Delivery point screening-Head to toe examination.pptx
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Delivery point screening of newborn
Delivery point screening-Head to toe examination.pptx
- 1. Head to toe examination Delivery point screening
- 3. Why is it important? 6 to 7% of NB have a birth defect 1.7 million birth defects annually in India. Contribute to 10% of neonatal mortality and 4% of infant mortality Early identification, referral , treatment and follow up will reduce the burden of disability, improve health and ensure development of children born with Birth Defects. Screening of newborns at delivery points is a crucial component of this strategy
- 4. What is a birth defect? Includes diverse health conditions Physical malformations such as cleft lip or palate Chromosomal abnormalities such as Down syndrome Functional defects congenital deafness and congenital cataract Metabolic defects including inborn error of metabolism Haemoglobinopathies Neurodevelopmental disorders. Complications related to prematurity
- 5. Birth defects Usually manifest at birth and can be identified at the delivery points Some manifest a few weeks or months later.
- 6. Approach to NB screening at delivery point Within the first few minutes after birth assess the vitals like respiration, heart rate A full and detailed assessment for identifying Birth Defects, prior to discharge from the facility within the first 48 hours of life Head to toe examination - to identify any visible defects, and also to reassure parents that their baby is healthy. To be performed by the Staff Nurse/ANM, facilitated by the Medical Officer for all NB at birth and at all delivery points
- 7. Process flow
- 8. Essential steps Wash your hands before you touch the baby Seek parental consent for examination Encourage breastfeeding Encourage bonding
- 9. Essential steps-Ensure: Warmth Lighting Correct identification Infection control precautions Privacy
- 10. Review history Maternal medical/obstetric/social Family history of Deafness, childhood blindness. Family history of congenital heart disease
- 11. Equipments needed Overhead warmer if required Stethoscope Pencil torch Inch tape Infant scales Growth charts, especially for head circumference Pulse oximetry (optional)
- 12. Timing Initial exam immediately after birth check the vitals. If any abnormal, refer/ resuscitation Full and detailed assessment for Birth Defects prior to discharge Follow-up in high risk cases If unwell/premature Refer if clinically indicated
- 14. Assessment areas Examine the Newborn when quiet, alert, not hungry or crying
- 15. General appearance State of alertness Activity Spontaneous movement Predominant Posture Responsiveness to stimulus Colour Refer if child looks ill, lethargic , has an abnormal cry , abnormal movements or colour of skin: pale,blue,yellow Check weight, length, head circumference and document
- 16. Head Shape and symmetry Scalp swelling Deformity Anterior and posterior fontanelle Head circumference Scalp lacerations/lesions
- 17. How to measure head circumference Head circumference- too small < 32cms/ too large > 38cms in full-term
- 18. Abnormalities in head Absence of cranial vault Herniation of the brain through a defect in the skull Closed fontanelles and fused sutures Enlarged, bulging or sunken fontanelle Microcephaly/macrocephaly Hydrocephalous
- 19. Spine Spinal column Scapulae and buttocks for symmetry Skin over the spine
- 20. Abnormalities in the spine Abnormal swelling of the spine Non-intact bony spine Abnormal curvature of spine Tufts of hair or dimple along intact spine
- 21. Face Facial expression Dysmorphic appearance Symmetry of structure Asymmetry on crying
- 22. Eyes Eyelid Facial marks near the eye Eyeball Position in relation to the nasal bridge Cornea Swelling, drooping or gap in the eye lid Port wine stain or haemangioma Abnormally small eye or absent eye Upward /downward slant/epicanthic fold Hazy, dull cornea, opacity
- 23. Eyes Pupil Lens Opacity with excessive tearing Conjunctiva Pupils unequal, dilated or constricted or gap in the pupil Congenital cataract Congenital glaucoma Purulent conjunctivitis White eye reflexes through a torch
- 25. Ears Position of ear Shape of ear Patency of the external auditory meatus If absent/abnormal shape/low set or family history or deafness -Refer
- 26. Mouth Lips Palate (hard/soft) Cleft lip / cyanosis Cleft palate
- 27. Chin, Neck and Clavicles Small receding chin/micrognathia Neck webbing/ Masses/swelling Absence of clavicles
- 28. Heart, Chest Chest: Chest size, shape and symmetry Number and position of nipples Respiratory: Chest movement and effort with respiration Respiratory rate Breath sounds Cardiac: Pulses femoral Position of apex beat
- 29. Urgent referral Signs of respiratory distress Apnoeic episodes Weak or absent pulses Positive pulse oximetry screen (if performed)
- 30. Abdomen Shape and symmetry Defect in the abdominal wall Umbilicus including number of arteries Any abdominal mass Abdominal distension: intestinal obstruction Scaphod abdomen with respiratory distress Defect in the abdominal wall: Gastroschisis/exomphalos Less than 3 umbilical vessels Abnormal abdominal mass
- 31. Abnormalities in the abdomen
- 32. Exomphalos vs Gastroschisis Exomphalos Gastroschisis The defect is usually to the right side of a normal umbilical cord with exposed abdominal contents.There is no membrane or sac The umbilical cord inserts into and is continuous with a membrane-covered midline defect.
- 33. Anus Position Patency Abnormal position of anus Absence, imperforate anus No meconium passed within 24 hours
- 34. Male genitalia Penis including foreskin Testes (confirm present bilaterally and position of testes) including any discolouration Scrotal size and colour Other masses such as hydrocele Micropenis (stretched length less than 2.5 cm) Inguinal hernia/swelling Ambiguous genitalia Bilateral undescended testes Testicular torsion Unequal scrotal size or scrotal discolouration
- 35. Female genitalia Clitoris Labia Hymen Urethral opening Absence of vaginal opening Pseudomenses Inguinal hernia/swelling Ambiguous genitalia
- 36. Urinary tract Bladder wall Has the Newborn passed urine? Urethral opening: look from where the urine comes out Check for urinary stream in a male child Bladder wall not intact- bladder exstrophy No urine passed within 24 hours Posterior urethral valve-disrupted flow Hypospadias/epispadias
- 38. Limbs Upper Limbs Arm Forearm Hand, digits and palm Lower Limbs Thigh Leg Foot and toes Absence of the whole or a part of the upper limb (arm/forearm, hand) Extra digits/webbing of fingers Single transverse crease Absence of the whole or a part of the lower limb Clubfoot
- 40. HIP Check symmetry of the legs Skin folds over the buttocks Risk factors for hip dysplasia: a. breech b. females c. family history Hip dysplasia
- 41. Signs of hip dyspasia (asymmetry of thigh and gluteus)
- 42. Screening for chromosomal disorders Look for any dysmorphic feature. Upward slanting eyes, epicanthic fold, flat nose, small ears, small mouth, single palmar crease and increase gap between the first and second toe. Presence of chromosomal disorder
- 43. Discuss, document and refer Stabilise before discharge or refer Place of referral
Editor's Notes
- #25: the ear is low-set when the helix of the ear meets the cranium at a level below that of a horizontal plane through both inner canthi (the inside corners of the eyes).
- #30: Single Umbilical Artery is associated strongly with gastrointestinal atresia or stenosis. May be associated with aneuploidy
- #31: clinical triad of deficient abdominal musculature, cryptorchidism, and urinary tract abnormalities
- #36: layout of the external urethral meatus is abnormal, on the ventral penis, ranging from the glans to the perineum; (2) curvature towards the ventralpenis (chordee); (3) abnormal prepuce with hood on the dorsal penis. In epispadiasurethra opens onto thedorsal aspect of the penis in boys