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CNS Examination in Newborn | Newborn Examination (Part-8) | Pediatrics — Transcript

by Learning Pediatrics · 2,460 words · 387 segments · language en · Watch on YouTube

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0:00hello
0:02everyone today in this video I'm going
0:05to tell you the details of CNS
0:08examination in the newborn baby and
0:10neetal reflexes it is a part of CNS
0:15examination so in the CNS examination in
0:18the new born first we have to assess the
0:21higher mental function then cranial L
0:23examination then motor system sensory
0:25system and Neal reflexes then in last
0:30skull and his spine should be
0:34examined so in higher mental function in
0:37newborn baby first we should assess the
0:40state of the baby the level of
0:42Consciousness then facial expressions
0:45then orientation and behavior then
0:47nature of cry then breathing and feeding
0:49pattern and
0:52habituation so in the state of baby here
0:55in this video you can see baby is fully
0:57active and crying and eyes are closed
1:02and respiration is regular so this is
1:05the state five so from State 1 to State
1:095 when baby is in quite deep
1:14sleep label as a state one then baby go
1:18into the RM sleep it is a state two then
1:22quite wakefulness is there state three
1:25then active wakefulness State four then
1:29baby becomes fully active and crying in
1:32state
1:33five so in the state one eyes are closed
1:39regular respiration no moments in RM s
1:42state to eyes closed but respiration is
1:46irregular no gross movements are there
1:49quiet wakefulness is state three when
1:52eyes open and regular respiration but no
1:55growth movement active wakefulness State
1:58four similar to the state three eyes
2:01open and regular respiration but there
2:05are gross M of the limbs present but no
2:09crying is there in fully active and
2:12crying estate five with this baby is
2:16crying
2:19also so here in this video baby is in
2:22the state
2:24five then assess the level of
2:26Consciousness baby is alert active as in
2:29this video or having a irritability
2:31lethargy or baby's drowsy or stuper or
2:36comos we label the normal Consciousness
2:40or normal alertness when the baby
2:42respond normally to the aerosal and
2:46having the normal movements of the limbs
2:49and face we label the irritability when
2:53uh neonate cannot be Soo or cannot be
2:57consolable and having the irrit able
3:00behavior and
3:02agitated cries with the minimal
3:04stimulation that means baby is
3:07irritable we label the lethargic neonate
3:11whenever neonate is unable to maintain
3:13the Alert state and but it is Eros but
3:18not having the
3:20alertness then we label the
3:22lethargy drowsiness and light coma when
3:26the baby is only Eros by sound verbal
3:29stimuli otherwise baby is Sleepy is
3:32stuper or moderate coma when baby is
3:35having the absent osal and motor
3:39response by the verbal stimuli or sound
3:41only Eros by the painful stimuli D
3:45stuper or coma or
3:49unconsciousness when baby cannot be
3:51arosed by the painful stimuli motor
3:55response are
3:56absent so these are the level of cons
3:59ious
4:02nness then observe the facial expression
4:05of the newborn baby either Bland or
4:07alert or fussing or crying or froing can
4:10be
4:11there then we have to assess the
4:14behavior of the newborn baby we can
4:17assess by the brazilan neetal behavior
4:20assessment scale in this we are
4:23assessing both cortical and subcortical
4:26function there are total 47 items we
4:29have to
4:3027 behavioral and 20 we have to elicit
4:34the response so in the behavioral
4:37various uh we have to see this response
4:40to the various
4:41stimuli uh example to the motor activity
4:44change in the skin color and we have to
4:47elicit the various response example
4:51grasp reflex rooting sucking Moro reflex
4:56and glab tape and we have to also see
4:59the uh patient orientation to the visual
5:04auditory so all are included in the
5:07Brazelton neetal Behavior assessment
5:09scale and for the behavioral item we
5:13have to uh give the score on the 9po
5:17scale and in the elicited response we
5:21have to give the score on the threo
5:25scale then we should do the assessment
5:28of the neetal cry quality
5:30type duration and intensity of the
5:33cry so the loud and Lusty cry is the
5:37normal cry for the full-term neonate
5:40whenever baby is depressed and having
5:43any illness then cry will be weak high
5:46pitch cry especially seen in the neetal
5:49condition example in
5:51menitis whenever there is a prolonged or
5:54excessive cry means baby is crying for
5:56more than 3 hours not consolable with
5:59the any measures and you had tried for
6:02the feeding and you have changed the
6:04diaper is still the baby is not
6:06consolable it suggest that baby is
6:08having the irritability and there are
6:10various causes of irritability in the
6:12newborn
6:14baby then we have to assess the
6:16breathing and the feeding pattern of the
6:18baby in breathing we have to check the
