Assessment of normal newbornPresentation Transcript
Assessment of normal newborn
Asia suliman mohamedPostgraduate student Mch department
Each newborn baby is carefullychecked at birth for signs of problems orcomplications. A complete physicalassessment will be performed thatincludes every body system. Throughoutthe hospital stay, physicians, nurses, andother healthcare providers continuallyassess a baby for changes in health andfor signs of problems or illness.
the neonatal period include the time from birth through the twenty eighth day of life .Newborn infant usually are considered to be tiny and power less ,completely depended on others.
Normal newborn appearance is full term infant approximately 3,5 kg ,when fully extended measures 50cm from the crown of his head to his heels ,and has an occipitofrontal circumference of 34-35cm .his head comprises one-quarter of his size. He is plump and has a prominent abdomen . He lies in attitude of flexion .
History Physical examination
Infant:- Name………………………… Birth weight………………… gestational age…………… sex………………………….. date and time of birth….. race…………………………..
Name Age. Gravida , Para + . blood group & Rh . Race. Education level. labor, delivery. Type of contraception used.
Location of prenatal care and number of visits. Medications - drug, dose, route, length of therapy, indication, when used during pregnancy.
Labor spontaneous or induced? Complications of labor Fetal monitoring? Fetal distress? Rupture of membranes: artificial or spontaneous, hours before delivery, character of fluid. Medications - including analgesia and anesthesia: drug, dose, route, time prior to delivery .
Relationship of neonates mother and father (married, divorced, cohabiting, live apart, no contact maintained, etc.) Mother: amount of education, and is she employed outside of the home?Father: age, amount of education, occupation Any illnesses or other problems in household members? Any significant illnesses (physical, mental, growth failure) in other members of fathers or mothers family? If so, what? Is there any disorder(s) in particular that mother worries her child might develop?
◦ Type of housing (trailer, apartment, etc.)◦ Number of bedrooms; running water, bath; electricity.◦ Is adequate heating or cooling a problem? If yes, explain.◦ Do any of the children sleep in the same bed or same room as their parents?◦ Are there adults other than the parents sleeping or living in the house?
◦ Approximate level of income. Are there a lot of debts? ◦ Will the baby be an added financial stress? Mother-Child Relationship: Mothers affect; attitude toward the child; knowledge of child care.
The initial assessment using the Apgar scoring system. Transitional assessment during the periods of reactivity. Assessment of gestational age, and Systematic physical examination
The most frequently used method to assess the newborn’s immediate adjustment to extrauterine life is the Apgar scoring system. The score is based on observation of heart rate, respiratory effort, muscle tone, reflex irritability, and color
Sign Score = 0 Score =1 Score=2Heart Rate Absent Below 100 per minute Above 100 per minuteRespiratory Absent Weak irregular (gasping) Good cryingEffortMuscle Flaccid Some flexion arms & Well flexed or activeTone legs movement of extremitiesReflex No response Grimace or weak cry Good cry(IrritabilityColor Blue all over Body pink hands and Ping all over or pale feet blue
First period of reactivity: During the first 30 minutes the newborn is very alert, cries vigorously, may suck a fist greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
It lasts for about 2-4 hours. Heartand respiratory rates decrease,temperature continues to fall, mucusproduction decreases, and urine or stoolis usually not passed. The newborn is instate of sleep and relative calm.
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gag reflex is active, gastric and respiratory secretions are increased, and passage of meconium commonly occurs. Following this stage is a period of stabilization of physiologic systems .
General Measurements: Birth weight: 2500-4000 g. Head Circumference: 33-35 cm, about 2-3 cm larger than chest circumference. Chest Circumference: 30.5- 33 cm. Head to heel length: 48-53cm.
Posture: Flexion of head and extremities while rest on chest and abdomen.Skin: At birth, bright red, puffy smooth. Second to third day dark pink and dry. It is soft and has good elasticity or tissue turgor due to hydrated subcutaneous tissue. Edema is seen around eye, face, legs and scrotum or labia. Cyanosis of hands and feet.
It is a soft yellowish cream, which covers the neonates at birth to protect the skin from infection. It is formed of sebaceous gland mixed with old epithelial cells. It may thickly cover the baby or it my be found only in the body crease and between the labia. It dries off within24-48 hours and fades spontaneously .
It is a long soft growth of fine hairobserved on the shoulders, back, extremities,forehead and temples of the neonate. The morepremature baby is, the heavier the presence oflanugo is. It disappears during the first weeksof life.
Pealing of the skin occurs within2-4 weeks of life. These are denoted areas where the delicate skin has been rubbed off the nose, knees and elbows, because of pressure and erosion of sheets. The skin of buttocks is particularly sensitive and should not be left wet and /or soiled.
These are small pinpoint white or yellow spotsdue to increased fat secretion. Common on the nose,forehead, cheeks, and chin of the newborn infants.They can be felt with the fingers they consist ofaccumulations of secretions from the sweat andsebaceous glands that have not yet begun to functionnormally. They will disappear within a few weeks(one to two weeks). They should not be expressed.
