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
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