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Группа авторов. Examination of the Newborn
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Examination of the Newborn. An Evidence‐Based Guide
List of contributors
Acknowledgements
Introduction
Political drivers for examination of the newborn – past and present
Ensuring best practice
The UK National Screening Committee
Key documents
SMaRT 4 NIPE
Third edition Examination of the Newborn: An Evidence‐Based Guide – what’s new?
REFERENCES
About the companion website
CHAPTER 1 HISTORY TAKING AND THE NEWBORN EXAMINATION : AN EVOLVING PERSPECTIVE
KEY POINTS
Introduction
Objectives and characteristics of good history taking
Building a history profile: where to start?
Evaluation of maternal medical records: biophysical information
Previous obstetric and medical history
Intrapartum history
Early onset neonatal sepsis
Infant of the diabetic mother
The NHS Antenatal Screening Programme. Antenatal serology results
The fetus in focus. Fetal anomaly screening
Smoking in pregnancy
Maternal alcohol consumption
Maternal substance use
Neonatal abstinence syndrome
Risk factors and the newborn examination
Increased risk of cardiac anomalies related to newborn
Other conditions of parental concern
SMaRT 4 NIPE (S4N)
The psychosocial and safeguarding agenda
Maternal mental health
Addressing safeguarding issues when reviewing the antenatal history
Parental dialogue and involvement with the newborn assessment process
Interpretation of the information
Importance of location for the newborn examination
Limitations to history taking
Conclusion
REFERENCES
CHAPTER 2 Cardiovascular and respiratory assessment of the baby
KEY POINTS
Introduction
Development of the lungs
Development of the heart
Transition to extrauterine life
Fetal circulation
Postnatal circulation
Delayed cord clamping in full‐term healthy infants
Respiratory considerations
Postnatal events
Impact of hypoglycaemia, hypoxia and hypothermia on transitional events
Thermoregulation
Blood glucose levels
In summary
Examination of the cardiovascular and respiratory systems
Incidence
Presentation
Heart sounds
Murmurs
Other sounds
Tools
Examination of the heart. History
Examination
Observation
Palpation
Capillary refill time
Auscultation
Things to note during auscultation
Palpating the femoral pulses
Femoral pulses and coarctation of the aorta
Detection of an abnormality
Investigations. Blood pressure
Pulse oximetry
Electrocardiography
Echocardiography
Follow‐up
Screening. Antenatal ultrasound examination
Screening pulse oximetry
Postnatal screening echocardiography
Examination of the respiratory system
Examination of the chest. History
Examination
Abnormalities
Investigations
Transillumination of the chest wall
Antenatal screening
Conclusion
Cardiac abnormality – a case study
Look here for resources on congenital heart defects
REFERENCES
CHAPTER 3 The neonatal skin: examination of the jaundiced newborn
KEY POINTS
Introduction
Physiology and development
The hypodermis (subcutaneous fat layer)
The dermis (connective tissue layer)
The epidermis (outermost layer)
Fetal development of the skin
Maturation of the skin after birth
Assessment of the neonatal skin. Colour
Care of the neonatal skin: a consistent approach to practice
Aims of skin care after birth
Care of the umbilical cord
Common skin lesions in the neonate
Non‐infectious skin disorders. Erythema toxicum neonatorum
Milia
Miliaria
Neonatal acne
Seborrhoeic dermatitis (cradle cap)
Sucking blisters
Transient neonatal pustulosis
Infectious skin disorders. Impetigo
Staphylococcal scalded skin syndrome
Neonatal herpes
Candida infection
Common lesions involving pigment
Café‐au‐lait spots
Pigmented naevi
Common vascular birthmarks
Salmon patch haemangioma (naevus simplex) or ‘stork marks’
Strawberry haemangioma
Cavernous haemangioma
Port wine stain (naevus flammeus)
Examination of the jaundiced newborn. Introduction
