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Examinarea nou-nscutului
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Obiectivele prezentrii:
Examinarea iniial postnatal a nou-nscutului (primele 2 ore postnatal)
Primul examen neonatal de rutin (n primele72 ore de via)
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Examinarea primar a nou-nscutului are cascop:
Determinarea vrstei gestaionale a nou-
nscutuluii corespunderii acestei vrste
Detectarea strilor patologice ale nou-nscutului
Stabilirea prezenei anomaliilor congenitale de
dezvoltare.
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EVALUAREA I CONDUITA NOU-NSCUTULUI
Ev
aluarea
pentru
respiraie normal Neregulatsau absent
Normal normal
Frecvencardiac
FC>100bat/min
FC100bat/min
FC>100bat/min
Greutate/vrst degestaie
GN>2500
VG>37sapt
GN2500
VG37sapt
GN2500
VG37sapt
GN2500
VG37sapt
Defecte/traume la natere
Absente Absente Absente Present
clasificare copil sntos Asfixie Greutate
mic lanatere
Defect/traum
e la natere
conduit ngrijireacopiluluisntos
ngrijireacopiluluiasfixic
ngrijireacopilului cugreutate mic
la natere
ngrijireacopilului cutraume/defec
te la natere
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Variantele vrstei gestaionale:
a)nou-nscut matur(nscut ntre 37 i 42 sptmni)
b)nou-nscut prematur (nscutpn la 36 sptmni desarcin)
c)nou-nscut postmatur(nscutdup 42 sptmnidupsarcin).
Nou-nscut imaturcopil, nscut la termen, cu particularitimorfologice i funcionale caracteristice prematurului.
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Starea nou-nscutului n cadrul primuluiexamen clinic n sala de natere:
- scorul Apgar;
- criteriile antropometrice (greutatea, talia,perimetrul cranian i toracic);
- sexul;
- rezultatele primelorsimptome de depistajurgent.
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IPTUL NOU-NSCUTULUI (Strigtul copilului)
se apreciaz intensitatea (puternic, slbit, lipsete),durata (scurt, ndelungat), modularea (cefalic,afonic, nazonat, de frecven nalt),
emoionalitatea -strigtul emoional adecvat aparela aplicarea excitantului i se ntrerupe n scurttimpdup aciunea lui.
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Sistemul osos
Se ncepe cu examinarea extern: apreciereanumrului de degete, forma lor, micrile nele.
Examinarea feei.
Examinarea articulaiei coxo-femurale
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Examinarea tegumentelor i esutului adipos
subcutanat:
Pielea nou-nscutului e cald la palpare, fin,catifelat.
Particularitile pielei, sntoase:
- milia- milia cristalina
- hemoragii peteiale n cantiti mici
teleanghiectazii lanugo- pete mongolice
- nev pigmentar congenital
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Culoarea tegumentelor
n primele minute dup natere tegumentele pot ficianotice sau se observ cianoza perioral sau acrocianoz.Dup toaleta igienic a tegumentelor apare coloraiaroie-aprins a ei (eritemul fiziologic). Mai rar copilul se nate cu
tegumentele roze. Icterul fiziologic coloraia icteric a pielii (doar minile i
plantele, de asemenea sclerele i mucoasele pstreazculoarea obinuit) sentlnete la 60 70% nou-nscui.
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Examenul capului Forma - brahi-, dolicocefalic,asimetric, craniu n turn oxicefalic.
Configuraia - ca urmare aparcurgerii cilor de natere.
Perimetrul capului de obiceimsoar 34 37 cm i e cu 2 3 cm
mai mare dect perimetrul toracic. Palparea capuluideterminmintegritatea oaselor craniene,prezena bosei sero - sanguine saucefalohematomului, hemoragieisubaponeurotice, herniilor cerebrale,infiltratelor, abceselor.
Percutarea palpatorie
Aprecierea strii fontanelelor isuturilor craniene.
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Examinarea analizorului vizual
Reacia la excitanii vizuali.Pentru nou-nscutulsntos sunt caracteristice:
simetria fantelor palpebrale
corneea transparent, vie reacie vie la lumin
poate fi strabism convergent i nistagmus orizontal nestabil
exoftalmie nepronunat la prematuri
conjunctiva neted,roz,strlucitoare
fixeaz privirea la a doua sptmn de via
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Examinarea simului olfactiv
pe rnd se apropie spre nasul sugaruluisubstane mirositoare (picturi de mint,tinctur de valerian).
