FORMAT IS AVAILABLE

1. NEWBORN ASSESSMENT/EXAMINATION

2. DEFINITION: It is systematic examination
(physical and neurological) of newborn
OBJECTIVES:
 1. To provide an assessment of infant’s
state of development of wellbeing.
 2. To detect any deviation from normal.
 3. To assess the progress of the child.

3. • INDICATIONS
First examination: a detailed one in labor
room within 2 hours of birth.
Second examination: Before discharge.
Third examination: After 6-8 weeks of
neonatal life.

4. . TERMONOLOGIES:
 • Small for gestational age (SGA)is less than 10% for weight at the time
of birth • Large for gestational age (LGA) is more than 90% for weight at
the time of birth • Appropriate for gestational age( AGA) is the birth
weight between 10-90%
 • FULL TERM: 37 to 42 weeks or 259 to 294 days. • PRE-TERM: after 28
weeks and before 37 weeks. • POST- TERM: after 42 weeks.

6. ARTICLES REQUIRED TPR Tray A tray containing: 1.
Hand washing articles 2. Apron 3. Stethoscope 4. Inch
tape 5. Torch 6. Bowl containing cotton wisp 7.
Weighing machine 8. Bowl with extra cotton 9.
Mackintosh 10. Kidney tray 11. Paper bag
INITIAL ASSESSMENT OF NEWBORN 1.
IDENTIFICATION Check and identify the sex of the
infant and verify the records with the correct name,
sex and registration number. 2. GESTATIONAL AGE
FULL TERM/ PRE-TERM/ POST- TERM

7. VITAL SIGNS Check the vital signs in the following
order: a) RESPIRATION: normal value of respiration is
40-60 breaths/min. b) HEART RATE: normal value of
heart rate is 120-140 beats/min. c) TEMPERATURE:
normal value of temperature is 36.5-37.5 degree
Celsius.
PHYSICAL EXAMINATION LENGTH: Crown to heel
length with infant supine/ upside down/ with the
knees slightly pressed down to obtain maximum leg
extension. (47-50 cm) HEAD CIRCUMFERENCE: It is
measured with a tape measure drawn across the
center of the forehead and the most prominent

8. CHEST CIRCUMFERENCE: It is measured at the level of
nipples and is about 2 cm less than head
circumference. 30-33 cm WEIGHT: Average birth
weight 2.5 -3.5 kg
POSTURE AND MOVEMENTS: # Supine position with
partial flexion of arms, legs and hand commonly
turned a little to one side. Hip joints are partially
abducted. # Movement is most evident in face and
limbs. Unusual movement or lack of movements and
asymmetry should be noted and reported.

9. 1.SKIN a) Colour: # Most term newborns have a
ruddy complexion because of the increased
concentration of red blood cells in the blood vessels
and a decrease in the amount of subcutaneous fat.
This ruddiness fades slightly over the 1st month. .
2.13. # Peripheral cyanosis appear due to immature
peripheral circulation. This is a normal phenomenon
in the first 24 to 48 hour after birth. # Central
cyanosis indicates decreased oxygenation. It may be
the result of temporary respiratory obstruction or an
underlying disease Cyanosis:
3.14. b) VERNIX CASEOSA: It is a white, cream cheese-
like substance that serves as a lubricant, is secreted
by the fetal sebaceous glands and which disappear
within a few days.
4.15. c) LANUGO: is the fine, downy hair that covers a
newborn’s shoulder, back and upper arms. It may be
found also on the forehead and ears. # Pre-term
newborns has more lanugo then post-term.
5.16. DESQUAMTION: Peeling of the skin takes place
few days after birth and most marked on the hands
and feet.

10. 1.e) MILIA: Newborn sebaceous glands are immature,
therefore pinpoint white papule can be found on the
cheek or across the bridge of the nose of newborn. It
disappear by 2 to 4 weeks.
2.18. f) Erythema toxicum: It begin as a papule,
increasing in severity to become erythema by the 2nd
day and then disappearing by the 3rd day.
3.19. Forceps mark: If forceps were used for birth,
there may be circular or linear contusion matching
the rim of the blade of the forceps on the infant’s
cheek. This marks disappear in 1 to 2 days along with
he edema that accompanies it.

