How to perform the NEURO exam on a baby// Head-to-Toe CNS evaluation!
ฝัง
- เผยแพร่เมื่อ 5 ก.ค. 2024
- How do you evaluate TONE? What about REFLEXES? What are the PRIMITIVE reflexes: moro, gag, suck, rooting? How do we differentiate jitteriness vs SEIZURES? How we we test the cranial nerves? How does a baby position itself with a and brachial plexus injuries (Erb's palsy)? In this video learn all about how to evaluate the CNS/ and peripheral nervous system!
---------------------------------------------------------------------
Please be sure to give us a like, comment about future topics, and subscribe to this channel to stay up to date on all things NICU! Also, click the notification bell after you subscribe to gain your weekly NICU knowledge as soon as it's loaded!
---------------------------------------------------------------------
Dr. Tala is a board-certified neonatologist, and has worked in busy level III and IV units for the past 16 years. She has won multiple teaching awards throughout her time as a neonatologist.
----------------------------------------------------------------------
Peredo, D.E. and Hannibal, M.C. (2009). The floppy infant: Evaluation of hypotonia. Pediatrics in Review, 30 (9), e66-e76. doi: doi.org/10.1542/pir.30-9-e66
-------------------------------
Asymmetrical tone neck reflex. (2020). Wikipedia. Retrieved from en.wikipedia.org/wiki/Asymmet...
-------------------------------
Buchanan, E.P., Richardson, R., and Tse, R. (2013). Isolated lower brachial plexus (klumpke) palsy with compound arm presentation: Case report. The Journal of Hand Surgery, 38 (8), 1567-1570. doi: doi.org/10.1016/j.jhsa.2013.0...
------------------------------
Heise, C.O., Martins, R., and Siqueira, M. (2015). Paralisia do plexo braquial neonatal: A desafio permanente. Arquivos de Neuro-Psiquiatria, 73 (9). doi: dx.doi.org/10.1590/0004-282X20...
------------------------------
Sharma, D., Pandita, A., Shatri, S., and Sharma, P.K. (2016). Duchenne-Erb's palsy in newborn: Result of birth trauma. Medical Journal of Dr. D.Y. Patil Vidyapeeth, 9 (2), 274-276. doi: 10.4103/0975-2870.167961
-------------------------------
Stavis, R.L. (2019). Gestational age. Merck Manual Professional Version. Retrieved from www.merckmanuals.com/professi...
-------------------------------
Reuters News Agency. (2016). Babies expose to zika developed microcephaly months after birth. The Telegraph. Retrieved from www.telegraph.co.uk/news/2016...
--------------------------------
Sharma, D., Murki, S., and Dhanraj, G. (2015). Traumatic facial nerve palsy in newborn: A benign condition. Journal of Clinical Neonatology, 4 (3), 213-214. doi: 10.4103/2249-4847.154135
--------------------------------
Cameron, C., Lodes, M.W., and Gershan, W.M. (2007). Facial nerve palsy associated with a low serum vitamin A level in an infant with cystic fibrosis. Journal of Cystic Fibrosis, 6 (3), 241-243. doi: doi.org/10.1016/j.jcf.2006.08...
---------------------------------
Hypotelorism. (2020). Wikipedia. Retrieved from en.wikipedia.org/wiki/Hypotel...
---------------------------------
How to determine eye shape. (2021). WikiHow. Retrieved from www.wikihow.com/Determine-Eye...
---------------------------------
Apgar score. (2019). Pregnancybirthandbaby. Retrieved from www.pregnancybirthbaby.org.au...
--------------------------------
Brandslet, S. (2017). How early can a mother have skin contact with her premature baby. Norweigan SciTech News. Retrieved from norwegianscitechnews.com/2017...
--------------------------------
Irons, J. (2016). Hydranencephaly. Confusing Health Enigmas. Retrieved from confusinghealthengimas.wordpr...
----------------------------------------------------------------------------
Music: www.bensound.com (royalty free with credit)
----------------------------------------------------------------------------
*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.
