CP2 Paediatric E-learning

8/16/2019 CP2 Paediatric E-learning

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CP2 Paediatric e-learningTHE NEWBORN SICAL AND INFANT

PHYSICAL EXAMINATION

(NIPE)Dr Amjad IMAM

Medical Educator Dept of Paediatrics


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NIPE


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Overview of Website

• Pre Course Quiz•

Learning Objectives• Post Course Quiz• Feed Back Session• Resource


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1.What's this rash?


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Answer: Milia

• Epidermal inclusion cysts• Pearly, yellow, 1-3mm diameter papules•

Face, chin, forehead• 50% newborns• Usually resolve in first month without

treatment, but may persist for several months


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2. What is this rash?


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Answer: Mongolian blue spot

• Blue/black macular discolouration at the baseof spine and on the buttocks

• Occasionally on legs or other parts• Usually in dark skin ,afro-Caribbean or Asians• Fades slowly over few days to 1 yr•

Reassurance


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3.What's this abnormality?


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Answer:Hemangioma

(Strawberry Naevus)• Most common benign tumour of infancy,morecommon in preterm

• Begin as barely visible telangiectasia or red

macules and grow in size until9 month ,then regress• 60% occur on head and neck area• All gone by age 5yrs• Large one treated with steriods or interferon-

alpha.


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4.List 3 Cranio- facial feature of thissyndrome


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Answer:Down Syndrome (Tri 21)

• Round face and flat nasal Bridge• Upslanted plepebral fissures• Epicanthic folds• Brushfield spots in IRIS (pigmented spots)• Small mouth and protruding tongue• Small low set Ears• Flat Occiput (Brachycephaly)• Short neck (risk of atlantoaxial subluxation)


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Learning Objectives (CP2 students)

• What is NIPE?•

Pertinent Maternal History before NIPE?• How to Examine Heart,HIPS,Eye,Testis?• THINGS NOT TO MISS IN NIPE?


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What is NIPE

• Service Improvement Programme under theumbrella of NSC(National Antenatal Screeningprogram) & DH(Dept of Health)

• Improve quality of newborn examination andreduce late diagnosis and misdiagnosis

•

Website:http://newbornphysical.screening.nhs.uk/elearning


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NIPE –Screening


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Pertinent Maternal History

• Everyone involved in the care of the infant shouldhave knowledge of the relevant maternal history

– Pre-partum –

Antenatal – Perinatal

• This information can routinely be found on thematernal fact sheet in newborn’s chart or in themother’s chart.


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Maternal History

• Family History – Inherited diseases (cystic fibrosis, sickle cell

disease, metabolic disease, polycystic kidneys,hemophilia, and history of perinatal death)

• Maternal History – Age, blood type, chronic diseases, diabetes,

hypertension, renal disease, cardiac disease,bleeding disorders, infertility, recentinfections/exposures, rubella status, GBS status,and STD’s


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Maternal History• Sexually transmitted diseases (STD’s)

– HIV – Syphilis (RPR or VDRL) – Hepatitis B (HepBsAg) – Gonorrhea (GC DNA) – Chlamydia (Cz DNA)

• Group B Streptococcus “GBS” –

(streptococcus agalactiae ) – Rectal/vaginal swab results at 35-37 weeks gestation

**all maternal results must be verified/confirmed by visualizing a lab report**

Group B Strep


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Maternal History

• Previous pregnancies – Abortions, fetal demise, neonatal death,

premature births, postdate births, malformations,

respiratory distress syndrome, jaundice, apnea

• Drug history – Medications, drugs of abuse, Alcohol abuse,

tobacco usage during pregnancy


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Examine Heart

• Incidence CHD: 7-8 per 1000• 25% detected on fetal anomaly scan• Risk factors: Down syndrome

Family HxAntenatal Infection(Rubella)

WRBSITE FOR AUSCULTATION:

http://depts.washington.edu/physdx/heart/demo.html


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Examine HIPS

• Instability• Subluxation•

Dislocatable• Reducible dislocation• Irreducible dislocation


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DDH

Risk Factors• Family Hx•

Breech• Oligohydramnios• Female• swaddling


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Barlow Provocative Test

•

Dislocates hip (exit)

Clunk


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Ortolani Maneuver

• Reducesdislocated hip(entry)

Abduction

Clunk


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Hip Exam


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Examine EyeAbsent Red reflex


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EXAMINE TESTIS


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Genitourinary Abnormalities: Male

Normal neonatal phimosiswww.vghtpe.gov.tw

Hypospadiaswww.meddean.luc.edu


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Genitourinary Abnormalities

Ambiguous genitaliawww.thefetus.net

Imperforate anuswww.bms.brown.edu


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THINGS NOT TO Miss on NIPE?• CLEFT PALATE• CHD• DDH• Eyes• Anal atresia• Ambigious genitalia/abnormal genitalia• Birth injuries - facial palsy,Erbs, Fractures Clavicle• Syndromes/Face/Head• Spine/hair tuffs• Foot abnormalies


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POST COURSE QUIZ


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1.What's are these 2 rashes?


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Answer:Nappy rashesLEFT(Irritant) & RIGHT(Candidal)

• Irritant rash(contact) most common occur when nappies arenot changed frequently (urine).

Skin Flexures (Intertriginous areas) usually sparedTreat with emollient(aquous cream), barrier cream(Zinc oxide)

Nappy free period?Hydrocartisone cream?• Candidal Rash involve skin flexures & associated satellite

lesionsTreat with topical antifungal agents+/- hydrocortisone


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2.What is the abnormality?


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Erb’s Palsy

• Follows a traumatic delivery or shoulderpresentation

• Traction of upper nerve roots of C5/C6of Brachial Plexus

• Most resolve by physiotherapy•

Refer to orthopedics if not resolve by 6 week


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3.What is this swelling?


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Answer:Cephalhaematoma

• Result from bleeding below the periosteum• Involve parietal bone• Resolve over several weeks• Complication-jaundice and infection• Treatment is conservation•

D/D Caput Succedaneum


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4.What is the diagnosis?

Ferguson E C et al. Radiogr aphics 2007;27:1323-1334

©2007 by Radiological Society of North America


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Answer:Tetralogy of Fallot (TOF)

• VSD• RV outflow obstruction( valvular+infundibular stenosis )• Overriding aorta• RV hypertrophyAssociations:Down syndromeDi GeorgeCHARGEVACTERAL


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FEEDBACK CP2 students

• Your feedback is valued immensely and will takearound 2 minutes of your time.

Please click on the link shown to completefeedback.

Many thanks!•

Survey monkey link• Link Description• https://www.surveymonkey.com/s/BJ8LRSC

https://www.surveymonkey.com/s/BJ8LRSChttps://www.surveymonkey.com/s/BJ8LRSChttps://www.surveymonkey.com/s/BJ8LRSC


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CP2 Paediatric E-learning