NIPE

Question 1

What is used as a screening tool for newborns?

Answer 1

It is used to pick up abnormalities in the newborn baby.

Question 2

What happens as a result of screening abnormalities?

Answer 2

Referrals are sent to specialities that may need to follow up the baby.

Question 3

When is the examination performed?

Answer 3

The examination is performed within the first 72 hours after birth and is repeated at 6 – 8 weeks by their GP.

Question 4

Who performs the initial examination?

Answer 4

The initial check can be performed by a trained midwife or paediatric doctor. For home births, the GP may visit to perform the baby check.

Question 5

What questions would you ask the parents before starting the examination?

Answer 5

Has the baby passed meconium? Is the baby feeding ok? Is there a family history of congenital heart, eye or hips problems?

Question 6

What two oxygen saturations need to be measured?

Answer 6

Pre-ductal and post-ductal oxygen saturations need to be checked. Normal saturations are 96% or above, with no more than a 2% difference between them.

Question 7

Where is the ductus arteriosus located and what is its role?

Answer 7

The ductus arteriosus is located along the arch of the aorta and connects the aorta with the pulmonary artery. It allows blood from the deoxygenated right-sided circulation to mix with the oxygenated left-sided circulation.

Question 8

When is the ductus arteriosus needed?

Answer 8

It is needed for certain congenital heart conditions that are duct-dependent. If it closes, there can be a rapid deterioration in symptoms.
- duct depended conditions may be picked up by measuring the difference in pre and post ductal saturations

Question 9

Where are the pre-ductal and post-ductal saturations measured?

Answer 9

• Pre-ductal saturations are measured in the baby’s right hand - the R hand receives blood from the R subclavian artery, a branch of brachiocephalic artery which branches from the aorta before the ductus arteriosus
• post-ductal saturations are measured in either foot - feet receive blood travelling from the descending aorta, which occurs after the ductus arteriosus

Question 10

What should you look for on a general examination?

Answer 10

Colour (pink is good), tone, and cry.

Question 11

What should you assess on the head?

Answer 11

• General appearance: size, shape,dysmorphology,caput succedaneum,cephalohaematomaand anyfacial injury
• Head circumference: known as theoccipital frontal circumference(OCP)
• Anteriorandposterior fontanelles
• Sutures: overlapping sutures are common and usually resolve as the baby grows
• Ears: skin tags, low set ears and asymmetry
• Eyes: slightsquintsare normal, epicanthic folds can indicate Down’s, purulent discharge could indicate infection
• Red reflexusing anophthalmoscope: check for symmetry. It is often more pale in darker skinned babies. It is absent withcongenital cataractsandretinoblastoma.
• Mouth: cleft lip or tongue tie
• Put your little finger in their mouth to check thesuckling reflectand feel thepalateall the way back, checking for a cleft palate.

Question 12

What should you assess on the shoulders and arms?

Answer 12

• Shoulder symmetry: check for a clavicle fracture
• Arm movements: check for an Erbs palsy
• Brachial pulses
• Radial pulses
• Palmar creases: a single palmar crease is associated with Down’s, but can be normal
• Digits: check the number of digits and if the fingers are straight or curved (clinodactyly)
• Use asats probeon the right wrist for apre-ductal reading

Question 13

What should you do on the chest examination?

Answer 13

• Oxygen saturationsin the right wrist and a feet: 95% and above is normal
• Observe breathing: look for respiration distress, symmetry and listen for stridor
• Heart sounds: listen for murmurs, heart sounds, heart rate and identify which side the heart is on heart
• Breath sounds: listen for symmetry, good air entry and added sounds

Question 14

What should you assess on the abdomen?

Answer 14

• Observe the shape: a concave abdomen may indicatediaphragmatic herniawith abdominal contents in the chest
• Umbilical stump: look for discharge, infection and a periumbilical hernia
• Palpatefor organomegaly, hernias or masses

Question 15

What should you assess in the genitals?

Answer 15

• Observefor the sex, ambiguity and any obvious abnormalities
• Palpate testes and scrotum: check both are present and descended, check for hernias or hydroceles
• Inspect the penisfor hypospadias, epispadias and urination
• Inspect the anusto check if it is patent
• Ask about meconiumand whether the baby has opened the bowel

Question 16

What should you do with the legs?

Answer 16

• Observe the legs and hipsfor equal movements, skin creases, tone and talipes
• Barlows and Ortolani manoeuvres: check for clunking, clicking and dislocation of the hips
• Count the toes

Question 17

What should you assess in the back?

Answer 17

Inspect and palpate the spine: look for curvature, spina bifida and a pilonidal sinus

Question 18

What reflexes do you need to test?

Answer 18

• Moro reflex: when rapidly tipped backwards the arms and legs will extend
• Suckling reflex: placing a finger in the mouth will prompt them to suck
• Rooting reflex: tickling the cheek will cause them to turn towards the stimulus
• Grasp reflex: placing a finger in the palm will cause them to grasp
• Stepping reflex: when held upright and the feet touch a surface they will make a stepping motion

Question 19

What skin findings may you find?

Answer 19

Haemangiomas, port wine stains, Mongolian blue spot, cradle cap, desquamation, erythema toxicum, milia, acne, naevus simplex, moles, and transient pustular melanosis.

Question 20

What does positional talipes require?

Answer 20

Referral to a physiotherapist for exercises; it will resolve with time.

Question 21

What does structural talipes require?

Answer 21

Structural talipesinvolves the bones of the foot and ankle and requires referral to an orthopaedic surgeon.

Question 22

What does undescended testes require?

Answer 22

Monitoring and referral to a urologist.

Question 23

What do skin findings need?

Answer 23

Skin findings generally do not require any action; many will fade with time.

Question 24

What do haemangiomas near the eyes, mouth, or airway require?

Answer 24

Referral for treatment with beta blockers; otherwise, they can be monitored.

Question 25

What are port wine stains and what condition can they be associated with?

Answer 25

- ***Port wine stains*** are pink patches of skin, often on the face, caused by abnormalities affecting the capillaries. - They don’t fade with time and typically turn a darker red or purple colour. - Rarely they can be related to a condition called ***Sturge-Weber syndrome***, where there can be visual impairment, learning difficulties, headaches, epilepsy and glaucoma.

Question 26

What do clicky and clunky hips require?

Answer 26

Referral for a hip ultrasound to rule out developmental dysplasia of the hips.

Question 27

What do cephalohaematomas require?

Answer 27

Monitoring for jaundice and anaemia.

Question 28

What do bony injuries require?

Answer 28

An x-ray to look for fractures.

Question 29

What do soft systolic murmurs require?

Answer 29

Soft systolic murmurs of grade 2 or less in otherwise healthy well neonates may be monitored, as these often resolve after 24 – 48 hours. 

Question 30

What should you do if you suspect heart failure or congenital heart disease?

Answer 30

Refer to cardiology for an ECG and echocardiogram. If unwell, they require admission to the neonatal unit.

Question 31

What needs to be done after the examination?

Answer 31

Discuss abnormalities with a senior, document findings on computer system and in baby's red book, explain to parents, and arrange referrals if required.