Newborn examination and screening — branching viva

Stem

You are examining a well term newborn before discharge. The examiner asks you to defend the four universal newborn screens and your response to abnormal findings. [1] [19]

Examiner: Name the four universal newborn screens and the silent condition each is designed to detect. [1]

Strong answer: Pulse oximetry detects critical duct-dependent congenital heart disease; the red reflex detects cataract and retinoblastoma; the hearing screen detects congenital hearing loss; and the hip examination (Barlow and Ortolani) detects developmental dysplasia of the hip. Each finds a condition that is silent in a well-looking newborn. [1] [11]

Examiner: Your pulse-oximetry reading is 96% in the right hand and 88% in a foot. Interpret it. [1]

Strong answer: The screen is positive — a foot reading under 90 per cent is positive on its own. Repeat it; if still abnormal, examine clinically and arrange echocardiography, and if duct-dependent disease is suspected, start a prostaglandin infusion and prepare for possible breathing support. [1] [2]

Examiner: Why can a normal clinical examination not exclude duct-dependent disease? [2]

Strong answer: These lesions are survivable while the ductus arteriosus stays open. The baby looks well until the duct closes over the first days, then decompensates. The clinical exam alone misses the silent window, which is why pulse oximetry was added. [1] [2]

Examiner: You find a white pupil. What do you do, and why? [11]

Strong answer: Same-day ophthalmology referral. A white pupil (leucocoria) is retinoblastoma until proven otherwise; congenital cataract must also be excluded because delayed surgery causes irreversible amblyopia. Never watch and wait. [11] [12]

Examiner: You feel a clunk on Barlow. Distinguish it from a click. [5]

Strong answer: A clunk is the femoral head dislocating out of the acetabulum on posterior pressure — the positive sign of DDH. A click is a benign ligamentous snap. The clunk drives a hip ultrasound and orthopaedic referral; breech and family history trigger imaging even with a normal exam. [5] [6]

Examiner: There is a dimple within the gluteal cleft. Investigate? [15]

Strong answer: No, if it is simple — within or below the cleft, under 5 mm deep, no other stigmata. Imaging is reserved for high-risk markers: a dimple above the cleft, a hair tuft, lipoma, or a deviated gluteal fold, which suggest occult spinal dysraphism. [15] [16]

Examiner: One action you will never skip on a normal baby? [19]

Strong answer: Complete every screen, every time. A normal examination does not replace the targeted screens, and a passed screen does not replace the head-to-toe sweep. [1] [19]