Fantaaaaastic love every second of the video
💐💐💐
So happy! It was one of your requests!!! HIE will be soon :)
I love this channel! Thank you all so much for putting these videos together! I am a new RN starting in NICU in less than a month and all your videos help me feel more prepared to be a competent nurse. I can’t thank y’all enough!! ✨
Congratulations Vanessa on your new job- so exciting! We're so happy you're 'studying' in advance and that these are helpful! Also happy that you used y'all- are you a fellow Texan?! (Obviously I wasn't originally but now my husband says I'm more Texan all the way)- Tala.
Thank you so much, Dr. Tala, I really appreciate it!! I love learning and your videos are so helpful since we only get so little neonatology in nursing school. And, funny enough, I was born in Texas-but didn’t grow up there so I wouldn’t say I’m a fellow Texan exactly 😅 So my use of “y’all” was to be gender inclusive😁 Looking forward to continuing my learning through the rest of your videos & Questions! Take care, Team!
Well, I've taken the exams for the 2nd time now and still didn't succeed, i wonder how those who succeeded did it. 😭💔💔
Just say "I haven't passed yet." Don't
take it as a failure but see it as a learning opportunity. There is a lot of power in "Yet"; you are telling yourself that you will get there and that your eyes and heart are still fixed on your goal
I failed twice, i lost money to reviews that never helped but the major thing is that l've not lost hope
This video is GOLD!!! Thank you so much!!! 🎉God bless you Dr. Tala and your Team!
Thank you so much! What a lovely compliment- so happy you found it helpful :)
Great point about autonomic responses with seizures when differentiating from just jitteriness. It’s like I knew it subconsciously, but had to hear it to confirm it! Thank you!😊
Isn’t it so funny that we all kind of innately know things without actually verbalizing it. Maybe that’s the experience part coming in? Thanks so much for watching :)
simply staggering in its high-yeildedness, like all of Dr. T's presentations.
Thank you so much for the lovely comment!!!! Totally what we’re always striving for and I can’t tell you how happy it makes us that these videos help anyone! Thank you!!!
Your videos are actually the best! I have learned so much and your videos have helped me so much as a new graduate nurse. I started writing down some videos I feel would be beneficial and I personally would love to see!
-Late onset GBS infection in term and ELGAN babies
-ELGAN protocol
-IUGR
-Body cooling
-Kangaroo care effects
-Cystic fibrosis in newborn
-Duodenal atresia/ostomy care
-Thermoregulation and humidity
-TPN and lipids explained
-Donor breast milk
-ICH
-Dart protocol
This list is fantastic!!!!! Thanks so much for these suggestions- we'll be going over body cooling very soon in HIE video, and then we'll slowly go through rest. That's fun you're in a surgical unit! Really appreciate your input Juliette :)
Wonderful topic well explained, i am working at NBU set up and i have never seen such vids in youtube that contain all the info/tools i needed at my workplace, well done dr tala. Thank you
Wow! That was a lot of lovely compliments! Thanks Hussein- we really appreciate it!
You make me a better Respiratory Therapist with every video I watch. Thank you so much for posting such quality videos! ❤
Oh wow!!!! What a lovely comment! Also that’s so amazing you’re watching videos not related to lungs etc/ we bet you’re fantastic in your role!
@@TalaTalksNICUThank you for your kind words. I definitely try, sometimes I don't retain well. So, I use every opportunity as a learning experience.
What a great teacher ❤
Im in love with her teaching style ❤
Thank you so much/ what a lovely compliment :)
Another great video! I love them! Can’t wait for the HIE video
Thanks so much for continuing to watch!!! We really appreciate your loyalty! We'll be posting HIE soon!
Thank you so much !
You have explained everything so wonderfully !
Oh wow- thanks so much- so glad you found this at all helpful! Thanks for writing in to us :)
Thank you so much! I can't wait to watch the one in seizures.
Thank you so much for watching Mao- we really appreciate you taking the time to write in too. We will get around to this!!!! Thanks!
Would love to see your follow-up lecture on seizures!
Thank you, Dr. Tala & Team!
We promise we’re getting there!!!! Keep thinking we need like a couple of months off to film everything!!!! Thanks for being here xxx
Thank you for discussing this crucial topic.
Thank you for watching :)
As a paediatric resident,it's extremely helpful.Thank you!
