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CNS Examination in Newborn | Newborn Examination (Part-10) | Pediatrics — Transcript

by Learning Pediatrics · 3,258 words · 481 segments · language en · Watch on YouTube

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0:00hello
0:02everyone after higher mental function
0:04and the cranial no examination and motor
0:07system today I'm going to tell you the
0:08details of sensory system neetal
0:11reflexes and escal
0:16spine in sensory system examination
0:19basically its role in the newborn baby
0:20is very
0:22limited but we can perform sensory
0:25system examination by observing the
0:28response to the touch and if it is
0:30required then only to the
0:32Pain by both we can assess the brain and
0:36peripheral sensory system function and
0:39in response to the touch we have to just
0:41touch the face Limb and trunk either
0:44with the uh finger or with the coton tip
0:47and we have to observe the facial
0:49expression and the change in the
0:51behavior if required then only we will
0:54uh see the response to the pain if baby
0:58is comos and we we are willing to assess
1:01the conscious level then only we will
1:04perform this test and this baby will
1:07either cry or extremity withdrawal
1:11response will occur whenever we will
1:13give the painful stimulus to the
1:17baby after sensory system examination we
1:20have to perform the neetal reflexes also
1:24known as primitive reflexes or release
1:27reflexes these are the brain State Med
1:30automatic movement in the newborn baby
1:33it's begin During the antinal period
1:36around the 25 to 26 weeks of gestation
1:40age and fully present in the fullterm
1:43baby at the time of birth and it
1:46disappear when the brain is mature and
1:49voluntary motor activity Ms replace the
1:52Primitive reflex so we have to perform
1:56Moro reflex Palmer grasp reflex planter
2:00is stepping
2:02walking sucking rooting tonic neck
2:05reflex Gant reflex Gula tip all are
2:08considered as a neetal reflexes there is
2:11a long list of neetal reflexes today I'm
2:14going to tell you the details of these
2:16common reflexes which we routinely
2:19perform in the newborn
2:23baby so in Moro reflex we have to
2:26elevate the head of the baby up to the
2:2845° angle from the head and then
2:31suddenly we have to drop but we have to
2:33remember we have to quickly support the
2:36head of the baby over our hand also and
2:39we have to see all three components of
2:41the moro reflex so here in this video
2:44you can see first component which appear
2:48around the 28 weeks of gastation age is
2:51opening of hand it is the first
2:53component baby is opening the hand
2:56Finning of finger occur and second
2:58component is abduction and extension of
3:02upper limak which is appearing at around
3:0532 weeks of gestation age and third
3:08component is adduction and flexion of
3:12upper limbs which is appear around 36 to
3:1637 weeks of age so whenever baby is
3:19pre-term then all three components will
3:22not be there depends on the maturity of
3:24the baby if baby is less than 28 weeks
3:27of gestation age no Mor reflex will be
3:31there if baby is more than 28 but less
3:34than 32 means between 28 to 32 then only
3:39opening of hand first component will be
3:41there if baby
3:44is more than 32 weeks of gestation age
3:47but less than 36 weeks of gestation age
3:51then two components will be there first
3:53opening of hands and second abduction
3:55and extension of upper Li when the baby
3:58is fullterm fully mature then only third
4:02component adduction and flexion ofer
4:05limbs will be there and after all three
4:09component baby cry and this uh Moro
4:13reflex persist up to 4 to 6 month of the
4:17age and after that if it is perses then
4:20it is abnormal and we have to find out
4:22the what neurological problem baby is
4:25having so we label the incomplete Muro
4:29reflex when whenever baby is pre-term
4:31and having the uh less than three
4:34components not all the components are
4:39there there are various uh iology which
4:42lead to the abnormal Moro reflex example
4:46absent and depressed Moro reflex can be
4:49there in a full-time baby if having the
4:52cerebral depression example in birth
4:55asfixia because of hypoxemic anop thaty
4:59baby is having the cerebral depression
5:02and absent moror reflex can be there
5:06exagerated moror reflex is also present
5:09which suggest that baby is having the
5:12cerebral irritability it is present in
5:15hypoxic ischemic anop thaty grade
5:18one we label the incomplete moral reflex
5:22whenever the maturity of the baby is
5:25less than 36 week because all three
5:27components will not be there in the
5:29preum baby an asymmetrical Moro reflex
5:33Whenever there is we are eliciting the
5:35moro reflex only present on the one side
5:38of the limb not in the other limb so it
5:42can be due to the local pathology
5:44example breel paly fracture of the
5:47clavical humorus will lead to the
