Examination of the Newborn: An Evidence-Based Guide

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A Practical Guide, 3rd Edition

Checkout Your Cart Price. Description Details Customer Reviews "Examination of the Newborn: An Evidence Based Guide" is a practical and comprehensive guide for practitioners to enable them to undertake physical examination of neonates safely and competently. Cardiovascular and respiratory assessment of the babyAssessment of the neonatal skin and jaundiceExamination of the eyes head and neckExamination of the abdomen and genitaliaAbnormalities of the lower extremities including developmental dysplasia of the hipThe dysmorphic infant and common congenital abnormalitiesBehavioural issuesProfessional issues in practiceSafeguarding Children "Examination of the Newborn" provides essential reading for all health care professionals who are continually striving to update their knowledge and contribute to the standardisation of care on a national scale.

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This item has been added to your basket View basket Checkout. Your local Waterstones may have stock of this item. View other formats and editions. A practical, evidence-based guide for students and practitioners to undertake safe and effective neonatal examination Revised and updated throughout in line with current national and Nursing and Midwifery Council guidelines Full colour photographs and illustrations, as well as clinical case studies at the end of each chapter to help guide and illustrate good practice A new companion website available at: www.

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Examination of the Newborn: An Evidence-Based Guide (2nd edition)

Raising Martians - from Crash-landing to Leaving Home. Joshua Muggleton. Martin L. Some babies in neonatal units may be too ill at the time the examination is due or too premature for examination to be completed. An example would be because a baby has fused eyes. Undertake all screening elements if possible. If not, complete each element of the NIPE screen as soon as possible. Some elements of the NIPE screen may need to be repeated in very preterm babies, for example, the eyes. Referrals should still be made as per national standards regarding screen positive cases.

Babies less than 32 weeks gestational age up to 31 weeks and 6 days or less than 1,g birthweight should be screened for retinopathy of prematurity ROP. Information about the 6 to 8-week infant physical examination should be given to the mother during the postnatal period and again before the infant examination is offered and undertaken. This examination typically takes place in a community setting usually undertaken by the GP between 6 and 8 weeks of age. If the baby is screen positive for any element of the newborn examination, the practitioner undertaking the 6 to 8-week examination should check the progress along the care pathway to ensure required actions have taken place.

The prime purpose of screening is to identify congenital cataracts which may require urgent management. Please note the guidance below relates to both the newborn and 6 to 8-week infant examination unless otherwise stated. Approximately 2 or 3 in 10, babies have congenital cataracts in one or both eyes. A cataract is an opacity within the lens of the eye, which is located just behind the pupil.

Newborn Examination Neonatology II

Although the primary purpose of screening is to identify congenital cataracts, local referral pathways should be followed if major abnormalities of the eyes, clinical risk factors or other incidental eye abnormalities are identified during the examination. The red reflex is the normal reflection of white light from the back of the eye which is seen as a red glow in the pupil on ophthalmoscopy. This is like the red-eye effect seen on flash photography.

The red reflex is viewed through the ophthalmoscope eyepiece. The colour, brightness and presence of any shadows on the red reflex should be noted in each eye. Caucasian babies have a bright, pinky-red reflex. If the examination is equivocal, the examination should be repeated by a more experienced practitioner within the guideline period.

In addition to the assessment described for the newborn screen, the 6 to 8-week examination includes checking:. If the NIPE eye examinations are normal, care should be transferred to the Healthy Child Programme with routine vision screening at 4 to 5 years of age.

Some babies will need regular monitoring, even if the examination shows no evidence of an ocular problem. Referral to consultant-led ophthalmology service through the NIPE screening pathway is needed if a dark area within the red reflex is present or if the red reflex is dim or absent cataract. Babies with positive screen identified at the newborn examination require assessment by a consultant ophthalmologist or paediatric ophthalmology service by 2 weeks of age.

Infants with a positive screen at the 6 to 8-week examination require assessment by a consultant ophthalmologist or paediatric ophthalmology service by 11 weeks of age. Ranging from non-significant to major and critical lesions, the overall incidence of congenital heart disease CHD is about 8 per 1, range 6 to 12 per 1, live births. Some critical and major cardiac lesions may be detected during pregnancy as part of the fetal anomaly screening programme FASP during the fetal anomaly ultrasound scan.

Auscultation listening to the internal sounds of the body covers presence of a murmur, either systolic or diastolic or loudness. Parents should be advised to contact their healthcare professional or emergency services if they have any concerns about their baby.

Babies with screen positive clinical findings should be seen by a senior paediatrician with expertise in cardiology in the early neonatal period as required. The urgency will depend on suspected condition. Any babies with a suspected major or critical heart condition should be seen as a matter of urgency and definitely before discharge home. These are typically short, soft, systolic, and localised to the left sternal border. They have no added sounds or other clinical abnormalities associated with them.


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The examining practitioner should discuss findings with a senior paediatrician or a paediatrician with expertise in cardiology and refer as appropriate. Urgency will depend on the assessment of the clinical condition of the baby. Many babies will have cardiac murmurs in the first 24 hours of life in the absence of a cardiac defect linked to physiological changes at birth.

However, cardiac murmurs may be absent in babies with a significant cardiac defect. Although there are no NIPE cardiac standards, it is recommended that the national clinical guidance above is followed.

Examination of the Newborn

The guidance below relates to both newborn and 6 to 8-week infant examination unless otherwise stated. Please note that as a result of the hip consultation, the NIPE hip screening guidance and standards will be changing. Further details will be circulated via the PHE Screening blog in due course. Early diagnosis and intervention will improve health outcomes and reduce the need for surgical intervention.

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This includes breech babies who have had a successful external cephalic version ECV. This is where any of the NIPE hip risk factors listed above is present. All babies from that pregnancy should have a hip ultrasound. The rationale for this advice is that if one of the babies meets the criteria of breech presentation, as described above, it may be difficult to accurately identify which baby was affected.

Babies with any of the above NIPE risk factors should still have NIPE hip clinical examination and an ultrasound scan should be arranged in line with national guidance. Isolated clicks without any other relevant clinical findings should not be classified as screen positive and do not require referral for ultrasound.

Confirmation of the screening outcome by an experienced clinician should be sought if the examiner is unsure. After a second opinion and if a screening outcome is still unclear, an ultrasound scan at 6 weeks of age may be considered. This would be a local clinical referral and not part of the national NIPE screening pathway.

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Hip screening is to identify instability. Local audits may be carried out to assess clinical competency and feedback to practitioners about clicky hip findings. The examination should take place in a warm environment and on a firm flat surface with the baby undressed and settled. Please note that observation of skin creases for symmetry is no longer part of the NIPE screen. Undertake both the Barlow and Ortolani test manoeuvres on each hip separately to assess hip stability.

Barlow manoeuvre is used to screen for dislocatable hip. Ortolani manoeuvre is used to screen for a dislocated hip. Please note that as a result of the hip screening consultation asymmetrical skin creases has been removed from the list of screen positive criteria.