Nou-nscuii i sugarii la aciunea mirosurilorreacioneaz nemulumii prin: nchidereapleoapelor, grimas a feii,ipt, se intensific
pulsul irespiraia.
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Examinarea cavitii bucale
Atragem atenie la prezena anomaliilor dedezvoltare:
micro-, macroglosia
macroglosia relativ n sindromul Pierre-Robin (areloc subdezvoltarea mandibulei micrognatie)
heiloschizis (dehiscena buzei superioare, buz de
iepure) palatoschizis (dehiscena palatului dur, gur de lup)
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Examinarea analizorului auditiv
Reacia la excitani auditivi. Normal de la 27 28 sptmni de gestaie copilul la aciuneaexcitantului auditiv rspunde prin reflexul
cohleopalpebral, tresrire, micri n membre,ncetinirea respiraiei i btilor cardiace.
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Examinarea gtului
poziia capului i palparea muchilui
sterno-cleido-mastoidian (excluderea
torticolisului)determinarea integritii claviculelor
prezena chisturilor i fistulelor
gt pterigoidian n sindromul
Shershevski-Turner
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Examinarea cutiei toracice
Normal cutia toracic a nou-nscutului e de formconic,simetric.
Stri patologice sunt considerate: asimetria cutiei
toracice, cutia toraciccuneiform sau n form deplnie, prezena ghibusului cardiac.
Palparea cutiei toracice
Percuia
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Aprecierea strii sistemului respirator
Respiraiediminuat.
Raluri
Respiraiezgomotoas
Tahipnee
Bradipnee
Dereglarea ritmului respirator
Apnee ndelungat fr bradicardie e consideratca echivalentul convulsiilor (predominant laprematuri).
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Aprecierea sistemului cardio
vascular
Referitor la suflurile cardiace la nou-nscui, trebuie atrasatenie la urmtoarele:
n primele 24-48 ore de via 60-80 % din toi nou-nscuii ausuflu cardiac. De obicei el e la mijloc de sistol
Suflu diastolic izolat la nou-nscui e depistat destul de rar,adic e suflu sistolic sau sistolic n combinare cu diastolic.
La majoritatea absolut a nou-nscuilor (mai mult de 95%)suflurile nu sunt legate de afeciuni cardiace sau suntcondiionate de defecte
Muli copii cu vicii congenitale cardiace n primele zile dupnatere nu au suflu cardiac
La nou-nscutul sntos zgomotele cardiace sunt clare, ritmice
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Examenul sistemului digestiv
Anomaliile de dezvoltare ale pereteluiabdominal, herniile.
Balonarea abdomenului
Excavarea abdomenului Asimetria abdomenului
Palparea abdomenului
Ficatul Splina
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Sistemul uro-genital
Rinichiinormal se palpeaz numai rinichiul drept.
Examinarea organelor genitale externe.
La fetie cercetarea fantei vaginale
La este necesar de examinat: hipo-, epispadie, deformareapenisului, hernie inghinal, criptorhism, hidrocele.
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. Examinarea regiunii lombare ifeselor:
hipertrihoz n reglarea formrii coloanei vertebrale
asimetrie n cazul hemoragiei suprarenalelor
simptomul mingiiperforate la afectarea regiunii lombare a mduveispinrii.
vicii de dezvoltare grave (lipsa membrelor, degetelor, etc.) articulaiile coxo-femurale normal abducia nu e limitati marginea
lateral a genunchilor nu atinge msua de examinare
Limitarea abduciei
Motilitatea patologic
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Examinarea neurologic a nounscutului
Comunicabilitatea nou-nscutului
Reacia la lumin
Reacia la excitani sonori
Activitatea motorie spontan
Mimica nou-nscutului
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Aprecierea simptomaticii neurologice
Dereglri vegetative
Aprecierea simptomaticii patologice oculare
Aprecierea simptomaticii plcii nazo-labiale
Lipsa reaciei la sunet
Lipsa suptului
Diagnosticul parezelor
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MODALITATEA APRECIERII REFLEXELOR
Se recomand cercetarea tripl a fiecrui reflex.
Reflex normal - amplitudinea reflexului n toate 3 cazuri esteidentic sau puin sczut la a 3-a apreciere.