5:49asymmetrical Moro reflex so in fullterm
5:54healthy normal baby always Moro reflex
5:58will be there which sest just baby is
6:00having the normal brain function and
6:02this will persist up to 4 to 6 month of
6:06the age Beyond this it should not be
6:08persist otherwise it is
6:13abnormal to we see the Palmer grasp
6:16reflex here in this video you can see we
6:19have to insert our index finger into the
6:21palm of the newborn baby and we have to
6:23give the gentle pressure to the Palm
6:25also in response to this flexion of the
6:27newborn's finger occur this reflects
6:31fully mature and appear around the 25
6:34weeks of gastation age and disappear
6:37around 3 to 4 months of age and when it
6:40disappear baby develop the hand regards
6:42at 4 months then B extros grasp at 5
6:45months then unit extros at 6
6:49month if this clex is present between 26
6:52weeks of gestational age till the 3 to 4
6:56months it considered as a normal if it
6:58is symmetric Ally absent during this
7:00duration that means baby is having the
7:03any brain leion example maybe because of
7:06severe birth aixia any brain injury at
7:09the time of birth or intracanal
7:11Hemorrhage if it is asymmetrically
7:14absent one side it is present and one
7:17side it is absent then we have to think
7:19about any local pathology any peripheral
7:22nerve roote or plexus injury or maybe
7:25because of a spinal cord
7:27involvement in more than 6 months of age
7:30baby if it is symmetrically present that
7:33means baby is having
7:35the [ __ ] cerebral paly and mostly in
7:40the quarri plgic CP child this reflex
7:44persist even after the 6 months of age
7:47if it is asymmetrically present after
7:49the 6 month of age that means baby is
7:52having the hemic [ __ ] CP so
7:56Persistence of Palmer grass reflex
7:59Beyond 6 month of age we should suspect
8:03about the cerebral
8:08paly here you can see how to perform the
8:11planter grasp reflex we have to praise
8:13our finger or thumb against the so just
8:17behind the toes of the newborn baby in
8:20response to this there is a flexion and
8:22adduction of newbor tools occur around
8:26our finger and this reflect appear at 25
8:30weeks of gestational age and disappear
8:32by the 6 to 9 months of
8:34age if this reflex is present between 26
8:38weeks till 6 month that means it is
8:40normal if it is absent during this
8:44period Then possibility of ESP [ __ ]
8:47cerebral paly can be there if it persist
8:50Beyond 1 year of age then chances of
8:54that baby may be having the aeto CP or
8:58mental [ __ ]
9:01a for strapping reflex here in this uh
9:04image you can see we have to H the baby
9:06in upright position which SES should
9:09touch the surface and in response to
9:12this baby will move the lower limb as
9:16walking or dancing so Ms of the low Lim
9:20up and down occur when the soul is
9:22touching the surface this reflex also
9:24known as walking or dancing reflex this
9:27reflex appear between 20 to 30 weeks of
9:30gestational age and disappear by 3
9:33months of age and normally this reflex
9:36again reappear between 10 to 12 months
9:39of age if this reflex is absent during
9:4330 weeks to 3 months of
9:46age if asymmetrically absent then we
9:49have to suspect any peripheral nerve
9:51root plexus injury or spinal cord injury
9:54if symmetrically this reflex is absent
9:57during 30 weeks of gational age to 3
9:59months of age that means baby is having
10:03any CNS depression example in seever
10:05birth asfixia or any drug intake During
10:08the antinal period by the mothers
10:10example opiates so we should suspect all
10:13these causes whenever it is
10:17absent for sucking reflex here in this
10:20image and in this video you can see
10:23either examiner just keep the finger in
10:26the mouth and finger is touching the
10:29pallate of the baby's mouth or when baby
10:31is taking the breastfeeding then breast
10:34nipple is touching the pallate of the
10:36baby's mouth it stimulate the sucking
10:38reflex and baby is having the strong
10:41rapid sucking movement of the mouth this
10:44reflex appear
10:45between 32 to 34 weeks of gastal age and
10:49fully mature by 34 to 36 week and
10:53disappear by 3 months of age really
10:56persist Beyond 1 year after 3 months of
10:59age the sucking of the baby is result of
11:03the conscious effort no longer it is a
11:05reflex and before 3 months it is the
11:09sucking reflex just touching the pallet
11:12baby will start the sucking Ms while
11:15after 3 months baby is doing the sucking
11:19by the conscious efforts as the brain is
11:22mature this reflex is disappearing and
11:27before 34 weeks of gestation age in
11:30preum baby this reflex is not very
11:33coordinated with the uh swallowing and
11:38it is not easy to give the breastfeeding
11:40in less than 34 weeks of gestational age
11:43so coordinated sucking
11:45swellow reflexs appear between 34 to 36
11:49week and by that time we can give the
11:51breastfeeding very easily this is also
11:54known as sucking swallowing and