Physiology of neonatal jaundice
Dangers of newborn jaundice
Categorising newborn jaundice
Assessing newborn jaundice
Early jaundice
Haemolytic disease of the newborn
Physiological jaundice
Prolonged/late onset jaundice
Management of newborn jaundice
Physiological jaundice and umbilical infection – a case study
Acknowledgements
Look here for resources on neonatal infection and management of jaundice
REFERENCES
CHAPTER 4 Examination of the head, neck and eyes
KEY POINTS
Examination of the head and neck. Introduction
Examination of the head
Examination of the face
Examination of the ears
Examination of the nose
Examination of the mouth
Examination of the soft and hard palates
Checking the palate
Tongue‐tie
Frenulotomy for tongue‐tie
Parents of a baby with tongue‐tie
Natal teeth
Examination of the neck
Examination of the eye. Introduction
Embryology
Physiology
Timeline for referral
History taking and examination of the newborn
Clinical examination. Preliminary observations
Direct ophthalmoscopy
Sight‐threatening eye problems. Leukocoria
Congenital cataracts
Retinoblastoma
Infections (TORCH)
Toxoplasmosis
Toxocara
Cytomegalovirus
Ophthalmia neonatorum
Developmental abnormalities. Persistent hyperplastic primary vitreous
Retinopathy of prematurity
Non‐accidental injury
Congenital glaucoma buphthalmos (‘ox eye’)
Capillary haemangioma (strawberry naevus)
Ptosis
Strabismus and eye movements
Non‐sight‐threatening eye problems ‘Watery eyes’ due to nasolacrimal duct obstruction
Conclusion
Tongue‐tie (ankyloglossia) – a case study
Look here for resources on tongue‐tie
REFERENCES
CHAPTER 5 Assessment of gestational age and newborn reflexes
KEY POINTS
Introduction
Assessment of gestational age
Neurological state of the newborn
Newborn reflexes
Moro reflex
Grasp responses
Babinski reflex
Rooting, sucking reflexes
Tonic neck reflex
Stepping reflex
Growth charts
Conclusion
Look here for resources on gestational age and reflexes
REFERENCES
CHAPTER 6 Examination of the newborn abdomen and genitalia
KEY POINTS
Examination of the newborn abdomen
An approach to abdominal examination
Deviations from the norm
Bowel obstruction
Observation. Upper GI obstruction
Lower GI obstruction
Necrotising enterocolitis
Examination of the newborn genitalia
Development of genitalia and determinants of sex
An approach to genitalia examination
Male examination
Female examination
Undescended testicles
Testicular torsion
Inguinal hernia
Hydrocele
Hypospadias
Epispadias
Ambiguous genitalia
Congenital adrenal hyperplasia (CAH)
Androgen insensitivity syndrome
Conclusion
Undescended testes (cryptorchidism) with associated hypospadias – a case study
Acknowledgements
Look here for resources on undescended testes and hypospadias
REFERENCES
CHAPTER 7 Developmental dysplasia of the hip and abnormalities of the foot
KEY POINTS
Developmental dysplasia of the hip. Definition
Consequences of DDH
DDH: incidence
Clinical hip joint instability
Clinical screening
The Ortolani hip screening examination test
The Barlow clinical examination test
Clinical screening
Other clinical signs
Ultrasound screening and DDH
Universal ultrasound screening programmes
Selective ultrasound screening
Ultrasound screening: summary
Treatment of DDH
Rigid devices
Dynamic splintage
Abnormalities of the foot
The newborn foot
Clubfoot
Diagnosis. Antenatal diagnosis
Postnatal diagnosis
Structural clubfoot
Positional clubfoot
Treatment
Metatarsus adductus
Calcaneovalgus
Congenital vertical talus
Polydactyly
Syndactyly
Absence or shortening of digits
Conclusion
Hyperextension of the knee – a case study
Look here for resources on congenital knee abnormalities and examination of the hips
Glossary of terms
REFERENCES
CHAPTER 8 Chromosomal and genetic problems: giving feedback to parents
KEY POINTS
Background
Useful genetic terminology
Modes of inheritance
Antenatal screening
Antenatal ultrasound. The ‘Booking’ scan