6:21rate Rhythm depth and any sign of
6:24respirative distress all will be
6:27included in the breathing pattern of the
6:29unit and in feeding pattern any abnormal
6:33feeding pattern is there example poor
6:35sucking refusal to feed should be
6:37mentioned
6:39here then we have to test the
6:41habituation normally newborn is having
6:44the capacity to habituate whenever we
6:46are giving the repeated stimuli example
6:49visual auditory or any painful
6:52stimuli uh then baby can adapt
6:55adequately to the stimulus and to test
6:58and to perform the test for the
7:01habituation we can perform the moro
7:04reflex or we can perform the gabula tap
7:07so here in this video you can see I'm
7:09performing repeatedly Moro
7:11reflex and shutdown of the body movement
7:14or we can say uh decrease response seen
7:19after 3 to four stimuli so if you are
7:22performing the gular tape then
7:24diamination in the blink response occur
7:27after 3 to four stimuli in the normal
7:30healthy fulltime baby if it is
7:32persisting that means baby is having the
7:35abnormal neurological
7:38function then we should assess the
7:40cranial nerve
7:42examination so first all Factory nerve
7:45for the smell it is rarely tested in the
7:47newborn baby and we can test this n by
7:52the CL or Min normal response in the
7:55newborn baby will be the change in the
7:57behavior example GRE missing strle resp
7:59response can be there in more than 32
8:01weeks of gestation age baby in less than
8:0532 weeks of gestation age no response
8:07will be
8:10present now second optic now for the
8:13vision it can be tested by shining the
8:17torch light in the peripheral visual
8:19field in more than 28 weeks of gestation
8:23age baby baby will blink in response to
8:26the light while in the more than 32
8:28weeks baby will turn the head toward the
8:31diffus
8:33light we have to move the bright object
8:37side by side we we can choose a red
8:40color ball or any other red color object
8:44and distance between the eyes of the
8:46newborn and the object at least 1 ft far
8:50from the new ey because visual equity in
8:53the term newborn is 6X 45 so we have to
8:56keep this distance the normal respon
8:59resps in more than 34 weeks of gastation
9:02age baby baby will follow the moving
9:05object red ball and able to
9:08fix here you can see this is the red
9:11object 1 ft far from the newborn's eye
9:15and we have to see newborn is moving the
9:18head toward the object or not to assist
9:21for the
9:24reason then we have to check the
9:27pupilary light reflects
9:29for this we have to shine the torch
9:32light and from the peripheral visual
9:35field and we have to see
9:37the uh pupilary Construction in response
9:41to the light in both the eyes so
9:43pupilary light reflects absent in less
9:46than 30 weeks of Gest age baby and
9:48completely develop in more than 35
9:52weeks we consider the direct pupilary
9:55light reflex when pupil constrict in
9:58response to the light in same eye and uh
10:02pupil constrict in the opposite eye is
10:06uh label as a indirect pupilary light
10:09reflex here in this video you can see
10:12how to perform the pupilary light reflex
10:14and also check the response to the light
10:16baby is blinking in response to the
10:19light and also turning the head toward
10:21the diffused
10:23light and for the pupilary light reflexs
10:26for the direct and indirect both we have
10:28to shine the torch light from the
10:32lateral position towards the pupil and
10:35we have to see the constriction of the
10:37pupil on the same side of eye mentioned
10:40as a direct pupilary light reflex and in
10:42the opposite eye indirect pupilary light
10:48reflex so abnormal response to the
10:52pupilary light reflex can be seen
10:54Whenever there is a leion in either in
10:57the Fint or E pathway way so F of
11:01pupilary Li reflex is second cranial now
11:04and E is third cranial now so an
11:08unresponsive direct and
11:10indirect both pupilary light reflex from
11:14light shined in the eye on the side of
11:18second Crane and down region example if
11:21the baby is having the Left sided optic
11:24nerve lesion then when you will shine
11:26the light in the left eye there will be
11:29no pupilary constriction occur in both
11:33the
11:34eyes and when you will shine the light
11:36in unaffected eye example when the left
11:39optic nve is damaged you are shining the
11:41light in the right eye then both the
11:44pupil will constrict both direct and
11:46indirect will be present when Eep
11:49pupilary defect is there when the leion
11:52in the third cranial n then unresponsive
11:55ipsilateral pupilary constriction on the
11:58affected side when the light is shined
12:01in either eye so if third left third is
12:05affected
12:09then left sided third cranial L if
12:12damage then in Left Eye there will be no
12:17direct no indirect pupilary response
12:20occur so absent pupilary light reflex in
12:25on the affected side will be present in
12:27third greenal l
12:32if pil is dileted and
12:35fixed when you are shining the light
12:38that means baby is having either optic
