NEWBORN

ASSESSMENT
OUR LADY OF FATIMA UNIVERSITY
COLLEGE OF NURSING
 To provide assessment of the
newborn state of development of
wellbeing
To detect any deviation from normal
OBJECTIVES To assess progress of the child
To detect disease in early age
To determine the nature of
treatment or care needed for the
newborn
 First examination: monitoring
the baby inside the womb of the
mother before the delivery and 2
hours after birth
INDICATIONS
Second examination: before
discharge
Third examination: after 6-
8weeks of neonatal life
 Initial
PHASES OF Transitional
ASSESSMENT Assessment of gestational age
Systemic physical examinations
INITIAL
ASSESSMENT
TRANSITIONAL
ASSESMENT

Fetal-to-neonatal
transition
 1ST STAGE: lasts for 6 hours
 first 30 minutes awake and
remaining hours the newborn will be
TRANSITIONAL
ASSESMENT
sleeping
2ND STAGE: 6 – 12 hours observation
should be made until the vital signs
are established
  Ballard score is commonly used to determine
gestational age. Scores are given for 6 physical
and 6 nerve and muscle development
(neuromuscular) signs of maturity.
ASSESSMENT OF The scores for each may range from -1 to 5.
GESTATIONAL The scores are added together to determine
AGE the baby's gestational age.
 NEUROMUSCULAR MATURITY – include posture,
square window, arm recoil, popliteal angle, scarf
sign, heal to ear
 PHYSICAL MATURITY – skin, lanugo, plantar
surface, breast, eye/ear, genitalia(male/female)
BALLARD
SCORE
  Appropriate for gestational age (AGA) – the
newborn is within the ideal range of birth
weight 2500 – 4000 gms

ASSESSMENT OF  Small for gestational age (SGA) – the

GESTATIONAL newborn is less than 10% of the ideal weight at
AGE the time of birth, less than 2500 gms
 Large for gestational age (LGA) – the
newborn is more than 90% of the ideal weight
at the time of birth, more than 4000 gms
 FULL TERM – pregnancy that reached
37 to 42 weeks age of gestation
ASSESSMENT OF PRE-TERM – pregnancy that reached
GESTATIONAL 28 to 37 weeks age of gestation
AGE
POST TERM – pregnancy that has
extended to or beyond 42 weeks of
gestation
  VITAL SIGNS:
 TEMPERATURE: can be taken through rectal (to
check also for the patency of the anus) or axilla
 Normal temperature: 36.5 to 37.4C
 Hypothermia: less than 36C
GENERAL  Hyperthermia: more than 40C
PHYSICAL  RESPIRATION: count by observing the abdominal
EXAMINATION movements and count in one full minute for
accuracy
 Normal respiration – 30 to 60 cpm
 Tachypnea – more than 60 cpm
 Bradypnea – less than 20 cpm
VITAL SIGNS
 PULSE – you may use the apical pulse which is
located on the midclavicular between 4th and
5th inter coastal space left. Count in one full
minute for accuracy
 Normal pulse rate – 120 – 160 bpm
 Bradycardia – less than 120 bpm
 Tachycardia – more than 160 bpm
 BLOOD PRESSURE – blood pressure
monitoring is not routinely done. The average
systolic and diastolic pressure is 66/44mmHg at
1-3 days of age
 To assess the body size, shape and the
composition of the newborn’s body
ANTHROPOMETRIC To compare the size with estimated
MEASUREMENT period of gestation
To identify if there are abnormalities in
newborn
  HEAD CIRCUMFERENCE – 33 – 35 cm

