Neonatal examination

Neonatal examination

DR RIADH ALOBAYDI

NEWBORN EXAMINATIONwhen? How?

Newborn should be examined within 72hr of birth neonatal examination
a: birth immediately the newborn should be checked by nurse or midwife or general practitioner by rapid screening physical examination for the status of breathing and heart status; Apgar scor, and checking the head and neck, chest , limbs, genitalia, and anus, in a rapid way .
b: on discharge from nursery; 24hr-48hr of birth another examination with detailed examinations for the baby from ; head to toes should be performed in the presence of mother so as to ask her about her baby and to confirm baby health status and to exclude any anomalies.

Objectives of n.exam

Define apgar score
What are the criteria of apgar score and how to interpret the results.
Timing of apgar score performed.at First minute, at 5min
What is the significance (value) of the apgar score. or why we do it? To assess the status of NB and to see whether NB needs medical intervention or just usual baby care
Does apgar score assess the future status? No, it is not designed to assess the future neurodevelopment status.
but If at 5 or 10 min shows low score, what possible long term effects upon baby? My have significant percentage to develop CP.
Discuss the timing and how to do neonatal examination?

Apgar score (definition)

It is the rapid and immediate examination to test the physical condition of the newborn in the delivery room or operation room ; used to assess the status of the baby at 1- minute and again at 5 -minute ,and rarely at 10 ,15,20,30 m. ,done by nurse or doctor, to see how the newborn adapt to the outside environment and to show if the newborn needs immediate intervention or resuscitation or just normal care and should be documented for medicolegal purpose; using five criteria ; (appearance,pulse,grimace,activity,respiration)


Apgar score criteria
criteria
0
1
2
appearance
Blue or pale
acrocyanosis
Body and limbs pink
pulse
absent
< 100
> 100
Grimace
Absent response to stimuli
Grimace on aggressive stimuli
Active crying
activity
No tone ; flat
Some flexion
Active flexion of all limbs
respiratory
No breathing
Some weak, irreguler or gasping breathing
Good crying


Interpretation of apgar score
The test is done at 1 min and 5 min after birth and may be repeated later if the score is low and remains low.
Scores 7 and above are generally normal,
Score 4-6 fairly low: and may need some intervention,
Score 3 and below are generally regarded as critically low and needs resuscitations for the birth asphyxia.
Low score at 1min <3; the baby needs resuscitation but may improve at 5 min. but if remains <3 at 5 min and 10 min: it indicates possible long term neurological damage (cerebral palsy) in the future.
Normal or fair low Apgar score does not be considered as current test to expect the long term future neurodevelopmental status .

Other steps in N.examination

Perform systematic ( head to toes ) examination:
Usually mean wt 3.250kg with length 50cm in fullterm
Head ;shape,size:micro,or macrocephaly, symmetry, fontanelle size, scalp defects. Normal head circumference range33-38cm
Eyes; light reflex : red reflex is normal, while white reflex mean retinoblastoma or cataract, done by ophthalmoscope looking 12 inch from baby eye , search for neonatal conjunctivitis. And shape and size as for microophtalmia , slunting eye
Ears ;shape and site whether low set ears.
Mouth ; colour ,sucking reflex, epstien pearl,cleft palate and lip
Arms and hands; shape, fingers ,palmer crease, Erbs palsy. Arm defect as in phocomelia or amelia
Peripheral pulses; brachial, femoral , delayed femoral or absent pulse.
Skin for café aule spot, mongolian spots, milia,erythema toxicum

Neonatal exam. steps (continue)

Heart ;check for dextrocardia, for thrill, for murmurs.
Lungs ; shape ,for breathing ,for air entery ,for stridor
Abdomen ; shape ,organs, hernia,genitalia as ambigious genitalia .
Back ;for spina bifida, scoliosis, mongolian spot remains for 1-2 years and for pilonidal sinus,
Anus ; to check the patency= Imperforate anus
Hips ;for develpmental dysplasia of hips DDH; by Ortalani and Barlow tests,
Neonatal reflexes; moro,grasp,sucking,rooting,placing stepping, landu reflex, tonic neck reflex; if poor reflexes; mean depressed CNS
Hearing test by screening test using (accoustic echo check)
Screening tests ; like ;TSH for hypothyroidism , test forPKU, sickle cell Anemia, cystic fibrosis.