assessment of newborn

1. Neonatal
Assessment
Presented by: Ms. Deepa krishnaPresented by: Ms. Deepa krishna
11 M.Sc nsg11 M.Sc nsg
RMCONRMCON

2. INTRUCTION:
Newborn assessment is done as soon as after
birth as possible, the mother should be
allowed to spend some time with the baby
immediately after birth to initiate the bonding
process. Early assessment can assist the
nurse in ascertaining if the newborn is infant
is within the arrange of ‘normal’.
Definition:
• Health assessment is thorough inspection or
a detailed study of entire body or some part
of the body to determine the general physical
or mental conditions of the body.

3. Purposes:
• To understand the physical and mental
well being of the child.
• To detect disease in early stage.
• To determine the cause and effect of the
disease.
• To teach child and parent.
• To measure the health in future.
• To determine the nature of treatment or
care needed for the child.

4. • General Points to be Remembered During Examination
of a Newborn:
– examine 1 hour after feeding
– examine in neutral thermal environment
– examine the presence of the mother.
– examine gently, methodically ( from top to bottom)
– examine those system which require a quiet child first and later
do examination that tend to disturb the child. Eg. Reflex testing,
ear examination.
Recommendations for general physical examination is to
examine patient in a supine position from the patient’s
right side. Right side is preferred because;
• Right jugular veins are more reliable for estimating
venous pressure.
• Palpating hand rests more comfortably on apical
impulse.
• A kidney is more frequently palpable.

5. Health assessment:
Assessment of the newborn as sson as possible after birth
and subsequent assessment in the neonatal period are
responsibility of the mucous working in the hospital and
in the community.
PHASES ASSESSMENT:
 Initial
 Transitional
 Assessment of gestational age
 Systemic physical examinations

6. • INITIAL ASSESSMENT:
• The most frequently used method to assess the newborns
immediate assessment is done in newborn life including Apgar
Scoring System.
Apgar Scoring:
In 1953, virgenia Apgar introduced a simple systematic assessment of
intrapartum stress and neurologic depression at birth.

8. Causes of low Apgar Score:
• Asphyxia
• Maternal drugs
• Central nervous system disease
• Congenital muscular disease
• Prematurity
• Fetal sepsis
TRANSITIONAL ASSESSMENT:
1 stage: lasts for 6 hours, first 30 minutes awake, remaining hours
baby will be sleeping.

9. • 2 stage: 6 to 12 hours observation should be made until the vital
signs are stabilised.
ASSESSMENT OF GESTATIONAL AGE:
Dubowitz scale:It is an imporatnt criteria because perinatal morbidity
and mortality are related to gestational age and birth weight. A
frequently used method is by the use of determining gestational
age is by the ‘ Dubowitz scale’ a simplified version developed by
Ballard,Novack and Driver (1979).
Ballard scale: the new ballard scale is a revised scale of dubowitz
scale. It can be used with newborns as young as 20 weeks of
gestation. The tool has the same physical and neuromuscular
sections but includes -1 and -2 scores.
Neuromuscular maturity include: posture, square window, arm recoil,
popliteal angle, scarf sign, heel to ear.
Physical maturity: skin, lanugo, plantar surface, breast, eye/ear,
genital(male, female)

10. • GENERAL PHYSICAL EXAMINATIONS:
Vital signs:
Temperature: --neonates normally respond to infection with low
temperatures.
-- in neonates the temperature can be taken from the groin, axilla or
groin.
Normal temperature  36.5-37.5oC
Hypothermia  < 36o C
Hyperthermia  > 41oC
Respiration: -- count by observing the abdominal movements in
infants as the movement are primarily diaphgramatic.
-- count for one full minute for accuracy.
normal respiration  35 breath/ min
tachypnoea  >40 breath/min
bradycardia  < 20 breath/min

11. • Pulse:
 apical pulse are more reliable for infants (between 4th
and 5th
intercoastal).
 Pulse is counted for one full minute in infants and young children.
Blood pressure: manual blood pressure monitoring is not
routinely done in neonatal nursery but in certain circumstances
with Oscillometry. The average systolic/ diastolic pressure is
65/44mmHg at 1 to 3 days of age.

