Newborn Assessment

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Newborn Assessment

• Chapter 18

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Assessment

• Consider maternal and prenatal hx
• Birthing hx
• Analgesia and Anesthesia
• Wgt and gest age
• Complications of birth
• Examination results

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Timing of Assessment

• In birthing area- Evaluate airway and transition
• Within 4 hours
• Prior to discharge home
• Determine gestational age within 4 hours

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Apgars

• Heart rate- absent- below 100 above 100
• Resp effort- absent- slow- irreg
• Tone- flaccid some flexion- active motion
• Reflex irritability- none- grimace- vigorous cry
• Color-pale- body pink- ext. blue- completely pink
• Given at 1 minute and 5

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Weights and Measurements

• Average weight-3400 gms
• Fluid shift causes weight loss
• Average length 20 inch
• Head larger than abdomen
• Temp. control

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Heart

• 120-160- influenced by activity
• Auscultate, L axilla, scapula
• 90 of murmurs transient
• Assess pulses- femoral brachial- pedal

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Ballard Dubowitz

• Tool to assess gestational age
• Optimal accuracy within 12 hours
• Most accurate 28 wks and under 43 wks
• Physical more accurate than neurological
• GA effected by PIH, DM, meds

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Physical Characteristic

• Resting posture
• Skin
• Lanugo
• Plantar creases
• Areola
• Ear
• Genitalia

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Neuromuscular

• Develops from lower to upper
• Square window
• Recoil- posture
• Popliteal angle
• Scarf sign
• Heal to ear

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Plotting Gestational Age

• Upper 10 LGA, bottom 10 SGA
• Length
• Head
• Weight
• Complete exam from head to toe

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Skin

• Acrocyanosis
• Mottling
• Harlequin
• Jaundice
• Erythema toxicum
• Milia
• Turgor

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Birthmarks

• Stork bites
• Mongolian spots- dark skin, resolve 1-2 yrs
• Port wine stain- eval. for seizures
• Nevus vasculosus
• Educate parents

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Head

• Molding- over-riding sutures
• Palpate fontanelles
• Cephalahematoma- does not cross suture
• Caput succedaneum-crosses suture line

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Face-Nose

• Evaluate for symmetry and movement
• Ability to smell
• Obligate nose breathers

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Mouth

• Ability to discriminate
• Assess suck
• Check palate
• Precocious teeth
• Epstein's Pearls-disappear
• Thrush
• Teach hand washing

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Eyes

• Bluish white sclera
• Erythro.-for gonorrhea and Chlamydia
• Conjuctival hemorrhages
• Check reflexes
• Doll eyes- move in opposite direction
• Tearless
• Some visual acuity
• Strabismus

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Ears

• Symmetry
• Low set r/t Downs, mental retardation, renal
  problems
• Respond to sound
• Habituation
• Term vs. preterm
• Hearing Test

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Neck

• Lacks tone
• Provide support
• Evaluate for masses
• Check clavicles

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Chest-Respirations

• Xiphoid cartilage visible
• Breast engorged due to mat. hormones
• Do not squeeze
• Assess for grunting- retracting- flaring
• NSVD vs. C/S

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Cry

• Should be lusty, medium pitched
• Piercing cry from
• Hypoglycemia
• Neurological disorders
• Sepsis
• Withdrawal

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Abdomen

• Slightly distended
• Assess for tenderness and masses
• Bowel sounds
• NSVD vs. C/S

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Genitalia

• Note size of labia majora and minora
• May have pseudomenstruation
• Hymenal skin tag
• Clean gently

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Male genitalia

• Hypospadias- meatus on ventral side
• Phimosos-foreskin cannot be retracted
• Cryptotorchidism-testes not descended
• Hydrocele- excess fluid
• Dusky or solid- think torsion

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Extremities

• Count fingers and toes
• Polydactyly-Syndactyly
• Simian crease- associated with Downs
• Brachial palsy trauma
• Erbs entire arm
• Teach parents passive motion exercises

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Legs and Feet

• Evaluate skin folds
• Check for hip click
• Keep fingers over greater trochanter
• Evaluate for clubfeet

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Back

• Evaluate spine
• Straight, flat, no curves
• Visualize bottom of dimple
• Hair associated with spina bifida

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Umbilical cord

• 2 arteries-1 vein
• Begins to dry within 1-3 hours
• Falls off 7-10 days
• Note bleeding or discharge
• Wash hands- do not apply alcohol

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Newborn Reflexes

• Protective reflexes
• Moro- startle until 6 months
• Tonic clonic- fencing
• Grasp
• Rooting
• Babinski
• Sucking

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Newborn Behaviors

• Habituation-decreasing response to stimuli
• Attention to auditory and visual stimuli
• Motor activity- response to being held
• Alert, state, color changes
• Self quieting behavior
• Cuddliness