Newborn assessment

1. Initial and daily NEWBORN ASSESSMENT

2. DEFINITION:
 It is through inspection or a detailed study
of the entire body or some part of the
body to determine the general physical or
mental conditions of the body.

3. PURPOSE:
 To understand the physical & mental well-
being
 To detect disease
 To safeguard the child & family by noting
the early sign
 To contribute in medical research

4. PRINCIPLES:
 Provide a nor-mothermic & non-
stimulating examination area
 Check equipment are working or not
 Proceed quickly
 Undress only body area examined to
prevent heat loss
 Proceed in orderly sequence

5. ARTICLES:
 Weight Scale
 Inch tap
 Stethoscope
 Watch
 Thermometer
 TPR Sheet
 Kidney tray
 Paper bag
 Gauze Piece
 Sterile cotton for eye care
 Mackintosh with draw sheet
 Play article

6. Cont..

7. STEPS OF PROCEDURE:

8. 1. IMMEDIATE ASSESSMENT
WITH APGAR SCORE:

9. SCORE INTERPRETATION:
 7-10: Normal
 4-6 : Moderate
 0-3 : Danger

10. 2. The Transitional assessment
during the periods of reactivity.
(a) First period of reactivity:
 After birth during first 6-8 hours.
 During first 30 minute of period
neonate is alert, active cries and has
strong sucking reflex.
 This is good time for breast feeding
and eye to eye contact with mother.

11. (b). Second period of reactivity:
 It is start when neonate awakes from
first sleep.
 This period the neonate again
becomes alert, active and responsive,
respiration rate and heart rate will
also slightly increase.
 During this period the stabilization of
physiological system will also occur.

12. 3. Systematic physical assessment.
Sr. No Paramete
r
Child
value
Normal
value
Remark
1. Temperatu
re
97.6-98.6
F
2. Pulse 120-140
beats/ min
3. Respiratio
n
30-60
breath/min
4. Blood
pressure
60/40 mm
of Hg

14. 2. Anthropometric Measurement:
Sr. No. Parameter Child
value
Normal
value
Remark
1. Length 46-50 cm
2. Weight 2.5-3 kg
3. Head
circumference
33-35 cm
4. Chest
circumference
31-33 cm
5. Abdominal
Girth
29-32 cm

15. Anthropometric Measurement:

16. 3. General appearance:
 Posture:
Infant lies with extremities in flexed
position.
“Frog like” posture may indicate
poliomyelitis or scurvy.
 Nourishment: well nourished or under
nourished
 Body built: Thin or obese
 Health: Healthy or unhealthy
 Activity: Active or dull.

17. 4.Mental Status:
 Consciousness: conscious,
unconscious, drowsy, Stupor,
delirious.
 Look: Anxious, worried and
depressed.

18. 5. Skin color:
Hair distribution
Turgor
Pallor:
 Anemia
 Birth asphyxia
 Shock

19. Turgor:

20. Cont…
Cyanosis:
 Central cyanosis: (bluish skin, including
tongue and lips), due to congenital heart
or lung disease.
 Peripheral cyanosis: (bluish skin with pink
lips and tongue), due to drug or hereditary.
 Acrocyanosis: (bluish hands and feet
only), due to cold stress.

21. Acrocyanosis

22. Cont…
Plethora:
 Reddish coloration.
 Seen in infant with polycythemia.
 Seen in over heated or over oxygenated
infant.
Jaundice:
 Immaturity of liver.
Extensive brushing:
 Due to difficult or traumatic delivery.

23. Neonate with Jaundice:

24. Skin rashes:
 Milia:
Seen on nose, cheeks, fore head.
Due to plugged sweat glands.
Mongolian spots:
Bluish, often large, seen on the back,
buttocks or thighs.
Present in Black and Asians.
Disappear by four years of age.

25. Milia and Mongolian spots:

26. Cont…
Erythema toxicum:
 Papular lesions.
 Seen after 48 hours of birth.
 Resolve spontaneously.
Diaper rash:
 Skin fold are involved.
 Infected with candida albicans.

27. 6. Head and face:
 Shape of skull and fontanels ; flat
elevated or depressed.
 If the sutures are wide and
fontanelles are buldge: increase
intracranial pressure
 Depressed fontanelles: Indicate
Dehydration

28. Suture and fontanels:

29. Cont…
 Scalp: Cleanliness, hair, dandruff,
pediculi, cephalhematoma, Caput
succedaneum, Moldings.
 Hair: Colour, texture, sparseness,
distribution of hair and easy pluckability.