11. 1. Skin turgor: If a fold of skin is grasped between the thumb and
fingers, it should feel elastic. When it is released it should fall
back to form a smooth surface. If severe dehydration is present,
the skin will not smooth out again and will remain in an elevated
ridge.
2.21. i) Mongolian spots: • Slate-gray to blue- black lesions
Usually over lumbo sacral area and buttocks Accumulation of
melanocytes within the dermis. Generally fade by age 7 years
3.22. 3. HEAD a) A newborn’s head appears disproportionately
large because it is one fourth of the total length. b) Fontanelles:
The anterior fontanelle will be felt as a soft spot. The posterior
fontanelle is so small that it cannot be palpated readily.
4.23. • Sutures: Suture lines should never appear widely separated
in newborns. Separation denotes increased intracranial pressure
from either abnormal brain formation, abnormal accumulation of
CSF in the cranium (hydrocephalus), or an accumulation of blood

13. 1.. EYES: Newborn’s usually crt tearlessely because of
the lacrimal ducts are not fully mature until about 3
months of age. # Eyes should appear clear without
any redness or purulent discharge. # we should
observe for subconjuctival hemorrhage, opthalmia
neonatorum etc.
2.28. EARS: The level of the top part of the external
ear should be on a line drawn from the inner canthus
to the outer canthus of the eye and back across the
side of head. # Ear Cartilage: Pinna firm, cartilage felt
along with the edge. # Ear Recoil: Instant recoil.

14. 1.6.MOUTH: # Mouth should be observed for cleft lip,
cleft palate and tongue tie. The palate of newborn
should be intact. Occasionally, one or two small
round, glistening, well- circumscribed cysts (EPSTEIN
PEARLS) are present on the palate, a result of the
extra load of calcium that was deposited in utero.
2.30. Sometimes in some newborns one or two natal
teeth may have erupted. NECK: The neck of newborn
is short, often chubby and creased with skin fold.
Head should rotate freely on it.

15. 1.8. CHEST: It looks small because the infant’s head is
large in proportion. # Possible breast engorgement
with possible secretion of thin’ watery fluid popularly
termed witch’s milk.. # Absence of retraction.
2.32. 9. ABDOMEN: # Bowel sounds present within an
hour after birth. # Edge of the liver usually palpable
at 1 to 2 cm below the right costal margin. Edge of
the spleen usually palpable at 1 to 2 cm below the
left costal margin.
3.33. UMBLICAL CORD • It has 2 arteries and 1 veins •
At birth cord appears bluish white and moist • After
clamping , it begin dry and appears a dull yellowish
brown and sheds after 6-10 days
4.34. If presence of 1 artery then it is associated with
V- Vertebral A- anorectal C- cardiac TE-
tracheoesophageal R- renal L- limbic
ABNORMALITIES

16. 1.10.BACK:The spine of newborn typically appears flat
in the lumbar and sacral areas. The base of the spine
should be free of any pinpoint openings, dimpling, or
sinus tracts in the skin, which would suggest a dermal
sinus or SPINA BIFIDA or occulta, Lumbar hair tuft &
haemangioma
2.36. 11. ANOGENITAL AREA # The anus of newborn
must be inspected to be certain that is present,
patent, and not covered by a membrane (imperforate
anus). Male Genitalia: Scrotum is pendulous and both
the testes are present in the scrotum. Males with one
or both undescended testicles (cryptorchidism) needs
further evaluation.
3.37. # Female Genitalia: in female newborns labia
majora fully covers labia minora. Some newborns
have a mucous vaginal secretion, which is sometimes
blood tinged, called pseudomenstruation. This
discharge disappears as soon as the infant’s system
has cleared the hormones.
4.38. . EXTREMITIES: We should observe for
syndactyly or polydactyly.