11:56breathing sequence which is mature
11:59by the 34 weeks of gestational
12:04age in roting reflex we have to keep our
12:07finger over the cheek near the mouth and
12:11in response to this baby will turn the
12:14face toward the finger and open the
12:17mouth
12:18also this reflex is also known as search
12:22reflex this reflex helps in the baby to
12:25get the breastfeeding to localize the
12:28nipple and this reflect appear between
12:3028 to 30 weeks of gastal age and
12:33disappear by the 4 months of age rarely
12:36it persist Beyond 12
12:38months this reflects normally present
12:41between 28 weeks to till 4 months of age
12:45if it is not present that means baby is
12:48having the CNS depression any
12:49neurological disorder if this reflex
12:52persist after 12 months that means baby
12:56is having the hyper sensitivity around
12:58the lips and mouth or baby may be
13:01developing the any social speech or
13:04learning problems and difficulty with
13:06the solid foods and baby can become the
13:10mcy eater or dribbling these kind of
13:13problems can be there whenever this
13:15reflex persist Beyond 12
13:19months then asymmetrical tonic neck
13:22reflex also known as fencing reflex we
13:24have to rotate the neonate's head toward
13:27the one side in response resp ons to
13:29this extension of the extremities toward
13:33which we have turned the face will occur
13:36and the opposite side of extremities
13:39will show the flexion both upper and
13:42lower limb this reflects appear around
13:4518 weeks of gastal age and disappear by
13:49the 4 to 6 month of age and it is fully
13:51mature and prominently present between 1
13:54to 3 months of age
13:59if this reflex is absent between birth
14:01to 6 month that means baby is having any
14:04neurological disorder and baby will also
14:07have the delete grow and fine motor
14:10development if it is present Beyond 6
14:13month of age that means baby will
14:16develop the either difficulty in
14:18learning to read and difficulty in
14:23visual coordination and baby can also
14:27develop the scoliosis or dislocation of
14:30femoral head all these complication can
14:32also occur if this reflex persist Beyond
14:366 month of
14:38age in a spinal Gallant reflex also
14:41known as trunk incurvation reflex we
14:44have to hold the new born in vental
14:46suspension and we have to strike along
14:49the one side of lower spine from pelvis
14:53toward the neck and in response to this
14:56newon will laterally Flex the spine and
15:00also raise the hip toward the stimulated
15:04side again see in this
15:08video baby is turning the
15:12spine toward the stimulated side and
15:15also raising the hip this reflex appear
15:19around 20 weeks of gestational age and
15:21disappear by the 6 month of age maximum
15:24it can persist up to 12
15:27months if it is absent between 20 weeks
15:30of gestational age till 6 month that
15:32means baby is having any neurological
15:34problems example in SE birth is VX
15:37intracanal Hemorrhage if it is
15:40symmetrically present or persist after
15:4312 months then baby will have the
15:45various problems example gate and postal
15:48abnormity ADHD bed waiting if
15:52asymmetrically present Beyond 12 months
15:55then gate problems can be there
16:00then in last es skull and spine should
16:02be examined in the CNS examination so we
16:06should do the inspection and palpation
16:08of the skull spine then we have to
16:10measure the head circumference Fontanel
16:13should be palpitated then suture line
16:16should be pulped here in this image also
16:19you can see this is anti Fontanel this
16:22is posterior and this is the metopic
16:26suture this is coronal suture this is
16:29sagital suture and we should palpate all
16:32the suture line and Fontanel and in last
16:35osculation of a skull should be
16:39done so in the skull inspection and
16:42palpation we should palpate the skull
16:45for any swelling which is present at the
16:47time of birth maybe because of the birth
16:50trauma example Caper suum Cil hematoma
16:53sub galal Hemorrhage and then we have to
16:56palpate the fontel and the suture lines
17:01by this image you can understand the
17:03scalp swelling these are the layer of
17:05scalp first is the skin layer below the
17:10skin this is the subcutaneous space
17:12below this it is epicranial epon
17:14neurosis and this is periostium doed
17:17Line This is the skull bone and this is
17:21a periostium and this is dura and this
17:24is the brain tissue whenever at the time
17:27of birth because of
17:29the pressure on the fetal head during
17:32the delivery
17:34process serosanguinous flu is collected
17:37in the subcutaneous space it will lead
17:39to the swelling and it is known as capet
17:44suum it is crossing the midline present
17:47at the time of bir generally resolved by
17:4972 hours of
17:52life no complication occur because of
17:55Caper sued
17:56Dina now because of the does trauma at
18:00the time of