31. 7. Face:
 Observed for symmetry, paralysis,
shape, swelling, etc.
 Pale, flushed, puffiness, fatigue, pain,
fear, anxiety.

32. 8. Eyes:
 Assess for pale conjunctiva,
jaundiced sclera, reaction of pupils to
light, discharge, redness, squint.
 Eye rashes.
 Eye movement.
 Distance of both inner cantus are
equal to each distance of inner to
outer cantus.
 Lids usually edematous.

33. 9. Ear:
 Size and shape.
 Large, flabby ears indicate kidney or
other parts of the urinary tract.
 Ear pinna are line with outer canthus.
 Full term infant has sufficient
cartilage.

34. Cont…
 Low set ear-Renal disease and
chromosomal abnormality-down
syndrome.
 Preauricular skin tags (Papillomas)
located at front of ear may be normal
or may be associated with genetic
disorders.
 Assess for crusts or discharge.

35. Preauricular skin tags and ear pinna

36. 10. Nose:
 Size and Shape.
 Patency.
 Nasal flarring.
 Note placement of the septum, it should
midline.
 Formation of nasal bridge.
 Low nasal bridge with broad base
associated with Down syndrome.

37. 11. Mouth and Throat:
 Examined when the neonate is
yawning or crying.
 Examine hard and soft palate for
closure.
 Size of tongue in relation to
mouth:
Excessively large tongue seen in
congenital anomalies.

38. Cont…
 Lips: Redness, swelling, crusts,
cyanosis.
 Odor of mouth: Foul smelling
 Teeth: Discoloration and dental
caries; Natal teeth.
 Mucus membrane and gums:
Ulceration, bleeding, swelling.

39. Lip cyanosis and natal teeth:

40. Cont…
 Tongue: Pale, dry lesions, tongue ties,
larger size (hypothyroidism), coated
 Cleft palate and lips.
 Proper alignment of teeth or not.
 Throat and Pharynx: Enlarge tonsils,
redness and pus.
 Infection: Oral thrush- white patches on
oral cavity due to Candida albicans.

41. Cleft palate and lips

42. 12. Neck:
 Mobility- Move from site to side; palpate
clavicle for fracture.
 Lymph nodes: Enlarged, palpable
 Thyroid gland: Enlarged
 Range of motion: Flexion, extension and
rotation.
 Excessive skin folds may be associated
with congenital abnormalities such as
trisomy 21.

43. Location of lymph nodes and
thyroid gland

44. 13. Chest:
Observation:
 Chest symmetrical.
 Barrel shaped.
 Chest retraction.
 Pneumothorax.
 Trachypnoea.
 Intercostals retractions (respiratory
distress).
 Breath sound: Equality bilaterally,
Grunting.

45. Chest retraction

46. Cont…
Pectus excavatum: Sternum that
is altered in shape.
Breast in newborn: May be
enlarged (normal 1 cm in
diameter) due to maternal
estrogen.
White discharge from nipple is
known as “witch milk”.

47. Pectus excavatum:

48. 14. Abdomen:
 Observation: Cylindrical, protrudes
slightly, redness around umbilical
cord, rashes, scar.
 Distention may be caused by bowel
obstruction, organ enlargement and
infection.
 Palpation: For masses, Liver margin,
palpable spleen, inguinal hernia.

49. Cont…
 Percussion: Presence of gas, fluid or
masses.
 Auscultation: At all four quadrant for
bowel sounds.
 Normal Abdomen Circumference in
newborn baby is 29-32 cm.

50. 15. Umbilicus:
 Should have 2 arteries 1 vein.
 Inspect for discharge, redness or
edema around base of the cord.
 Appearance: Should be translucent. A
greenish yellowish color suggest
Meconium staining.

51. 16. Genitalia :
Male Female
Length: >2 cm.
Determine site of meatus.
Palpate bilateral testicles.
Examine for inguinal
hernia.
Look for
hypospadias, epispadias.
Observe color of scrotum.
Phimosos-foreskin cannot
be retracted.
Cryptotorchidism-testes not
descended.
Inspect for size and location
of the labia, clitoris, meatus
and vaginal opening.
Pseudomenses.
Vaginal tag a small
appendage or flap on the
mucous membranes; common
neonatal variation that usually
disappears in few weeks.

52. Hypospadias:

54. 17. Back and spine:
 Assess for abnormal spinal curvature.
 Tuft of hair or skin disruptions indicate
spinal bifida.