Reflexul sczut amplitudinea iniial este sczut i se menine
n 3 cazuri de testare sau dac se micoreaz n testrileulterioare.
Istovirea reflexului - amplitudinea normal a reflexului la prima testare cumicorarea lui n urmtoarele testri sau dispariiei reflexului. Din contra,amplitudinea nalt a reflexului sau creterea ei pe msura testriidovedete creterea reflexului.
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Ce trebuie s cunoatemnainte de a examina nou-
nscutul?
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RASPUNS:
1. Evaluare familial:
etnia, condiiile socio-economice, vrsta prinilor;
toate afectrile ereditare din familie, a procreaturilor; expunerea mamei la diferii factori toxici; grupa sanguin a mamei, i dac este posibil - a tatlui; afeciunile somatice la mam; antecedente obstetrico-ginecologice la mam.
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Care sunt condiiile pentru
examinarea nou-nscutului ?
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RASPUNS:
copilul se examineaz n primele ore dup natere
temperatura ncperii unde se afl nou-nscutul vafi 24 26 C
examenul se efectueaz n incubator sau pemsu cu surs de nclzire, nou-nscutul trebuie
s fie uscat copilul se examineaz la lumina zilei sau la lumina
lmpilor de zi
minile examinatorului trebuie s fie uscate i
calde timpul binevenit pentru examinarentre hrniri
(de obicei dup 30 min dup hrnire).
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CE momente de bazeste necesar de evideniat inexaminarea nou-nscuilor ?
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s
a
u
n
u
s
e
m
n
e
RASPUNS
Copilul are cianoz?Copilul are icter?
Sunt sau nu semne de dereglare a
microcirculaiei,?
Destul de perfect e pronunatculoarea roz a Sunt tegumentelor;
paliditatea nu indic oc, anemie sau
acidoz?
Nu sunt erupii pe tegumente? Sunturme de meconiu?
E normal poza copilului? Nu sunt
tremurturi sau convulsii?
Nu sunt schimbri caracteristice pe fa sau exist vre
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Nu sunt schimbri caracteristice pe fa sau exist vre-un sindrom, de exemplu, Daunism? Respiraia eregulat? E normal frecvena ei (40) i caracterul?
Dac se petrece ventilaia artificial, e concordatdup faza respiraiei copilului cu regimulventilatorului?
Sunt edeme, focare de inflamaie, nu tinde copilul s
ia o poziie anumit (nu trebuie de schimbat)? Dac abdomenul e balonat, sunt sectoare cu
peristaltism sau fr, cu regiuni cu hiperemie?
Examinai scutecele, n care a fost nfat copilul, fiiateni dac nu sunt urme de vome, urin, snge,fecale, care ar putea indica schimbri patologice.
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Ce schimbri patologice aleculorii tegumentelor n/n
sunt ?
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Raspuns:Cianoza generalde caractercentralCianoza periferic.AcrocianozaSimptomul arlechinPaliditatea tegumentelorTen suriu (pmntiu)Icterul patologicAspect marmoratMacerarea pielii
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Ce poziii patologice ale
minii cunoasteti?
Ce poziie patologic a
plantei cunoasteti ?
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Raspuns:
1.Mna n form de ghear afectarea SNC2.Mn balan afectarea segmentelor cervicale inferioare ale mduveispinrii (Dejerin-Cliumpche)3.Mn de maimu (Aran-Duchenne, atrofic) afectarea perinatal a SNCde diferit genez4.Poziie patologic ale degetelor minii II- IV n sindromul Patau, IIIIV nsindromul Edwards
RASPUNS
1.Varusdevierea medial a planteide la axa piciorului2.Valgus - devierea lateral a planteide la axa piciorului
3.Picior calcanean flexia dorsala plantei
4.Picior balantafectarea mduveispinrii la nivelul segmentelorlombare sau afectarea trunchiurilor
nervoase ce pleac din acestesegmente
Ce patologie a tegumentelor
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Ce patologie a tegumentelorEste prezentata ?
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Ce patologie este in acest
slaid.
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RAspuns1.Cefalohamatom osusui parietal drept
2.Hidrocefalie
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Numiti patologia prezentata
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Enumerati dinamica reflexelor
necondiionate ale sugarului ?
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RASPUNS:
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Cum se apreciaza Reflexulde cercetare (Cussmaul
Henler)
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Cum se apreciaza Reflexul Babkin
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Cum se apreciaza Reflexul de
prehensiune ?