Thanks so much Dr. Azfer! What other videos do you think would be helpful for residents. I'm trying to think back and it's hard to remember what I really needed then! Thanks so much for watching!
More on congenital heart diseases
Also approach to inborn errors of metabolism..
Yes! We want to do a whole series on these! Starting with the cyanotic ones...thank you!!!
YES! This is an excellent idea- discussing the approach- and what we do in the NICU (rather than go through all the pathways and enzymes etc.- which we all memorize and then forget!!!) Thank you :)
Thank you Dr. Tala, I am NICU nurse from KSA.
Hello! Thanks for watching and commenting! It has been so interesting meeting like-minded people from, all over the world!!!
Very informative. Thank you... All the way from Kenya
Hello Moses from Kenya! So happy that you found us! We love that we get to meet NICU-minded people from around the world! Thanks for watching and commenting :)
Thank you so much Dr. God bless you❤️
Thank you so much Anne! We appreciate you taking the time to write to us :)
Your videos helps a lot Dr, thank you very much! Neonatal plethora next please :)
Hello Nina! We're so happy our videos are helpful! When you say plethora- do you mean elevated hematocrit? We spoke a little about this in our early RBC videos if you are interested in looking there? If there's something we didn't cover that you'd like to know about- let us know!!! Thanks again for being here :)
Very informative. Expecting more videos
Thank you!! You'll definitely be getting more videos! Next one is HIE. Thanks so much for watching and commenting!
I realize that you are not a pediatric neurologist or neurosurgeon, but I would love to hear from you, a neonatologist, regarding subdural hematomas and intrauterine stroke.
You explain everything so well!.
Thank you so much!
Hello Amanda- we could definitely do a video on strokes in newborn period since they're much more common than people would expect. We do occasionally see subdural hematomas (mostly incidentally on U/S/ CT scans etc), but I've never had a patient that needed surgery for one. A video on general bleeds in head which aren't IVH would be a great topic though!! Thanks so much for the suggestion :)
Very informative lecture.keep sharing ur knowledge with us Dr Tala ❤
So glad it was helpful- thank you for taking the time to comment!
you are amazing!!!! Finished it with out losing my attention even for second!
That's more a testament to your focus we think!! Thanks so much for watching and for continuing to write us such motivating comments!
@@TalaTalksNICU I truly appreciate you and your time you spent helping us!! I was bored with the 3 hr lectures, handouts and books and you reinvigorated my whole practice outlook! God bless you!!!!
That's amazing!!!! thanks so much for subscribing and for giving us your time :)
Great video, please do IVH and Meningomyelocele next. Thank you!
Hello Ayanda! Thanks so much for watching and for the positive feedback! We already filmed a video on IVH- so please check that out. And we'll definitely add MMCs to our list- and excellent suggestion- thank you!
watching this video & understanding alot more after my brain exploded from the amount of info in my textbook about the neuro exam 😂 , TYSM
Ha! Yes! Lots and lots of information to sift through in medicine- so glad this helped to fill in some of the gaps (although obviously way more we missed!!)
Good job Doctor!!
Thanks so much Angelios :)
exellent..thank you so much Dr Tala
Thank you so much for watching Elza :)
Very informative n crisp video thank u for the efforts mam.
Thank you so much for watching and for taking the time to write such a lovely comment!
Learning so much!
Oh dear. One small area of the world I know more than you about to be dashed...
Yes please more about sizures!!
Yes! We will get it done- we promise!!! Thanks for watching :)
Thank you so much Dr Tara... That was really very simplified ... Extremely helpful... I request you to make one on about how to assess muscle power or muscle testing in toddlers with cerebral palsy... Thank you so much!!
Hello- thanks for your great suggestion. Honestly, I don't work in. developmental clinic so I don't feel like I'm the best person to talk on this topic. But I have a friend and colleague who has agreed to discuss CP and the different exams. So I'll nag him again!!!
@@TalaTalksNICU please we need the CP and the Seizure videos🙏
@benjaminazumah9833 yes! I promise they’re coming! I’m sorry! We are behind!!!
Very informative. Keep it up 👏👏
We're so happy you think so Minhaj, Let us know if there are other videos you would like to watch.
