A 20 second neonatal neurological assessment in the ER !

Here are some great pointers from an ER Pediatrician for general specialists (& of course Pediatricians) on how to figure out if a neonate has possible neurological problems, within 20 seconds of reporting to the ER.

The most important thing that is different between a baby and an adult is that you get a ton of information just from picking up the baby. It's the first thing you are going to do when you see a neonate with one of these complaints or concerns — when the caregiver says, "I think he had a seizure," or "I think he stopped breathing," or "He threw up and changed color."

You undress them from top to bottom so you can see everything. Then you pick them up so that you can feel whether that baby is in respiratory distress. You're going to feel whether they have the right tone. They may be curled up, kind of in a little ball, with some flexor tone, which means their arms are curled in a little bit, their head's a little bit tucked, their legs are drawn up a little bit, kind of as if they had just come out of the womb. And if they are floppy, you're going to feel that. You're going to get a sense that this baby is not where he or she needs to be.

Then you lay them back down and you pull up on their arms, and you see at the very end of that if they can get their head a little bit righted. By about 3 weeks of age, they should have a nice increase in their head control and be able to pull it up a little bit on their own.

The third thing — and these things all take under 20 seconds to do — is to check whether they can visually fix on an object and follow it a full 180 degrees from left to right.

With those 3 things — tone, head control, and visual fix and follow — you're going to have a really good preliminary idea of what your baby's neurological exam is. If it's not normal, that's going to open up a whole different evaluation than if it's normal.

Source

Comments: This is by no means a comprehensive neurological examination, and should be supplemented by further tests as appropriate if the above examination is equivocal / abnormal. But by doing the above, you are unlikely to miss a gross neurological problem in a newborn.