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.
C i R fl l
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Cum se apreciaza ReflexulMoro ?
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Cum se apreciazaReflexul de sprijin i
mers automat
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Cum se apreciaza Reflexul de
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Cum se apreciaza Reflexul deaprare
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Cum se apreciaza Reflexul Galant
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Cum se apreciaza Reflexul Bauer
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Examenul fizic al nou-nscutului la 72 ore
Examinarea iniialpostnatal a nou-nscutului
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p(primele 2 ore dupnatere):
Aceast examinarea are ca scop detectareaunormalformaii majorei acordareaajutorului de urgen n aceste patologii.
O scurt examinare de screening ar trebui s
includ: examinarea feei, ochilor, cavitiibucale, toracelui, abdomenului, coloaneivertebrale i a membrelor pentru a excludeanomalii majore.
Un ipt puternic i o coloraie roz ategumentelor rspndit pe fai pe corp suntsemne bune i ne vorbesc despre un copilviguros la natere.
Unii copii pot fi nscuicu nediscifrarea,
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p p ,nedeterminarea organelor genitale. n astfel decazuri, este important snu se ghiceasc genul
copilului, deoarece situaia este incerti suntnecesare mai multe teste.
Dacaveisuficientexperienclinicisuntei
capabil de a efectua o sondare orogastric acesta artrebui s fie aplicat n cazul n care avem onatere cu: polihidramnios, pentru a excludeatresia deesofag.
Primul examen neonatal de rutin (n primele
http://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPOLYHYDRAMNIOS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgudIRoWYPIB3quMgUo6fNd4DzWmQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPOLYHYDRAMNIOS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgudIRoWYPIB3quMgUo6fNd4DzWmQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPOLYHYDRAMNIOS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgudIRoWYPIB3quMgUo6fNd4DzWmQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPOLYHYDRAMNIOS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgudIRoWYPIB3quMgUo6fNd4DzWmQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPOLYHYDRAMNIOS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgudIRoWYPIB3quMgUo6fNd4DzWmQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPOLYHYDRAMNIOS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgudIRoWYPIB3quMgUo6fNd4DzWmQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPOLYHYDRAMNIOS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgudIRoWYPIB3quMgUo6fNd4DzWmQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPOLYHYDRAMNIOS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgudIRoWYPIB3quMgUo6fNd4DzWmQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPOLYHYDRAMNIOS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgudIRoWYPIB3quMgUo6fNd4DzWmQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPOLYHYDRAMNIOS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgudIRoWYPIB3quMgUo6fNd4DzWmQ7/29/2019 Examinareastud Inter
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( p72 ore de via):
Acest examen trebuie s fie efectuat de unmembru al echipei n cazul n care copilul seafl nc n maternitate/spital (medicul
neonatolog sau medical rezident ninstituiile de nivel II i III), n cele de nivel Ide ctre medicul primar de ngrijire (mediculneonatolog sau medicul pediatru).
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Obiectivele acestei examinri sunt ndreptate pe deplin
a explica mamei nainte de a fi efectuate, rezultatele artrebui s fie comunicate mamei (prinilor) inregistrate n planul de ngrijire postnatalifia deexaminare.
Se recomand ca examinarea s fie efectuat nprimele 72 de ore de la natereiinclude:
O revizuire privind starea de nutriie a copilului ianamnesticul familial, matern antenatal a mamei, peperioada de sarcininatere
Despre sarcinele, naterele anterioare, inclusiv orice sarcin,naterefinalizat cu deces, de a identifica greutatea icircumferina capului n naterile precedente.
Dac copilul a avut meconium iurin.
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Se recomand ca examenul s fie efectuatntr-un loc bine iluminat i cald.
!!! n primul rnd splai-vminile riguros pentru a reduce
riscul de infecie.
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Apoi:Ascult i respect
Evaluarea n aspect general.Evaluarea generalinclude tonusul, starea de veghe a copiluluiicoloraia tegumentelor.
Observarea general include proporiile i maturitateacopilului.
Uitai-vcu atenie pentru a exclude icterul (depreferin la lumina natural).
Dac exist birthmarks, rashes sau alte anomalii alepielii?