Very interesting
Thank you 🌹🌹🌹
Thanks so much for watching and for taking the time to write to us!
Very informative lec thank you
So glad you found it helpful- thanks for writing to us!
Thank you very much
Thank you so much for watching !
Thanks so much for much much valuable data
Thanks so much for taking the time to comment Dr. Ahmed Kamal! Happy you find it useful!
@@TalaTalksNICU
It’s very nice and kind of you to reply
Transport Exam in t minus 5 days. yikes. Thanks for the refresher on NICU Neuro. Wish you did pedi, too.
You’ve got this! Thanks for watching our videos! Good luck!!!
Excellent
Thank you so much!
Thank you! 😊
You're welcome 😊
Thank you 😊
You've been busy watching these! Thank you for your loyalty and support :)
Very nice work ; good job , 👏🌷🌷
I have one note about erbs palsy , in fact the arm is internally rotated not externally ...
Hello!! You’re absolutely right- another viewer pointed this out to us too. The annoying this is it’s really hard to go back and film it with the correction! We’ll find out a way to correct it though!!! Thanks again for watching and for pointing this out!!!
@@TalaTalksNICU we appreciate your efforts , god bless you 🌷
this is great thankyou!
Thank you so much for watching and for taking the time to comment :)
This channel is underrated
Honestly why it just have 800 likes?
Ha! We'll take that as a compliment! We'd love you to be a marketer for us!!!! :)
it is a very helpful video👍 thanks.. can you make a video on CPAP algorithm please
Hello! So glad you found this helpful. We've been planning a non-invasive support for ages- we need to get it out! Thanks for the reminder!
U r awesome ma'am...💐waiting fr ur nxt vdo ..
Thank you so much- we really appreciate you watching and your lovely comment :)
Amazing explanation 😍
Thank you so much :)
Thanks Dr Tala
Thank you for continuing to watch Themby!
Very nice dr Tala❤❤
Thank you so much for being here :)
Great video
Thanks so much Anwar!
Very nice..thank you
Thank you so much for taking the time to comment :)
Please explain the significance of pupil exami ation eg fixed and dilated pupils following instrumental deliveries where you suspect skull fracture.thanks
This is a tough one! Generally a fixed dilated pupil can be indicative of severe neurological injury- and in a patient with HIE , this is an ominous sign. Since the sympathetic system is responsible for dilating the pupils- this can also happen from too much sympathetic activity (e.g. dopamine, cocaine exposure). Also it could result from a blockage of the parasympathetic system- e.g. in infantile botulism. The most common reason for a fixed dilated pupil in a neonate is that the infant received their eye-drops for an ROP exam!! I can do a separate lecture on pupils if you are interested!
Thankyou for the explanation.Would really appreciate if you could do a separate lecture on pupils.Really want to say thankyou so much for making learning easy because you go down to the basics and simplify everything.
Thank you so much Marina! That is definitely our goal- to emphasize the basics to help people retain stuff, not just randomly memorize it! I will do a NICU nugget on pupils soon. I owe a few videos but I'll get around to it I promise!!! Really, really appreciate you being here- thank you again!
Very informative video
Thank you so much Nadar :)
Perfect 👏🏻👏🏻👏🏻
Thanks so much Havva- we love that you're joining us for these videos!!
So great.why do i happend to find this videos so late.anyway doc can you elaborate ballard exam.?Thanks . Looking forward to your interesting topics.💕😘
Hi! This is such a great idea for a video! we're so happy you found us at all! ha! Thanks so much for subscribing and for your wonderful support!
Awesome.could you go through BPD
Thank you so much!!! We have already filmed BPD and we’ll be editing it and putting it out soon! Thanks :)
Fantastic video! how about assessment on sensory? How shall I assess?
Hello Wein. Great question, and I probably should have alluded to this in talk. Many of the reflexes (e.g. root and grasp reflexes) rely on sensation to function- so in a sense you are testing sensation. Many times babies respond to touch- moving toward your fingers or trying to grasp something if near the face. If sensation is decreased then you need to press a little harder (not too hard!) to evaluate whether the infant withdraws. Ultimately though, because infants are non-verbal, it would be very difficult to obtain an exact dermatomal assessment of sensation. We would have to rely on other methods for that (e.g. with spinal cord defect- check DTR). I hope this helps?