ANTHROPOMETRIC
MEASUREMENT

 CHEST CIRCUMFERENCE – 31 – 33 cm
  ABDOMINAL CIRCUMFERENCE – 31 – 33cm

ANTHROPOMETRIC
MEASUREMENT
 BODY LENGTH – 47 – 54cm

 BODY WEIGHT – 2500 – 4000GMS

 NORMAL DEVIATION
- Newborn’s head appears - Microcephaly – Hc >33cm/> 2.5 cm
disproportionately large because it is - Macrocephaly – HC < 35cm/ < 2 cm
HEAD ¼ of the total body length
- Head circumference is 33 – 35cm
- Widely separated sutures: preterm,
hydrocephalus, cerebral edema
- Fontanelles - Bulging fontanelle: subdural
- Anterior fontanelle – soft and closes hemorrhage, hydrocephalus, CHF
9 – 18 months, diamond shape - Delayed closure: rickets,
- Posterior fontanelle – soft and hypothyroidism, down syndrome
2 – 4 months, triangular in shape - Caput succedaneum – swelling or
edema or a bump on newborn’s head
shortly after delivery
- Cephalhematoma – a collection of
blood between a newborn’s scalp and
the skull.

CAPUT SUCCEDANEUM
 NORMAL DEVIATION
Fine and silky hair Preterm – fuzzy hair
Turner’s Syndrome – low hair line
HAIR and - Eye movements are not yet - Upper slant eye would indicate
EYES coordinated down syndrome
- Eyelids maybe edematous for 2 - Cataract is a signed of rubella and
days others
- Sclera may be pale in color - Conjunctivitis
- Iris is round - Nystagmus
- No tears because lacrimal ducts - Corneal reflex should be checked
are not yet fully mature. It will
mature after 3 months

Cataract caused by Down Syndrome

Congenital rubella eyes
 NORMAL DEVIATION
- Top portion of the external ears Low set ears would indicate genetic
should be at the level of the eye syndrome
EARS and - Ear cartilage: pinna is firm, cartilage

NOSE can be felt at the edges

- Instant ear recoil
- Tympanic membrane is grey
- Normal infant can hear sound and can
stimulate moro reflex due to sudden
noise
- Neonates are also nose breathers - Obstruction of mucus plugs
- Nose are usually flattened after birth - Flaring of nares
- Patency of the nasal passages should
be assessed

Different abnormalities in Polyps on the nose Flat nose for client with
the ear down syndrome
 NORMAL DEVIATION
- No deviation - Excessive salivation
- Intact palate - Cleft lip

MOUTH and - EPSTEIN PEARLS are one or two

small round well circumscribed cysts
- Cleft palate

NECK are present in the palate, a result of

extra load of calcium that was
deposited in the utero
Webbing
- Newborn’s neck are usually short - Webbing of neck would indicate
- Head should be extended when turner’s syndrome
examined - Swelling of the neck maybe due to
tumor and other abnormalities
SKIN NORMAL
- Pink in color, ruddy or reddish in
DEVIATION
- Pallor would indicate anemia, edema,
color because of the increased shock hypoxia, and hypotension
concentration of red blood cells in the - Cyanosis
blood vessels and a decrease in the - Central Cyanosis – indicates
amount of subcutaneous fat. This decreased oxygenation
color will fades slightly over the 1st - Peripheral Cyanosis – due to
month immature peripheral circulation and its
- Skin turgor: sensation of fullness normal within 24 – 48 hours after birth
derived from the presence of - CHD
hydrated subcutaneous tissue - Severe respiratory distress
- Elasticity: when the skin is pinched - Jaundice if within the first 24hours, it
and release, it will go back again to could be hemolytic disease. Rh
normal incompatibility. ABO incompatibility,
- Lanugo known also as physiologic jaundice
- Vernix caseosa - Petechiae would indicate infection
- Mongolian spots - Edema indicate over hydration, renal
- Millia failure, coronary heart disease,
anemia
- Forcep mark
Newborn jaundice is a yellowing of a baby's skin
and eyes. Newborn jaundice is very common and
can occur when babies have a high level of bilirubin,
a yellow pigment produced during normal
breakdown of red blood cells.
 NORMAL DEVIATION
- Normal and absence of retractions - Chest retractions
CHEST and -
-
Proportion to the body
Normal circumference is 31 – 33cm
- Crackles sounds during auscultations

