physicalexaminationofthenewborninfant新生儿检查之标准流程.pptVIP

Upper limbs Inspect the arm: shape, posture, symmetry Examine the hand: flexion deformities of the fingers; palm creases; syndactyly or polydactyly Observe spontaneous arm movements Erb’s palsy -- lack of movement in the arm and the hand showed waiters tip position From Atlas of Neonatology 7th edition Clenched hand Lower limbs Inspect the legs and feet: posture, symmmetry, general size and shape Observe spontaneous or stimulated active movements: restriction of joint Feet: Rocker bottom shape and short hallux = Edward syndrome Puffy feet and hypoplastic nails = Turner syndrome Calcaneovalgus position = fetal position in utero Equinovarus position Over-riding toes: self-correcting Trisomy 18Edward syndrome Hip Congenital dislocation: common following breech presentation; most of girls Perform Ortolanis test Barlows test From Physical diagnosis in neonalology P.417 Neurological examination Formal testing is seldom needed Posture: normal neonate -- lies predominantly in a flexed position The presentation at birth can influence posture for several days Spontaneous motor activity Muscle tone and strength: test by Assessing resistance to passive movements Pull-to-sit maneuver Ventral suspension Crying: note if it is either-high pitched or very weak Feeding and sucking patterns Reflex responses: Moro reflex, Grasp reflex, Rooting and sucking reflex Primitive reflexes Rooting reflex Sucking reflex Grasp reflex Grasp reflex Moro reflex Thanks for your attention ! Physical Examination of the newborn infant新生兒檢查 高醫小兒科部 新生兒科 作完整新生兒檢查之準備事項 作完整新生兒檢查之時機︰在餵食之後約1到2個小時，因為此時嬰兒比較不會想睡或太飢餓。 維持溫暖的環境來作檢查。若可以的話，可使用頭頂的輻散發熱器 (radiant warmer)。 除尿布之外，除去外部衣服，以作全身之檢查 在檢查期間，你需要使用溫和、輕柔的聲音；並對嬰兒微笑。 儘量使檢查流程順利，不要突然嚇到嬰兒。 作較侵犯性的檢查時，可使用安撫奶嘴。 新生兒檢查之順序 在嬰兒生命徵象穩定之後，按照以下之檢查順序，進行新生兒檢查。 除去外部衣服，留下尿布。 測量頭圍、身長及體重並將其畫在生長曲線圖上。 摸前囟門(anterior fontanelle)，感受其張力(tension)是否正常或是有凹陷之情形。並檢查頭顱。 注視嬰兒的臉，看其膚色及是否有異常之處。 檢查眼睛，耳朵，鼻子和嘴。 檢查頸部，包括觸摸鎖骨。 聽心音及呼吸音，並估計心跳速率和呼吸速率。 摸腹部。 檢查手臂、手、腿和腳