12. • ANTHROPOMETRIC MEASUREMENTS:
Puposes:
1. To assess the body’s size against known standards for the
population.
2. To compare the size with estimated period of gestation
3. To provide a baseline against which susequent progress can be
measured.
Weight: it should be recorded within an hour of birth.
Average weight for term babies is about 2.5kg to 3.5kg.

13. • Length: the length can be taken more accurately in a
measuring table or a board with a fixes head piece on which the infant
lies supine with his legs fully extended. The average length of a
newborn is 48-50cm.
Head circumferance: this measurement may slighlt change during the
first three days owing to moulding during labour, scalp oedema or
bruising and cephalhematoma.
• Normally head circumferance is 33-35cm in a term baby.
• Head circumferance is 2-3 cm larger than chest circumferance.

14. • Chest circumferance: it is measured around nipple line
in mid expiration. Normal chest circumferance
30-33cm.
Abdominal circumferance: it will be same as that of the
chest circumferance.

15. • GENERAL APPEARANCE:
Physical activity: the first 30 min , immediately after birth the
baby will be active. The newborn will be at sleep most of the time for the first 3
days.
Posture: normal posture is that of universal flexion. Extended posture of
newborn may be due to hypotonicity.
Head to foot examination:
Area Normal Abnormal
Skin Color: pink in colour
Texture: soft
Turgidity : sensation of fullness
derived from the presencwe of
hydrated subcutaneous tissue.
Elasticity: when the skin is
grasped and released, the
skinpromptly springs back.
Lanugo:
Vernix caseosa
Mongolian spot
Milia etc
Pallor: anaemia, edema, shock,
hypoxia, hypotension.
Cyanosis: central cyanosis, CHD,
severe respiratory distress.
Jaundice: within first 24hrs-
hemolytic disease, Rh
incompatability, ABO
incompatabitlity.
Within 24hrs- physiological
jaundice.
Petechiae: infection, DIC
Edema: over hydration,renal
failure,CHD, anemia. etc

17. area normal Abnormal
Cry Depressed: maternal
sedation, asphyxia
neonatorum etc.
High pitched cry: CNS
involvement.
Weak cry: respiratory
distress.
Head Head circumferance: 33-
35cm
Sutures are normally
palpable as cracks.
Fontanalle: anterior
fontanalle-closes by 9-18
months. Its having
diamond shape.
Posterior fomtanalle:
closes by 2-4 months.
Microcephaly: H.C<2.5cm
of standard deviation.
Macrocephaly: H.C>2 cm
of standard deviation
Widely seperated sutures:
preterm, hydrocephalus,
cerebral oedema, high ICP
.
Bulging fontanalle:
subdural hemorrhage,
hydrocephalus, TORCH,
dymaturity, CHF.

18. Area Normal Abnormal
Delayed closure: rickets, hypothyroidism,
down syndrome.
Caput succedenum: diffuse swelling of
subcutaneous tissue, over presenting part at
birth, not restricted to suture line.
Cephalhematoma: well demarcated
subperiosteal hemorrhage over parietal
bone, restricted by suture line.
Hair Fine silky hair. Preterm- fuzzy hair
Low hair line- turner’s syndrome.
Eyes Eye movements are not
coordinated.
Eyelids may be edematous
for 2 days.
Sclera may be pale
coloured.
Iris of the eyes should be
round.
Upper slant- down syndrome
Cataract- congenital rubella, CMV etc
Conjunctivits:
Nystagmus:
Corneal reflex should be ruled out.

19. Areas Normal Abnormal
Nose Neonates are obligatory nose breathers.
Nose is usually flattened after birth. Nasal
patency should be assessed.
oral breathing: obstruction by mucus
plugs, choanal atresia.
Ears Top of pinna should be in line with outer
canthes of the eyes.
Tympanic membrane will be grey in
newborn. Normal infants hear at birth and
startle or have a complete moro reflex with
a sudden noise.
Low set ears- a feature of genetic
syndrome.