18:02delivery bleeding can occur in the sub
18:05perior space between the skull bone and
18:08periosteum and this swelling resolve by
18:12few weeks to few months after birth It
18:15generally take the 1 to 2 months and
18:18this swelling is not crossing the
18:21midline and we have to counsel the
18:24parents also because this swelling takes
18:26the few weeks to few months after birth
18:29to be resolved and this can lead to the
18:33exagerated zic and also sometime anemia
18:37can occur because of cphil
18:40hematoma sometime because of the trauma
18:43at the time of birth Emissary veins are
18:46ruptured in the subal space it lead to
18:49the subal hemorrage this swelling
18:52present between igraal epon neurosis and
18:56periost this is huge swelling compar to
18:59the capot and cphil hematoma and this
19:02swelling can lead to the lifethreatening
19:04complications also example patient can
19:07develop the hypo volumic shock or
19:10sometimes severe anemia so close
19:12monitoring is
19:14required this is a suggesting epidural
19:17hematoma it is a rare in neonate except
19:20Whenever there is a neetal head injury
19:23occur which is very rare and this is
19:27between the outer layer of dura and
19:32skullbone so you have to remember all
19:35the scalp swelling and you have to
19:37examine the new bone to see any scalp
19:40swelling is present or
19:43not here in this image you can see this
19:46is the bogy swelling crossing the
19:49midline present at the time of birth it
19:52is kepet suum this swelling is also
19:56similar Caper suum here in this image
19:59you can see the swelling which is not
20:03crossing the midline form it is cphil
20:09Homa now here you can see other than
20:14this swelling we have to see any other
20:16swelling is present over the scal so
20:19this swelling is
20:22anoil present over the occipital bone
20:25and this baby is having an En FY so we
20:30have to mention whenever we are uh doing
20:33the head to2 examination if any abnormal
20:36finding is there then a spine should be
20:39examined here in this video you can see
20:41for any abnormal finding if it is
20:43visible then we have to
20:46mention so these two are the images of
20:49spinal bid aperta here you can see this
20:51is meningo milil neural tissue is
20:55also visible this is meninges and this
21:00is neural tissue so this is
21:03menalo these two are the Espin bifida
21:06Ulta here the skin covering the swelling
21:11and this is the closed vertial defect
21:14this hair TFT also suggest patient may
21:16be having the espineda
21:21Ulta after escalus spine inspection we
21:23should measure the head circumference to
21:26see the head size is normal or not
21:29always we should measure the head
21:30circumference after 24 hours of birth
21:33because molding occur and we have to
21:36keep the non stretchable measuring tape
21:39in front above the eyebrows at the Supra
21:43orbital R and here also above the ear
21:47and posteriorly over the occipital
21:52protren if it is between 33 to 37 cm in
21:57Normal fullterm baby that means head
22:01size is normal between 10 to 90th
22:04percentile if head circumference is less
22:07than minus 3 SD that means baby is
22:10having
22:11micro if more than two standard
22:14deviation that means
22:18mcrell then we should palpate the
22:20Fontanel details of the fontal palpation
22:23I have already covered in the head Toto
22:26examination of the newborn baby
22:29then we should palpate the sutures here
22:31in this video you can see we have to
22:34palpate and we should see that the gap
22:37between the both the sutal line it is
22:40approximately less than 1 cm in the
22:42newborn baby at the time of birth head
22:45molding occur and it can cause the
22:47overriding overlap of the suture line
22:50which normalize in the first one week of
22:53the life so whenever there is a
22:56overlapping it is a normal finding
22:59but in cranos osis where the premature
23:02closure of the sutal line occur there is
23:05a feeling of Rage occur and baby is also
23:08having the
23:10micrell small head size and whenever
23:13these suture line are separated more
23:16than 1 cm then we should suspect the
23:19raise intracanal pressure and this is
23:22very common in the hydris so the gape
23:26between the suture line more than one C
23:29widely split and open suture line with
23:32the uh full Fontanel always we should
23:35suspect the raised intracranial pressure
23:38due to various causes example in the
23:40hydras or if the patient is having any
23:43CNS
23:45infection then in last we have to
23:47perform the osculation of a skull and
23:49transillumination test if any abnormal
23:51finding is there which is commonly
23:54present with the various congenital
23:56malformation then we have to mention
24:00thank you so much this is all about the
24:03CNS examination in the newborn baby
24:06today I have covered the sensory system
24:08neetal reflexes and iscal spine

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