The fontanels are soft spots. Consist of openings at the point of union of the skill bones.The anterior fontanel; is diamond in shape and located at the junction of two parietal and frontal bones. It is 2-3 cm in width and 3-4 cm in length. It closes between 12-18 months of age.The posterior fontanel; is triangular and located between the occipital and parietal bones. It closes by the 2nd month of age.Fontanels should be flat, soft, and firm. It bulge when the baby cries or if there is increased intracranial pressure.
Lids: Usually edematous. Color: Gary, dark blue, brown. True eyes color is not determined until the age of 3-6 months. Pupil: React to light. Absence of tears. Blinking reflex in response to light or touch. Rudimentary fixation on objects
Position: Top of pinna on horizontal line with outer canthus of eye. Startle reflex elicited by a loud sudden noise. Pinna flexible, cartilage present.Nose: Nasal patency. Nasal discharge – thin white mucous.
Intact, high-arched palate. Uvula in midline. Sucking reflex- strong and coordination. Rooting reflex. Gag reflex. Minimal salivation.Neck: Short, thick, usually surrounded by skin folds. Tonic neck reflex present.
Gastrointestinal System: ◦ Mouth should be examined for abnormalities such as cleft lip and cleft palate. ◦ Esptein pearls are brittle, white, shine spots near the center of the hard palate they mark the fusion of the 2 hollows of the palate. It will disappear in time.
◦ Gum: May appear with a quite irregular edge teeth are semi-formed but not erupted. ◦ Cheeks: Have a chubby appearance due to development of fatty sucking pads that help to create negative pressure inside mouth and facilitate sucking.Stomach and intestine: The capacity of infant’s stomach varies after birth from 30-60 cc and increase rapidly.
◦ Abdomen: Cylindrical in shape. Liver: Palpable 2-3 cm below costal margin. Spleen: Tip palpable at end of first week of age. Umbilical cord: Bluish white at birth with two arteries and one vein. It is formed of gelatinous connective tissue called Wharton’s jelly.
Heart: Apex- fourth to fifth intercostal space, lateral to left sternal border. Respiratory System: ◦ Slight sternal retraction evident during inspiration. ◦ Xiphesteranl process evident. ◦ Respiratory chiefly abdominal. ◦ Cough reflex absent at birth, present by 1-2 days. Soon after the head is delivered babies are nose breathers, they don’t breath through an open mouth.
Normally, the newborn has urine in his bladder and voids at birth or some hours later.Female genitalia: Labia and clitoris usually edematous. Urethral meatus behind clitoris. Vernix caseosa between labia..
Urethral opening is at tip of glans pens. Testes palpable in each scrotum. Scrotum usually large edematous, pendulous and covered with rugae and pigmented
There are maternal hormones that have crossed through the placenta to the baby. After birth these are withdrawn and cause some normal phenomenal such as:
Swollen breasts: This appears on 3rd day in both males and females. It lasts for 2-3 weeks and gradually disappears without treatment. Sometimes there is also breast secretion called “Witch’s milk”. Infantile menstruation: a few spots of blood for 1-2 days can be seen in the diaper.
Reflexes: Certain reflexes are absolutely essential to the infant life- as protective reflexes: ◦ Blinking reflex- it is aroused when the infant is subjected to light. ◦ Coughing and sneezing- to clear the respiratory tract. Gagging- to prevent choking. .
Feeding reflexes: ◦ The rooting reflex-cause the infant to turn his head towards anything, which touched his check, and in his way to reach for food. ◦ Sucking reflex provide such movements when anything touches the lips
Swallowing reflex: - It follows sucking reflex.The gagging reflex: - Comes into play when he has taken more into his mouth than he can successfully swallow, can also cough if a little of the fluid is swallowed the wrong way and enters the trachea.
The grasp reflex: An infant will grasp any object put into his hands, holds on briefly and then drop it. Moro reflex (startle reflex): This is aroused by a sudden loud noise or less of support. The tonic neck reflex: It is a postural reflex in which the infant when lying on his back turns his head to one side and extends the leg on the side to which the head turned.
◦ Extremities usually maintain some degree of flexion. ◦ Extension of an extremity followed by pervious position of flexion. ◦ Head lag while sitting, but momentary ability to hold the head erect.o Able to turn head in horizontal line with back when held prone.
Ten fingers and toes. Full range of motion. Nail beds pink, with transient cyanosis immediately after birth. Creases on anterior two thirds of sole. Symmetry of extremities. Equal bilateral brachial pulse.
•Extremities:•Ten fingers and toes.•Full range of motion.•Nail beds pink, with transientcyanosis immediately afterbirth.•Creases on anterior twothirds of sole.•Symmetry of extremities.•Equal bilateral brachialpulse.
Observation of the baby behaviour provides information about his general wellbeing .1/Feeding.2/excretion3sleeping and waking.
During feeds the midwife should observe the baby,s egerness or reluctance to feed ,theco –ordination of his sucking and swallowing reflex .she should note the frequency with which he demand feeds.sucking is interspersed with rest periods.
Observation of the phases of the stools and of any vomiting helps to identify abnormalities of the gastro- intestinal tract ,in born errors of metabolism and infection.
A newborn baby usually sleeps for most of the time between feeds but should be alert and responsive when awake .
Each day the baby should be examined by a midwives to evaluate his progress and identify problems as they arise.