Ascultiptul copilului i nota sa de sunet. Cntretecopilul i completeaz aceast dat pe
curba de cretere. Apoi fectuai o examinare sistemic de la cap spre
picioare"
EXAMINAREA NOU NSCUTULUI (SCREENING NEONATAL)
http://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DBIRTHMARKS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhiahL0GXdteCHM_Vcw9ByuxZor8MAhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DGROWTH%2520CHART%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgRrDM7c7olHtgDGUQXm2TJID-6ughttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DGROWTH%2520CHART%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgRrDM7c7olHtgDGUQXm2TJID-6ughttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DGROWTH%2520CHART%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgRrDM7c7olHtgDGUQXm2TJID-6ughttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DGROWTH%2520CHART%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgRrDM7c7olHtgDGUQXm2TJID-6ughttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DGROWTH%2520CHART%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgRrDM7c7olHtgDGUQXm2TJID-6ughttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DBIRTHMARKS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhiahL0GXdteCHM_Vcw9ByuxZor8MA7/29/2019 Examinareastud Inter
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EXAMINAREA NOU-NSCUTULUI (SCREENING NEONATAL)1.PREGTIREA EXAMINRII
Consimmntul prinilorPregtirea mediului (confort, temperatur, iluminare)Identificarea nou-nscutuluiTemperatura nou-nscutului
6. ABDOMEN/UMBILICForma abdomenului
Mase abdominal
Bontul ombilical
Numrul de vase ombilicale
2. STAREA GENERAL/TEGUMENTELECuloarea i integritatea tegumentelor i mucoaselorActivitatea
Caracteristici dismorfice
Asimetrie
Caracteristici distinctive
Vrst gestaionalPigmentaii, decolorarea pielii, etc.
7. ORGANELE GENITALE/ANUSULPasajul de urin (miciunea)
Bieei:
o Penisulo Meatul uretrei
o TesticuleleFetie:
o Vaginul i orificiul utetrei
o Anusul
o Pasajul meconiumuluiOrificiul anal
3. CAP/FASimetria feei, craniuluiFontanelele id suturileCircumferina craniuluiPrulEchimoze / abraziuni
Faa: ochi,i nasul, gur, urechi le
8.MUSCOCHELETALClaviculele
Brae, mini, degete
Coapse, picioare, degete
Gt
old (ine de competena practicianului)
Spate4. SISTEMUL RESPIRATOR
Culoarea tegumentelor
Frecvea respiraieiRespiraia nazalRetracie sternal sau tiraj intercostalGrunting
9. SISTEMUL NERVOSiptul
Reflexele
5. SISTEMUL CARDIOVASCULARFrecvena cardiac i suflurilePunctul maxim de auscultare
Pulsul brachial i femoral
Simptomul depatalb
10. DOCUMENTAIE/COMPLETAREnregistra-i greutatea i lungimea copilului
Consiliai prinii la constatarea unor patologii
Documentai n fi constatrile i concluziile
Capul:
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Capul:
Forma, prezena fontanelei i dimensiunele ei,dac este normal, excavat sau bombat
Dimensiunele circumferinei craniului, apoi elevor fi nregistrate n curba de cretere
Msoar i nregistreaz circumferina craniuluipe curba de cretere n diagram
Evaluarea aspectului facial i poziia ochilor
Verificai orice asimetrie sau anomalie de formfaciale
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Ochii
Forma i aspectul normal?Verificai prezena reflexuluirou
Examinai i depistai
cataracta congenitalevident sau oricare altesemne de infecieoftalmic
Urechile:
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Forma i mrimea
Inseria lor la nivelul normal sau "jos"?
Verificai pavilionul urechii, ductul auditiv extern Gura:
Culoarea mucoasei bucale, se observ boltapalatin
Verificai reflexul de sugere prin introducereaunui deget curatpuinuor n interiorul guriicopilului
Braele i cu minile:
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Braele i cu minile:
Sunt de forma normal i se deplaseaz n mod normal? Uita-te pentru o dovad de traum natal (de exemplu, de
paralizie Diushen-Erb)prin verificarea gtului, umerilor i aclaviculelor
Numrul degetelor, forma lor nu exist nici o dovad debrahidactilie, clinodactilie, sindactilie (rudimente, degetesuplimentare)?
