Morphological Examination

Question 1

What is the first thing that needs to be done before doing a morphological examination?

Answer 1

INFORMED CONSENT FROM THE PARENTS

Question 2

What characteristics are examined?

Answer 2

• Head
• Scalp
• Fontanelles
• Hair
• Face
• Eyes
• Ears
• Mouth
• Markers for downs syndrome

Question 3

What do we examine on the head of a neonate?

Answer 3

• Moulding: when the head shape is abnormal that results from the pressure of the baby’s head during childbirth. When the baby came out head first the birth canal may mould the head into an oblong shape. If was delivered by C-section or had a breech presentation then the head is most often round.
• Symmetry: right and left side of the face is symmetrical.
• MICROCEPHALY: this is when the head is smaller than normal. This often happens when the brain does not grow at a normal rate. This can happen if there is an infection, the genetic disorder, severe malnutrition.
• MACROCEPHALY: this is when the head is bigger than normal due to excess fluid and pressure. This can be noticed when the eyes are moving downwards, irritability and vomiting.

Question 4

What do we examine on the scalp of a neonate?

Answer 4

• redness of the scalp.
• CAPUT SUCCEDANEUM: swelling that occurs to a baby’s scalp shortly after delivery. In an OA position pressure may be exerted on a baby’s head and can damage the scalp.
• CEPHALHEMATOMA: Develops after birth and is the collection of blood between the head and the scalp.

Question 5

What do we examine the fontanelles of a neonate?

Answer 5

• The normal number of bones of a neonate skull is 5.
• Anterior fontanelle: closes by 18 month
• Posterior fontanelle: closes by 6 weeks
• Fontanelles are flat and soft, sunken and bulging
  The frontal suture is also called metopic suture.

Question 6

What do we examine on the hair of a neonate?

Answer 6

• Brittle hair: early signs of thyroid glands

- Hair whorl: going clockwise and one

Question 7

What do we examine on the face of a neonate?

Answer 7

• Symmetry- crying and at rest: nerve injury can only be seen when crying
• Evidence of trauma

Question 8

What do we examine the eyes of a neonate?

Answer 8

eyebrows and eyelashes
Shape and size
Oedema 
Haemorrhage of the conjunctiva: capillaries in eye burst in a white bit of the eye → should clear within 10 days
Colour of sclera: a sign of jaundice
Clean or sticky

Question 9

What do we examine the ears of a neonate?

Answer 9

EARS
Hearing 
Position: imaginary line from inner to outer canthus of the eye.
Helix of the ear
Posterior fontanel
Preauricular sinus

Question 10

What do we examine the mouth of a neonate?

Answer 10

MOUTH 
Cry 
Philtrum: vertical indentation of in the middle area of the upper lip.
Lips and mucous membranes 
Gums-natal teeth
Epstein pearls: are very small cysts that can appear in a baby’s mouth which looks like white bumps.
Sucking reflex 
Hard and soft palate 
Gag reflex
Uvula

Question 11

What are the markers for down’s syndrome?

Answer 11

MARKERS FOR DOWN’S SYNDROME- Trisomy 21
 Craniofacial 
 Eyes-Brushfield’s spots 
Protruding tongue
 Neuromuscular 
Hands and feet 
Cardiac-ASD, VSD 
GI-Oesophageal or duodenal atresia