HIE next please. Thanks!
Yes! It's coming! Two videos- one on pathophysiology and diagnosis and the other on cooling. Thanks for your patience!!!!
Good presentation
Thank you Sumathy!!
Very nice. ❤. Always waiting for your videos.
But one question about checking the reflexes that involve eyes.. Usually the eyes of a newborn are closed.. How can we examine them easily
Thanks for commenting! This is a great point- I've found that the easiest way to get a baby to open their eyes is to turn the lights off, and then to sit them up a bit (even if just the shoulders and head)- often that will be interesting enough for them to lift their lids. If the babies can't or shouldn't be lifted, then sometimes letting them suck your gloved finger works. Often though, we sometimes have to physically pull the eye-lids apart with some gauze to get a good look at the pupils and red reflexes.
I personally always try "The Hold" (look it up here on youtube) where the baby is held in a way that it looks downwards, sometimes that works.
The ophtalmologist that visits us to do the ROP screenings has a very scary metal instrument to keep the lids open, it gives me nightmares
Hopefully you will be able to have a lecture video on enteral nutrition for preterm babies. 🙂
Yes soon! We definitely have that on the list! But for now- breast milk, start early, and advance as fast as everyone else does in your unit!!! Thank you so much!!!!
Thanks for the response! Based on your experience, how do you go about their feeding? Is it okay if we start feeding the premmies at 30-40cc/kg/day of expressed breast milk? Or we go lower? Thanks much! 🙂
V.nice
We need a vedio about Neonatal Resuscitation please.
Thanks so much Monjid! We're figuring out the logistics of a neonatal resuscitation video- we're concerned about NRP copyrights- and obviously we don't want to do anything wrong! We'll figure it out and get something out!!! Thanks again!!
Thank you so much allah bless you
Thank you so much- really appreciate the sentiment
ما شاء اللة. بارك اللة فيكم
Thank you!
I wish you open telegram page to share us you knowledge and new guidelines for treating newborn and also to ask you if we need questions, because you are realy an amazing, smart and helpfull doctor tala
Ha! Thank you for the lovely compliments- eventually we'll get to the website and everything!!
Correction: For Erbs Palsy, the presentation is shoulder and elbow extension, INTERNAL rotation (and pronation) with wrist flexion.
Yes! Thanks Monica- arm is internally rotated (and difficult to externally rotate!). If I said something different, it was a mistake! Thanks for pointing it out :)
How to procced in cases of macrocephaly ..n brachial plexus injury neonate ....
Honestly- this is probably more of an OB question!!! Or the question is how do we treat brachial plexus injuries?
Great
Thank you for continuing to watch :) appreciate your support!
Hi I am in Germany
I want more information und update about brith Asphyxia and treatment
Thank you so much
Hello Esmael! So happy you’re watching from Germany. We put out a couple of videos on HIE and cooling. Go check those out and if there’s something else you think we should touch on please let us know! Thank you so much!
What does it mean when a neonate has trouble opening mandible? Able to suck and swallow but delayed mouth opening.
Hello Victoria- I'm not sure what this means! Does he have a small mandible? i.e. a small, short chin? Is it stiff? Is he still little? Obviously without knowing a lot more - we can't really guess! Good luck!
Nice
Thank you Immadi :)
Very helpful,love every single min of it!🤍🤍🤍
SO glad you found it helpful- thanks so much for taking the time to write to us. :)
16:57 I think she meant to say internal rotation.
YES I DID!!!! SORRY!!! WAS A BIG MISTAKE :(
I love it. But it may be helpful if you limit your videos to 5 minutes max. Thank you 😊
Thank you! I know- you’re right! I go on too long. It’s hard cutting everything down to bite sized pieces but I need to try harder! We’re planning on a whole month of v short videos for nurses. Really do appreciate you being here and your constructive feedback- very very helpful to us :)
Moro reflexes, suckling, rooting and gag reflex, grasps reflexes, why this are called "primitive" reflex
Because they’re reflexes that keep babies alive at start of life but then they all go away within a few months (would be a problem if an adult had a rooting or grasp reflex)