Verificai palma, pliurile palmare - sunt multiple sau doarunul singur? Un singur pliu palmar poate fi normal, darpoate fi un semn de sindrom Down.
http://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DERB%2520S%2520PALSY%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhbRxEGfhl1MT30DcqV1hgPRuKxOwhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DERB%2520S%2520PALSY%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhbRxEGfhl1MT30DcqV1hgPRuKxOwhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DERB%2520S%2520PALSY%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhbRxEGfhl1MT30DcqV1hgPRuKxOwhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DERB%2520S%2520PALSY%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhbRxEGfhl1MT30DcqV1hgPRuKxOwhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DCLINODACTYLY%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgJbEpSydSkJFy-B60D1YModxmHeQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DCLINODACTYLY%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgJbEpSydSkJFy-B60D1YModxmHeQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DDOWN%27S%2520SYNDROME%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhimpK3LXOnsBuWlGPFaBKeEP_nwCQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DDOWN%27S%2520SYNDROME%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhimpK3LXOnsBuWlGPFaBKeEP_nwCQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DDOWN%27S%2520SYNDROME%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhimpK3LXOnsBuWlGPFaBKeEP_nwCQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DCLINODACTYLY%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhgJbEpSydSkJFy-B60D1YModxmHeQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DERB%2520S%2520PALSY%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhbRxEGfhl1MT30DcqV1hgPRuKxOwhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DERB%2520S%2520PALSY%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhbRxEGfhl1MT30DcqV1hgPRuKxOwhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DERB%2520S%2520PALSY%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhbRxEGfhl1MT30DcqV1hgPRuKxOwhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DERB%2520S%2520PALSY%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhbRxEGfhl1MT30DcqV1hgPRuKxOwhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPERIPHERAL%2520PULSES%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhihtl1MSJqgpmtHXLFpeEpbcqNKghttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPERIPHERAL%2520PULSES%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhihtl1MSJqgpmtHXLFpeEpbcqNKg7/29/2019 Examinareastud Inter
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Pulsul
Verificai pulsul brachial, radial i femoral,amplitudinea, ritm i volumul
Un puls hiperdinamic poate sugera opersisten a
ductului arterial(DAP) Un puls slab poate s apar n o anomalie
congenital cardiac (afecteaz debitul cardiac)
Verificai pentru o posibil ntrziere radio-
femural (poate fi suspectat o coarctaie deaort)
Inima:
http://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPERIPHERAL%2520PULSES%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhihtl1MSJqgpmtHXLFpeEpbcqNKghttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPATENT%2520DUCTUS%2520ARTERIOSUS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhil-Ezb-gMrrQpGtW-UGyqJuSR2JQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPATENT%2520DUCTUS%2520ARTERIOSUS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhil-Ezb-gMrrQpGtW-UGyqJuSR2JQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DAORTIC%2520COARCTATION%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhiz_A7aZdMiyt0dGKh4cXGo7U5XzQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DAORTIC%2520COARCTATION%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhiz_A7aZdMiyt0dGKh4cXGo7U5XzQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DAORTIC%2520COARCTATION%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhiz_A7aZdMiyt0dGKh4cXGo7U5XzQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DAORTIC%2520COARCTATION%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhiz_A7aZdMiyt0dGKh4cXGo7U5XzQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPATENT%2520DUCTUS%2520ARTERIOSUS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhil-Ezb-gMrrQpGtW-UGyqJuSR2JQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPATENT%2520DUCTUS%2520ARTERIOSUS%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhil-Ezb-gMrrQpGtW-UGyqJuSR2JQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DPERIPHERAL%2520PULSES%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhhihtl1MSJqgpmtHXLFpeEpbcqNKg7/29/2019 Examinareastud Inter
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Inima:
Verificai poziia cordului la palpare i orice
depresiune sau proieminen Ascultai zgomotele inimii cu atenie, pentru a
depista orice sunet sau murmur suplimentar
