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The 6 week check Hannah Shore Consultant Neonatologist Leeds

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Plan Point of the newborn check Eyes Heart Hips Testis Cleft palates

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Why do it?

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Identify a range of conditions so that further assessment can be made and specialist care initiated ASAP Not fool proof ? Tie up results / safety net for hospital follow up

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What info do you need?

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Badger letter from hospital What do you want on this? Initial check results On Badger Child health record FH / Pregnancy details / antenatal screening General health / development of baby weight etc Parental concerns Consent ??NIPE

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What is NIPE? Currently hospital IT for newborn check Screening parameters set locally Output around 4 key KPIs Input follow up screening data Accessible from community in due course

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8 newbornphysical.screening.nhs.uk/

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Screening Summary: 9 newbornphysical.screening.nhs.uk/

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10 newbornphysical.screening.nhs.uk/

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Head What should you look for?

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Head Circumference Following centiles? Several measurements If concerned can do USS Fontanelles Too wide skeletal dysplasia Too small craniosynostosis Posterior is small Anterior up to 4cm is ok Think sutures

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Eyes What are you assessing?

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Eyes Structural issues Red reflex 30 cm away, large light Fix and follow Conjugate movements

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Risk factors

Risk factors Breech >36 weeks 23% of all DDH Family history of DDH needing treatment Multiple with 1 twin being breech Large girl hormones! Oligohydramnios Associated talipes / positional problems Majority have NO risk factors

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USS when? USS gold standard test for hip dysplasia Normal clinical exam within 6 weeks Expert opinion - within 8 weeks Abnormal clinical exam within 2 weeks Expert opinion - within 3 weeks

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USS them all?? Some centres do Cost 43 High False positive rate Low late presentations Additional cases treated many would resolve Cochrane review no change in treatment / late diagnosis

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Alpha angle Ileum Acetabular roof

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Dysplastic

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Dislocated

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Types of problems Dysplastic Low dislocation High dislocation

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Examination Full range of hip movement? Symmetrical knees when flexed Leg creases OrtoLani disLocated Try and relocate Barlow dislocataBle Try and dislocate

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Discussion with parents Any difference in skin creases in thighs Limited movement Leg length discrepancy Click Walk with limp or waddle

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If test abnormal Refer directly for urgent expert opinion USS to be done To be seen by 10 weeks of age

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Treatment Pavlik harness Rash, femoral nerve palsy, pressure sores Surgical reduction of the femoral head Needs long term follow up regarding actual outcomes

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Practical bit.

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Testis Cryptorchidism affects 2-6% boys at birth Risk factors Pre term / low birth weight First degree relative Complications Increased risk of malignancy Reduced fertility

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Examination Scrotum -size /symmetry Penis position of urethral opening Location of testis may be in inguinal canal

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What to do? Bilateral absence URGENT referral needs endocrine investigation Unilateral absence Review at 6 months Refer if still absent Surgery by 13 months If girl and inguinal hernia -always think is this an ovary or ??testicle?

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Cleft palate Can be hard to diagnose

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Neurology / development Fix and follow Head held in line in ventral suspension Symmetrical moro Smiles

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Summary Review of 6 week check Key areas Eyes Heart Hips Testis Cleft palate Introduced concept of NIPE http://newbornphysical.screening.nhs.uk