Transcript The Baby Check

The Baby Check
Newborn and Infant Examination
• Newborn examination - undertaken no later than 72
hours after birth.
• The physical examination is repeated at approximately
6-8 weeks of age
• The examinations tailored to patients needs
– Must review relevant issues:
•
•
•
•
•
Family history
Mother's pregnancy, the birth
Antenatal screening outcomes
When baby 1st PU and BO
The baby's development, feeding patterns, weight, alertness and
general wellbeing
• Any aspects of their baby that might be worrying the parent
New born and Infant examination
• Top to toe examination
• Also involves 4 screening examination
– Eyes
– Heart
– Hips
– Testes
Newborn and Infant Examination
•
•
Appearance including colour, breathing, behaviour, activity and posture
Head (including fontanelles)
–
–
•
•
•
Eyes - opacities and red reflex
Neck and clavicles, limbs, hands, feet and digits; assess proportions and symmetry
Heart
–
•
effort, rate and lung sounds
Abdomen
–
•
position, heart rate, rhythm and sounds, murmurs and femoral pulse volume
Lungs
–
•
face, nose, mouth including palate, ears, neck and general symmetry of head and facial features.
Measure and plot head circumference
shape and palpate to identify any organomegaly; also check condition of umbilical cord
Genitalia and anus
–
completeness and patency and undescended testes in males
•
Spine
•
Skin
–
–
•
note colour and texture as well as any birthmarks or rashes
Central nervous system
–
•
inspect and palpate bony structures and check integrity of the skin
observe tone, behaviour, movements and posture. Elicit newborn reflexes
Hips
–
symmetry of the limbs and skin folds (perform Barlow and Ortolani’s manoeuvres)
NICE Guideline CG37 - 2006
SCREENING EXAMINATIONS
Eyes
• About 200 children a year are born in the UK with
congenital cataract in one or both eyes
• Only one fifth of these 200 have a family history of
cataracts
• Cataract is the largest treatable cause of visual loss in
childhood in the UK
• Associated risk factors include:
– low birth weight <1500g
– low gestational age <32 weeks
– family history of any eye disorder of childhood onset including
congenital cataract, glaucoma and retinoblastoma
– maternal infections during pregnancy e.g. Rubella,
toxoplasmosis, herpes simplex virus (HSV)
Eyes
• Screen +ve
– The absence of any reflex suggests presence of a
congenital cataract
– A white reflex (leukocoria) is suggestive of tumour
of the eye (retinoblastoma)
– Other abnormal findings include:
• abnormalities of the iris
• small or absent eye
Eyes
• +ve Results
• @ Newborn check
– Refer for expert consultation
– To be seen by 2 weeks of age
• @ 8 Week Check
– Refer for expert opinion
– To be seen by 11 weeks of age
Heart
•
•
•
•
Congenital cardiac defects are a leading cause of infant death
Critical or serious congenital cardiac malformations are found in
approximately 6-8 in 1,000 newborn babies
Associated risk factors include:
– family history of congenital heart disease
– maternal conditions such as diabetes, systemic lupus erythematosus
(SLE)
– exposure to rubella during the first trimester of pregnancy,
– Some medications taken during pregnancy e.g. Lithium
– Syndromes Down’s, Noonan’s and Marfan’s
• A proportion of major cardiac lesions may be identified during the
fetal anomaly scan
Heart
• Screen +ve findings
– Tachypnoea at rest
– Episodes of apnoea lasting longer than 20 seconds or associated with
colour change
– Increased work of breathing.
– Central cyanosis
– Visible pulsations over the precordium, heaves, thrills
– Presence of murmurs/extra heart sounds
•
•
•
•
•
significant murmurs are usually loud
heard over a wide area
have a harsh quality
associated with other abnormal findings
benign murmurs are typically short, soft, systolic, localised to the left sternal
border, have no added
– Absent or weak femoral pulses
Heart
• Response to +ve finding
• @ New born examination
– Discuss with appropriate expert
– Urgency will depend on circumstances
– Measure pre and post ductal arterial O2 sats
(pulse oximetry) within 4 hours
• @ 8 Week Check
– Discuss with appropriate expert at the time of the
examination
Hips
Approximately 1-2 in 1000 babies have a hip problem that
requires treatment
• Major associated risk factors include:
– a first degree family history of hip problems in early life
– breech presentation at 36 weeks of pregnancy, irrespective of
presentation at delivery and mode of delivery
– breech delivery if earlier than 36 weeks
– Multiple births, if any of the above risk factors are present, all
babies should be referred for
• Undetected DDH or delayed treatment may result in
significant morbidity
• Early diagnosis and intervention improve health outcomes
and reduce the need for surgical intervention
Hips
• Screen +ve test
– Difference in leg length
– Knees at different levels when hips and knees are
bilaterally flexed
– Difficulty in abducting the hip to 90 degrees
– Palpable ‘clunk’ when undertaking either the
Ortolani or Barlow manoeuvres
Hips
• Response to +ve Screening test
• @ New born Exam
– Abnormal examination
• Refer for
– urgent ultrasound
– expert clinical consultation
– To be seen by 2 weeks of age
– Normal examination but has risk factors
• Refer for Uss Hip – completed by 6 weeks of age
Testes
• Cryptorchidism affects approximately 2-6% of male babies born at
Term
• Associated risk factors include:
– a first degree family history (father or sibling) of cryptorchidism
– low birth weight
– small for gestational age or pre-term delivery
• Cryptorchidism is significant as it is associated with:
– a significant increase in the risk of testicular cancer (primarily
seminoma)
– reduced fertility when compared with descended testes
– May also be associated with other urogenital problems such as
hypospadias and testicular torsion
• Early diagnosis and intervention improves fertility and may aid
earlier identification of testicular cancer
Testes
• The absence of one or both testes in the scrotal sac is a screen
positive finding
• Bilateral undescended testes in the newborn may be
associated with an underlying endocrine disorders
Testes
• @ New Born Check
• If Bilateral undescended testes
– To be seen by a senior paediatrician within 24 hours of the
examination
• If Unilateral undescended testis
– Review at 6-8 week examination
• @ 6-8 week check
• If Bilateral undescended testes
– To be seen by a senior paediatrician within 2 weeks
• If Persistent unilateral undescended testis
– GP to review between 24-30weeks of age
– Testis still absent -Refer to surgeon (Should be seen no later than 13
months)
References
• NHS E-Learning module – Video + Reference
sheets
– http://newbornphysical.screening.nhs.uk/elearning