17. 1.SIMIAN CREASE Unusual curvature of the little
finger and a simian crease (a single palmar crease) are
signs of Down syndrome.
2.40. SOLES • A full term newborn have creases
covering the entire sole of the foot • Post –mature
infants have deep crease over the foot • A premature
infant sole crease mat partially cover the upper two-
third or may be absent
3.41. MECONIUM MECONIUM It is the first fecal
material , is a sticky , odorless material, greenish black
to brownish green which is passed from 8-24 hours
after birth URINE The first urine is diluted because of
immaturity of the kidneys and lack of ability to
concentrate urine.

18. 1.NEONATAL REFLEXES • Also known as
developmental, primary, or primitive reflexes. • They
can provide information about lower motor neurons
and muscle tone. • They are often protective and
disappear as higher level motor functions emerge
2.43. BLINKING OR CORNEAL REFLEX • Infant blinks
at sudden appearance of a bright light or at approach
of an object towards cornea. • It persists throughout
life. PUPILLARY REFLX • Pupil constricts when a bright
light shines toward it. • It persists throughout life
3.44. DOLL’S EYE REFLEX • As head is moved slowly to
right or left , eyes lag behind and do not immediately
adjust to a new position of head • Disappears as
fixation develops. • If persists, indicate neurologic
damage.
4.45. SNEEZING REFLEX Spontaneous response of
nasal passages to irritation or obstruction Persists
throughout life. GLABELLAR REFLEX • Tapping briskly
on glabella (bridge of nose) causes eyes to close
tightly. Disappers as brain matures

19. 1.NEONATAL REFLEXES • Also known as
developmental, primary, or primitive reflexes. • They
can provide information about lower motor neurons
and muscle tone. • They are often protective and
disappear as higher level motor functions emerge
2.43. BLINKING OR CORNEAL REFLEX • Infant blinks
at sudden appearance of a bright light or at approach
of an object towards cornea. • It persists throughout
life. PUPILLARY REFLX • Pupil constricts when a bright
light shines toward it. • It persists throughout life
3.44. DOLL’S EYE REFLEX • As head is moved slowly to
right or left , eyes lag behind and do not immediately
adjust to a new position of head • Disappears as
fixation develops. • If persists, indicate neurologic
damage.
4.45. SNEEZING REFLEX Spontaneous response of
nasal passages to irritation or obstruction Persists
throughout life. GLABELLAR REFLEX • Tapping briskly
on glabella (bridge of nose) causes eyes to close
tightly. Disappers as brain matures

20. 1.MORO’S REFLEX • Onset: 28-32 weeks GA • Well-
established: 37 weeks GA • Disappearance: 6 months
• The examiner holds the infant so that one hand
supports the head and the other supports the
buttocks. The reflex is elicited by the sudden
dropping of the head in her hand. The response is a
series of movements: the infant’s hands open and
there is extension and abduction of the upper
extremities. This is followed by anterior flexion of the
upper extremities and audible cry.
2.54. • MORO’S REFLEX
3.55. MORO’s SIGNIFICANCE • An absent or
inadequate Moro response on one side : hemiplegia,
brachial plexus palsy, or a fractured clavicle •
Persistence beyond 5 months of age is : indicate
severe neurological defects STARTLE REFLEX
4.56. STEPPING(DANCING) REFLEX • Disappearance:
3-4 months • Elicited by touching the top of the
infant’s foot to the edge of a table while the infant is
held upright. The infant makes movements that
resemble stepping.
5.57. BABINSKI REFLEX • Disappearance: 12 months •
Elicited by stimulus applied to the outer edge of the

21. 1.CRAWLING REFLEX • When placed on abdomen,
infant makes crawling movements with arms and legs
• Disappears at about age 6 weeks.
2.59. HARLEQUIN COLOR CHANGE • Color changes as
the infant lies on the side, lower half of the body
becomes pink or red, and upper half is pale • It is
entirely harmless and never been associated with
permanent problem
3.60. TORTICOLLIS (WRY NECK) • Head held to one
side with chin pointing to opposite side due to
positioning in the womb Exercise the neck gently in
opposite direction
4.61. FOOD FOR THE BRAIN

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