12:40atrophy or retinal
12:43detachment then we have to perform the
12:45fundal examination in fundal examination
12:48normal finding will be optic disc is
12:51pale whitish green
12:54color red reflects by+ 10 diopter L of
12:59the opthalmoscope at 10 in distance
13:02present of red reflex is normal whenever
13:05absent or abnormal red reflex we can see
13:10example in congenital CCT retinal
13:13abnormity retinoblastoma sismas or
13:16refractory error is
13:19there then we have to test the ocul
13:22motor nerve we can again check the
13:25pupilary light response for the third
13:27nerve because third is the e different
13:29for the pupilary light response and
13:31details I have already explained in the
13:33previous slides and also we have to
13:36check the spontaneous and symmetrical
13:38eye Ms of the both
13:42eyes for the fourth cranial n trar n
13:46again we have to observe the ey moment
13:48symmetrical eye
13:49moment as we know s so4 Superior obli is
13:54supplied by the fourth cranial nerve
13:57trar nerve
14:01for the sixth crer now abducens
14:04now we have to see the spontaneous eye
14:07moment because abducent n Supply the
14:10lateral rectus
14:12lr6 and we have to perform the
14:15vestibular ocular reflex Do's eye
14:18maneuver in this we have to gently
14:20rotate the head to the side and we have
14:22to assess the direction of I deviation
14:26normal response in the newborn baby I
14:29deviate away from the direction of
14:31rotation if you are turning the head
14:32toward the right I will be deviated
14:35toward the
14:37left dolai maneuver valid in more than
14:4025 weeks of gastation age always present
14:43in first 10 days of life and disappear
14:46when
14:46fixation
14:49develops here in this video you can
14:52see head is turned toward the left side
14:56and eyes are deviated toward the right
14:58side this is the Dual side
15:03Manu for the trial now we can perform
15:06the Gaba tape in the newborn baby we
15:09have to
15:10repeatedly tape the newborn's head
15:13between the eyebrows and
15:15naion here and we should perform from
15:20the above and behind the patient to
15:22remove the visual stimuli we have to
15:24remember that whenever we are performing
15:26the gular tape we should extend
15:29uh on the head
15:31side prompt closure of the both eyes in
15:35response to the tape
15:37Ur in normal newborn baby blinking
15:41response disappear after 3 to four TS as
15:44I have explained in the habituation
15:47also then we have to perform the coral
15:50blink reflex we have to touch the
15:52corneal lightly with the piece of coton
15:54wool normal response in healthy baby it
15:57will stimulate and eyes will be closed
16:01and F for the coral blink response trial
16:05sensory now and E is facial motor nerve
16:09which innervate the orbicularis oculi
16:13muscle see in this video how to perform
16:16the coral blink
16:19reflex for the tramol we have to check
16:22the facial sensation also we can uh
16:25lightly touch the face for all three
16:29subdivision of the trial n and rooting
16:33reflex we have to elicit here in this
16:35image you can see and sucking reflex
16:38also we have to
16:41check for facial now we have to observe
16:44the facial symmetry when the baby is at
16:47rest and when baby is crying so baby is
16:50closing both the eyes normally forehead
16:52Ringling is there nasolabial folds are
16:54bilaterally symmetrical that means
16:57seventh cranial now is
17:00normal and also gular tape and rooting
17:03reflex as the facial nerve is e for the
17:08glab
17:09tap see in this video how to perform the
17:13glab
17:17tap then for the vestibular CA now we
17:20have to assess the hearing and for the
17:23assessment of hearing we have to uh
17:26stand behind the baby and we have to
17:29clap this will uh create the 60
17:34DB
17:38sound more than 28 weeks of gestation
17:41age baby will show the response by
17:44blinking the eyes or a startle response
17:47or Sudden Change in the activity or some
17:50body movements can be there in response
17:53to the
17:55sound we can check the Fingal gig reflex
17:58whenever we are performing the suction
18:01and we have to observe the when baby is
18:04taking the
18:05breastfeeding so we can check the
18:08sucking swallowing and breathing
18:10coordination in more than 34 weeks of
18:12gestation age Baby by observing the B
18:15baby is taking the
18:18feed then for the spinal love 11th kenal
18:22love stoco asid and trapes muscle we
18:26have to turn the gently heads side to
18:29side and we have to also compare the
18:31shoulder height of the normal newborn
18:35baby for the hypoglossal now tongue
18:39function tongue symmetry when the baby
18:41is taking the feed we can observe the
18:43tongue movements and tongue Symmetry and
18:45tongue
18:48fasiculations today in this video I have
18:51covered the higher mental function and
18:53the cranial nve examination in the
18:55newborn baby the rest of the part I will
18:57cover in next week video thank you so
19:00much

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