18–22‐week ‘anomaly’ scan
Hormonal screening
Antenatal screening for sickle cell and thalassaemia
Specific genetic testing: screening of parents
Testing of the fetus
Chorionic villus sampling
Amniocentesis
Postnatal screening via the newborn blood spot test
Ways in which actual or suspected genetic or chromosomal anomalies may present on the newborn check
Problems detected on antenatal screening
Family history of genetic disorders
Problems visible at birth or on first‐day check: dealing with a baby with dysmorphic features
Commoner specific genetic and chromosomal disorders. Trisomy 21 (Down’s syndrome)
Causes of Down’s syndrome
Clinical features
Medical problems seen in Down’s syndrome
Cardiac
Gastrointestinal
Hearing
Development
Other medical issues
Confirming trisomy 21
Checking the baby with antenatally diagnosed Down’s syndrome
Actions prior to discharge home in suspected or known Down’s syndrome
Trisomy 13, 18
Turner syndrome (XO)
Antenatal diagnosis
Features visible on the newborn examination
Postnatal management
Screening for associated problems
DiGeorge syndrome/velocardiofacial syndrome
Prader–Willi syndrome
Gene disorders. Osteogenesis imperfecta
Achondroplasia
Features at birth
Medical issues
Epidermolysis bullosa
Inborn errors of metabolism (IEM)
Feedback to the parents in cases of congenital abnormality
Conclusion
Mowat–Wilson syndrome – a case study
Look here for resources on Mowat–Wilson syndrome
REFERENCES
CHAPTER 9 Newborn behaviours: supporting parents to develop early attachments
KEY POINTS
Introduction
Fetal development
Maternal–fetal attachment
Attachment theory
How can health professionals promote parent–infant bonding? Continuity of care
Antenatal education
Promoting skin‐to‐skin contact at birth
Supporting vulnerable parents
The parents
Feedback to parents
The concept of behavioural states
Consoling strategies
The newborn infant’s smile
Behaviours indicating sensitivity and stress
Preparations before the newborn examination
Describing newborn behaviour during the examination
Documentation
Postgraduate training
Conclusion
Neonatal behavioural aspects – case study one
Neonatal behavioural aspects – case study two
Look here for resources on understanding neonatal behaviour
REFERENCES
CHAPTER 10 Examination of the newborn: professional issues in practice
KEY POINTS
Introduction
Newborn and infant physical examination standards and Programme Handbook
Significant Influences Affecting Professional Competency and Conduct
The neonatal examination: competence for practice
The Code and the newborn examination process
Consent in practice
Confidentiality in practice
The right to confidentiality
Role of the employer
Local policies to direct practice
Risk management
SMaRT 4 NIPE (S4N)
The newborn examination practitioner: education and competence
Integration of NIPE training into the undergraduate pre‐registration curriculum
New NMC standards for midwifery education
Recommendations for practice –keeping up to date
Keeping practice up to date
Clinical effectiveness
Conclusion
Examination of the newborn: professional issues – a case study
Look here for resources on dealing with professional issues surrounding the newborn examination
REFERENCES
APPENDIX 1 A step‐by‐step guide to examination of the newborn. Step one
Step two
Step three
Step four
Step five
Step six
Step seven
Step eight
Step nine
Step ten
Look here for additional resources to help with this process
APPENDIX 2 Useful website addresses. Chromosomal and genetic problems. Achondroplasia
Cystic fibrosis
DiGeorge syndrome
Down’s syndrome
Duchenne muscular dystrophy
Edwards and Patau’s syndromes
Epidermolysis bullosa
Inborn errors of metabolism and MCADD
Mowat‐Wilson Syndrome Support Group
Osteogenesis imperfecta
Prader–Willi syndrome
Sickle cell disease
Thalassaemia
Turner syndrome
General websites
Learning resources
Index
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