiasis
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Abdomen Contd..
• Bladder exstrophy
• Cloacal exstrophy
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Groin
• Femoral pulses
– to exclude coarctation
• Hip examination
– to exclude CDH
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Ortolani manoeuvre
abducting the femur
– palpable clunk
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Asymmetrical thigh creases in
unilateral dislocation of hip
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Genitalia• Ambiguous genitalia
• Undescended testes
• Hypospadias
• Hydrocele
• Imperforated anus
• Inguinal hernia
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Ambiguous genitalia
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Hypospadias
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Imperforated anus
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Hydrocele
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Inguinal hernia
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High imperforated anus communicates into vagina
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Imperforate hymen
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Limbs• Observe for spontaneous or stimulated activity
• Polydactyly
• Syndactyly
• Nerve damage
• Talipes (Club foot): CTEV
• Other abnormalities
• Erb’s palsy
• Amniotic band defects
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Turner syndrome
Low hairline
Abnormal ears
Neck webbing
Micrognathia
Shield chest with widespread nipples
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Lymphoedema in hands & feet - Turner syndrome
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Rocker-bottom feet (protruding calcanei) intrisomy 18
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Overlapping fingers in trisomy 18
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Polydactyly
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Syndactyly
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Lobster claw hand
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Amniotic band defects
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Talipes equino varus
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Erb’s palsy
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Spine
• Kyphoscoliosis
• Feel for defects
• Tuft of hair-Spina bifida occulta
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Back / spine contd….
• Meningomyelocele
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Skin• Pustules
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Skin Contd..
• Milia
- Sweat retention vesicles
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• Thrush
- oral
- nappy rash – satellite lesions
Skin Contd..
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Skin Contd..
• Mongolian blue
spots
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Skin contd..
• Haemangioma
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Skin Contd..
• Amoniacal dermatitis
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• Erythema toxicum
Skin contd..
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• Seborrhoeic dermatitis
Skin contd..
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Skin contd..
• Sweat rash
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Skin contd..
• Cutis marmorata
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Skin contd..
• Stork bite
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Anthropometric measurements
• Length
– infantometer
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• Weight
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• OFC
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New born reflexes
• Rooting
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• Sucking
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• Grasp
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• Moro
– gradually disappear by 4/12
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• Asymmetrical tonic
neck reflex
- Appear at 2- 4/12
- Disappear by 6/12
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You CAN’T miss1. Red reflex: Cataract
2. Femoral pulse: coarctation of aorta
3. DDH
• As missing any of the above in new borne examination does much harm than missing anything else.
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Summary
• New born examination is important in all babies to exclude congenital abnormalities & acquired infections.
• All babies should be examined before discharge.
• Thorough examination should be done from head to toe.
• If abnormalities were detected, can take early actions to correct them. Eg: DDH,CTEV
• Parents can be reassured if normal variations were found. Eg: Erythema toxicum