ABDOMEN -
-
Heart rate is 120 – 160bpm
Nipple size 5 - 10mm
- Witch’s milk - or neonatal milk is milk
secreted from the breasts of some
newborn human infants of either sex.
Neonatal milk secretion is considered
a normal
- Abdomen is protuberant - Distended abdomen
- Normal abdominal circumference 31 – - Prominent liver
33cm - Umbilical hernia
- Liver can be felt at 1 – 2cm below the
right coastal margin
- Bowel sound is present
- Umbilical cord two artery and one
vein
 NORMAL DEVIATION
MALE - Phimosis
- Prepuce covers the glans penis - Hypospadias - a birth defect in which
- Scrotum with rugae and the opening of the urethra is located on
descended testes the underside of penis instead of the tip
- Epispadias - rare congenital (present
at birth) abnormality that involves the
MALE and opening of the urethra is on the top
rather than on the tip
FEMALE - Cryptorchidism - undescended testes
GENITALIA FEMALE - Labia majora does not cover the labia
- Term Baby: Labia majora covers the minora indicate that the newborn is
labia minora and urethra (Prominent preterm (promient labia minora than
Labia majora) majora)
- white discharge seen (maternal
estrogen withdrawal
- Pseudomenstruation – tinge of blood
NORMAL: when a baby boy is
born, the prepuce is long with a
narrow tip
 Inability to retract the skin (foreskin or
prepuce) covering the head (glans) of the
penis

 Phimosis is divided into u: physiologic

Phimosis (esolves around 5-7 years of age) and
pathologic (scarring).
 - Hypospadias - opening of the urethra is located on
the underside
- Epispadias - opening of the urethra is on the top

Abnormal
urethral
opening
: testis are found within a sac of skin
called the scrotum, hanging below
the penis.

Late in pregnancy, the testes move

down from the abdomen into the
scrotum.

At birth, all but 3% of male

babies will have both testicles
drop
ABNORMAL:
undescended testicle
(cryptorchidism) is a testicle that
hasn't moved into its proper
position in the bag of skin
hanging below the penis
(scrotum) before birth.
 NORMAL DEVIATION
SPINE - Spina bifida - is a condition
- No mass or nodules that affects the spine and is
- Normally straight usually apparent at birth. It
is a type of neural tube
defect
- Meningomyelocele - is a sac
SPINE and that contains: part of the
ANUS spinal cord.
ANUS - No opening - Imperforate
- Patent anus
- Passes of meconium within
24hours after birth
Spina bifida is a birth defect that occurs when the spine
and spinal cord don't form properly
Types of spina
bifida
 NORMAL DEVIATIONS
HANDS - Simian usually presence of one
EXTREMETIES - Creases
- Complete Fingers
straight crease in the hand and can be
seen in client with down syndrome
- Syndactyl - the fingers or toes are
FEET webbed or joined and that the
- Creases condition was present at birth
- Fullterm –creases covering the entire - Polydactyl - is when a baby is born
sole with an extra finger on the hand or an
- Post mature – deep creases over the extra toe on the foot
foot - Clubfoot is a
- Premature – no creases or partially congenital foot deformity that affects
covering the upper 2/3 of the sole a child's bones, muscles, tendons, and
- Complete fingers blood vessels
- no abnormal curvature
Simian crease is a single transverse palmar
crease, or STPC. It refers to a single crease
common among down syndrome
Syndactyl - the fingers or toes are webbed or joined
and that the condition was present at birth
Simple syndactyly. This involves fusion between
only the tissues of the fingers.

Complex syndactyly. This involves fusion between

the bones.
Polydactyly is
a deformity in
which the
hand has one
or more extra
fingers in any
of three places
of the hand:
Planter surface of foot
 inward turning

Clubfoot

downward pointing upward pointing

position position
REFLEXES - are involuntary
movements or actions.
Some movements are spontaneous
and occur as part of the baby's
normal activity. Others are
responses to certain actions.
rooting reflex / sucking reflex is inhibited by the
third to fourth month.
REFLEXES
Tonic
neck
reflex
Grasp Reflex
STEP Reflex
CRAWL REFLEXES
 Stroke one side of infant's foot upward from heel & across
the ball of the foot

Babinski or
plantar reflex

hyperextending the toes;

inhibited at sixth to ninth month of post natal life
watch newborn reflexes attach on
your canvas .