20. Areas Normal Abnormal
Mouth or throat Epstein pearls are normally found on
both sides of the hard palate.
Precocious teeth may be present which
fall off soon.(1 in 2000 births)
Excessive salivation: hare lip, cleft
palate, deviation of angle of mouth –
7th
nerve palsy.
Neck Neonates neck is usually short. To
examine the neck, head should be
extended.
Webbing of neck- turner’s
syndrome.
Swelling of neck- sternomastoid
tumor common in breech,forceps
delivery etc
Thorax Shape- normally barrel shaped
Respiratory rate- 40-60 breath/min
Heart rate- 120-160 beats/min
Type of breathing –diaphragmatic
Witch’s milk- normal
Supernumerary nipples- harmless
Swollen breast- normal
Emphysematous chest-
pneumothorax.
Dextrocardia- suspect diaphgramatic
hernia
Abdomen Normally- protruberant
Inspection- round in shape
Palpation- liver can be felt 1inch (2-
3cm) below right coastal margin.
Tip of the spllen may be palpable by
about 1 weekafter in left upper
quaderant
Scaphoid- diaphramatic hernia
Distended- ascitis,hydronephrosis,
meconnium ileus etc.
Prominent liver- hematoma,
hepatoblastoma.
Gastric mass-bag & mask
ventilation, duodenal obstruction

21. Areas Normal Abnormal
Abdomen Percussion- help to identify any fluid or
gas collection
Auscultation- bowel sounds can be heard
soon after the initiation of feeding
Kidney may be palpable in case of
hydronephrosis, renal vein thrombosis.
Umbilical
cord
Color- blue to white at birth
Structure- 2 arteries and 1 vein are seen.
Green in mechonium staining
Single artery may be associated with
cardiac anomalies, intestinal
malformations.
Gentalia Male: normally perpuce covers the entire
glans penis. Sometimes perpuce cannot
be retracted back upto 4-6 months in
normal babies.
Scrotum: varies in size, rugated with
descended testis.
Female: normally labia majora covers
labia minora
Phimosis, hypospadiasis, epispadiasis.
Pretem female babies- labia majora does
not cover minora.
Spine Normally the curvature of the spine is
“C” shaped.
Tuft of hair, spina bifida,
meningomyelocele.
Anus Anal patency should be checked
Mechonium should be passed within
24hrs of birth.

22. • SYSTEMIC ASSESSMENT:
A careful general examination of a newborn baby provides
more information of the condition of the baby. The system
to be examined includes:
1. Cardiovascular system
2. Respiratory system
3. Central nervous system
Examination of CVS: history of drug and TORCH exposure
Anomalies - cleft lip/ cleft palate, cataract, polydactyl.
Repiratory rate - normal/ increased or decreased/ type of breathing
Pulse - 120-160 beats/min apical pulse normally taken
Average BP - term baby: 70/45mmhg
preterm: 60/20mmhg

23. • Examination of respiratory system:
History of cough - pneumonia
Diabetes mellitus - RDS
Preterm - RDS
Polyhydromnios - asphyxia, respiratory distress
Character:
Dyspnoea, tachypnoea, apnoea, grunting.
Examination of central nervous system:
- examination of neonatal reflexes
- Conventional examinations:
> consciousness; immediate and delayed response to external stimuli,
response to comforting, excessive crying, excessive quiteness.
> involuntary movements: jitterness, convulsive
movement, spasms of tetanus.
- neurological examination for the assessment of gestational age

24. REFLEXES OF NORMAL
NEWBORN
• Swallowing
Accompanies the sucking
reflex.Food reaching the posterior of the
mouth is swallowed.
• Extrusion
Substance placed on the anterior
portion of tongue.Extrusion of substance to
prevent swallowing.

25. • Sneezing and coughing
Foreign substance entering the upper
or lower airways.clearing of the upper air
passages by sneezing.Clearing of the
lower passages by swallowing.
• Blinking
Exposure of eyes to bright light.
Sudden movement of object toward eye.

26. Babinski

27. Moro Reflex

29. Rooting

30. Sucking

31. Doll’s Eye

32. Palmar grasp

33. Thank you