Suspectarea anomalilor necesit o examinare
suplimentar (i, adesea, sunt necesare mai multeopinii i investigaii)
http://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DHEART%2520MURMUR%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhjpYmObum3Krj86U3Aho_nFvkE_oQhttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DHEART%2520MURMUR%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhjpYmObum3Krj86U3Aho_nFvkE_oQ7/29/2019 Examinareastud Inter
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Pulmonii:
Verifica-i respiraia, frecvena, profunzimeapentru cteva secunde
Uita-te pentru orice dovad de recesiune
intercostal Ascult pentru a exclude stridorul
Auscultarea pulmonilor pentru a exclude sunetesuplimentare
Abdomenul:
http://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DINTERCOSTAL%2520RIB%2520RECESSION%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhjr3Ldq4js68q1oo-QrkSDQ0EVJ2ghttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DSTRIDOR%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhiRMNU-p0MwXP2NPk2zQWgOZ-jjfghttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DSTRIDOR%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhiRMNU-p0MwXP2NPk2zQWgOZ-jjfghttp://74.125.79.132/translate_c?hl=ro&sl=en&u=http://www.patient.co.uk/DisplayConcepts.asp%3FWordId%3DINTERCOSTAL%2520RIB%2520RECESSION%26MaxResults%3D50&prev=/search%3Fq%3DExamination%2Bof%2Bthe%2BNeonate%26hl%3Dro%26lr%3D%26sa%3DG&usg=ALkJrhjr3Ldq4js68q1oo-QrkSDQ0EVJ2g7/29/2019 Examinareastud Inter
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Abdomenul:
Msuraicircumferinabdominali forma lui Verificai cu atenie pentru a exclude hernia
umbilical, semne de infecie sau alte formaiuni
Palpaiuor organelle interne, pentru a exclude
formaiuni sau alte hernii, este necesar pentru a ficapabil de a se simi ficat i / sau splina la nou-nscuiisntoi
Verificai cu atenie organele genitale externe (a se
vedea ambiguitatea genital) alpai testicule la biei
Cercetai anusul (a fost evacuat meconiumul?)
Partea dorsal(spatele):
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75/82
Partea dorsal(spatele):
Uita-te cu atenie la tegumentele n regiuneaspatelui i la curbura spatelui / simetrie
Exist vreo dovad de spina bifida occult sau sinuspilonidal ?
Palpeaz coloana vertebral uor
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oldurile:
n mod specific este o manver pentrudepistarea displazia congenital de old,utiliznd combinaia manevrelor Barlow i
Ortolani
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Membrele inferioare:
Verificai i depistai equinovarus talipes Verificai numrul degetelor de la picioare i
verificai forma lor .
SNC:
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SNC:
Observai tonusul, comportamentul, micrile ipostura copilului
Verificai reflexele nou-nscutului
Toate constatrile se vor nregistra n fia deexaminare a nou-nscutului.
Frecvente anomalii depistate la nou-
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Frecvente anomalii depistate la nounscut n timul examenului-screening:
Capilare sau maculare haemangioame: De asemenea, sunt cunoscute i ca pata congenitalse depisteaz n jurul ochilor i a gtului, n
regiunea cefei la 30-50% copii Cele din jurul ochilor dispar n mod normal, n primul an de via, de obicei, dac persist pe ceaf i
gt .
Zona pigmentar blue-negru: De asemenea, sunt cunoscute ca pete mongoloide albastre; vzute n regiunea lombar i pe fese.
Acestea sunt comune la copiii din prini de ras neagr, dar poate s apar i la sugarii de originecaucazian.
n mod normal, ele dispar dup primul an de via
Nevus congenital
pate mongoloide albastre
hi i b l
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Chist n cavitatea bucal:
Acestea sunt gsite n apropiereapalatului i pe gingii (cunoscut isub numele de perle Epstein)
Ele pot fi mai mari i pe planeulbucal
De obicei, ele se rezolv spontan
Dinii pot fi prezeni la natere(nu este necesar nici o aciune,doar cu excepia cazului n care
acestea sunt n anormali, caz ncare acestea ar putea s fiextrai).
Anomaliile care pot indica o cauza a
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Anomaliile care pot indica o cauza aunei alte maladii:
Orice fontanel cu dimesiuni largi, cu prezena unor insuledin os (oase Wormian) pot indica anomalii craniene fiindcauzate de o serie de sindroame congenitale.
O a treiafontanel,ntre anterioarnormali ceaposterioar poate indica sindromul Down.
Forma urechilor anormal sau plasate anormal ne pot indicaSindromul alcoolic fetal, anomalii craniofaciale sau altestri, cum ar fi sindromul Edward's (trisomia 18) sauanomalii congenitale renale.
Pliu palmar unic pot indica sindromul Down, dar poate figsit la copii care nu sufer de aceastafeciune.
Anomalii ale feei, maxilarului i urechilor sunt adeseaasociate cu disfuncii de auz; deaceea sunt indicate examenulspecialistului ORL i testele auditive.
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