55. 18. Anus and Rectum:
 Inspect anus for position and verify
patency.
 Meconium should be passed within
48 hours of birth.
 Observed for any mass.
 Check for anal opening (imperforate
anus).

56. 19. Hips:
 Congenital hip dislocation.
 Toe anomalies.
 Wide space between first and second
toes and prominent longitudinal
creases indicate Down syndrome.
 Barlow & otlani sign

57. 20. Extremities:
 Assess for joints
 Range of motion.
 clubbing of fingers
 Polydactily: Increse number of finger.
 Syndactily: Joint finger.
 Brachdactaly: Short finger.

58. 21. Nervous system:
Muscle tone:
 Hypotonia: Floppiness.
 Hypertonia: Extended arms & legs,
hyperextension of back & tightly
clenched fits.

59. Hypotonia:

60.  Reflexes:
Sr. no. Reflex How to do
stimulation
Expected
response
Age of
Disappear
1. Blinking Exposure of
eyes to bright
light.
Protection of
eyes by rapid
eyelid closure.
Does not
disappear.
2. Pupillary Bright light
shines toward
Pupil.
Pupil constrict. Persists
throughout
life.
3. Doll’s eye Turn the
neonate’s head
slowly to right
or left side.
Normally eyes
do not move.
When
fixation
develops.

61. Cont..
4. Glabellar
reflex
Tapping
briskly on
glabella.
Eyes to close. Does not
disappear.
5. Sneezing
reflex
Foreign
substance
entering the
upper airway.
Clearing of
upper air
passages by
sneezing
Does not
disappear.
6. Rooting
reflex
Touching or
stroking the
cheek near the
corner of the
mouth.
Head turns
towards the
stimulation,
mainly to find
food.
3-4 months
when awake
and 7-8
months
when a
sleep.

62. Cont…
7. Sucking
Reflex.
Touching the
lips with the
nipple of the
breast.
Sucking
movement to
take in food.
Begins to
diminish at
6 months.
8. Swallowing Accompanies
the sucking
reflex
Food,
reaching the
posterior of
the mouth is
swallowed.
Does not
disappear.
9. Gagging When more
food is taken
in to the mouth
that can be
successfully
swallowed.
Immediate
return of
undigested
food.
Does not
disappear.

63. Cont…
10. Extrusion reflex Tongue is
touched or
depressed.
Infant
responds by
forcing it
outward.
Disappears
by age of 4
month.
11. Cough Irritation of
mucous
membranes of
larynx or
tracheobronch
ial tree.
Cause
coughing.
Does not
disappear.
12. Grasp Touching
palms or soles
near base of
digits .
Grasping of
object by
closing
fingers
around it.
Disappear in
6 weeks to 3
months

64. Cont..
13. Babinski Stroking
outer sole of
foot upward
from heel
and across
ball of foot.
Toes to
hyperexte
nd and
hallux to
dorsiflex.
Disappear
s after age
of 1 year.
14. Startle Sudden loud
noise.
Abduction
of arms
with
flexion of
elbows.
Disappear
s by age
of 4
months.

65. Cont…
15. Moro supine
position
supporting
upper back
and hand with
one hand and
lower back
with other.
The neonate’s
head is
suddenly
allowed to
drop down
backward for
an inch.
Symmetric
abduction and
extension of
arms and legs
with fanning
of fingers.
The thumb
and index
fingers form a
‘C’ shaped in
both hand.
The
extremities
then flex and
adduct. The
baby may cry.
Strong up to 2
months
disappears by
3-4 months.

66. Cont…
16. Stepping or
dancing
Hold neonate
in a vertical
position with
feet touching
a flat and
firm surface.
Rapid
alternating
flexion and
extension of
the legs as in
stepping.
Disappear
with 3 to 4
weeks.
17. Crawl When placed
on abdomen.
Infant makes
crawling
movement
with arms and
legs.
Disappear by
age 6 weeks.

67. Cont…
18. Perez Infant is
prone on
firm surface
and thumb
is pressed
along spine
from
sacrum to
neck.
Responds
by crying,
flexing
extremities;
elevating
pelvis and
head;
lordosis of
spine,
defecation
and
urination
may occure.
Disappear
by age 4-6
months

68. Cont…
19. Galant Stroking
infant
back
alongside
spine.
Hips to
move
toward
stimulate
d side.
Disappea
r by age 4
week.
20. Tonic
neck
Infant
head is
turned to
one side.
Arm and
leg extend
on that
side, and
opposite
arm and
leg flex.
Disappear
by age 3-4
months.