2. Normal Newborn
Average duration of pregnancy is 37-40 weeks.
A baby born after this period weighs 2.8 kg.
Any newborn with a birth weight of < 2.5 kg. is
classified as a Low Birth Weight Baby (LBW)
characteristics of a normal newborn
Weight 2.5 – 3.5 kg.
Length 45-55 cm.
Head circumference 33-35 cm.
Chest circumference 30-33 cm.
3. Cont…
vitalsigns-
Temperature- 96.8*-99*F (Axillary)
Heart rate 120-160 beats per minute.
Respiratory rates 30-60 breath per minute.
B.P. Usually not require, 80-90/40-50 mmHg
Extremities are bluish for short time period after birth, but
becomes pink within a few hours.
Urine is passed during birth or immediately after birth, but
a vast majority passes urine within the 24 hours.
First stool (meconium)
Black in colour and is paste like. Meconium is passes
within the first day and the stools change to golden brown
over the next 2 – 3 days.
4. Major steps in newborn assessment
Assess with initiation of respiration
Apgar score
Vital sign
Physical examination(head to toe)
Anthropometric measurement
Reflexes
5. Score of 0 Score of 1 Score of 2
Component
of acronym
Skin
Colour/Compl
exion
blue or pale
all over
blue at
extremities
body pink
(acrocyanosis)
no cyanosis
body and
extremities
pink
Appearance
Heart rate <60 <100 ≥100 Pulse
Reflex
irritability
no response
to stimulation
grimace/feebl
e cry when
stimulated
cry or pull
away when
stimulated
Grimace
Muscle tone none
some flexion
of extremities
flexed arms
and legs that
resist
extension
Activity
Breathing absent
weak,
irregular,
gasping
Good, strong,
crying
Respiration
Apgar score (1952, Dr.Verginia Apgar)
6. PHYSICALEXAMINATION
GENERAL MEASUREMENTS
Age
Term = start of 38th wk. end of 42nd week.
Preterm = before end of 37th wk.
Post-term = after end of 42nd wk.
Weight: - 2.5 kg. or above
Length:- 45-55 cm
Apgar Score:-7-10 is normal
7. HEAD MEASUREMENT
Shape- Round symmetrical , may have moulding ,
overriding sutures, Slight asymmetry.
Microcephaly <32 cm
Hydrocephaly >4 cm from chest
Cephalohematoma
Size-33-35 cm (2 cm> CC)
Fontanells
size,
shape,
consistency
8. Anterior Fontanells -
Sutures, palpable slight Soft
3-4 cm long
2-3 cm wide
Diamond shape, Full bulging, large, depressed,
Closed on 12-18month.
Posterior Fontanells
1-2 cm
Triangular shape
Closed on 2-3 month.
9. EYES
Symmetrical & clear
Color :- Greyish/ blue or gray brown iris, Blue white
sclera,
Movement :- Random, jerky, uneven. Focus
momentarily.
Reaction to Light :- Pupils equal in size, round
and reactive to light. fixed
Eyelids :- Size and movement symmetric, Blink
reflex, Eyes on a parallel plane.
Cross hand for inspection and vision
10. EARS
Reaction to noise Startle reflex to loud noise.
Position :-
Symmetrical.
Line drawn through inner and outer canthus of
eye comes to top notch of ear as pinna (where it
connects with scalp.)
Patency
Evidence of hearing. Reaction to noise.
11. NOSE
Symmetrical
Position
Situated in Midline
Mucus Clear,
Patency:-
Infants obligatory nose breathers.
Sneezing is common.
Flaring of nares
12. MOUTH
Symmetrical
Presence of sucking, gagging, rooting and
swallowing reflexes
Hard & soft palate intact,
Pink lip, no cracking, check mucus mem.
Presence of natal teeth or not,
Freely moving tongue
Oral infections (if any) -
(look for presence of “Thrush” candida albicans – white patchy are of
tongue & gums with pain )
13. NECK
Mobility
Short and thick
Stiffness or rigidity
Trachea and head held in midline
Cyst or mass
Excessive skin folds (trisomy 21)
Webbing
14. CHEST
Size &Shape
Almost circular, Barrel shaped.
2-3 cm <head circ. (30-33cm)
Breast tissue
3-10 mm breast nodule,
Nipples prominent
Breast tissues are present, equal in size
15. RESPIRATIONS
Rate: - 30-60/min
Tachypnea > 60/min
Bradypnea < 25/min
Rhythm: - Shallow, Irregular when infant awake.
Muscular activity involved-
Simultaneous rise and fall of chest and abdomen.
Subcostal and substernal retractions.
16. ARMSANDHANDS
Length --Arms equal in length.
Movements –Spontaneous, Full range of motion, Limited
movements.
Muscle tone --Generally flexed. Fist often clenched with
thumb under finger.
Erb’s palsy -damage to bronchial plexus during delivery (5th/6th
cervical nerve)
Fingers-Number should be Correct & check Absence of or
additional, or Short.
Position -Fists often clenched with thumb under finger.
Check palmer grasps reflex
Redial and brachial pulses are palpable
17. ABDOMEN
Contour
Rounded, protruding, distended or
Scaphoid (when the abdomen is sucked inwards)
Musculature Not fully developed.
(Bowel sounds audible 1-2 hours after birth)
18. UMBILICAL CORD
Assess Number of vessels at birth
(2 arteries & 1 vein )
Appearance
Clear,
gelatine
Odourless.
Drainage or
Redness
Cord should be clamped for at least first 24 hrs after
birth , clamped can be removed when cord is dried
or occluded and no longer bleeding occurs
19. GENITo-URINARY
Female Ambiguous genitals
(infant's external genitals don't appear to be clearly either male or
female)
1. Labia --Usually edematous
a. Size -Covers labia minora & majora widely
separated
b. Appearance --May have pigment,
Symmetric in size, Minora prominent.
2. Vaginal discharge:- Absence of vaginal orifice.
Color :- Smegma under labia, May be blood
tinged, Fecal discharge.
20. Male
1. Testes in scrotum
Palpable each side, Large.
Cremasteric reflex. (inner part of the thigh stroked)
Assess Abnormality/ Undescended
Scrotum smooth.
2. Urethral meatus at end of penis ,
Correct position , Prepuce (foreskin) covers glands
21. Voidings :
Color --Clear, light yellow.
Amount --Well saturated diapers
Frequency --By 24 hrs after delivery. At least 3-4
times/day
Specific gravity -1.008-1.010
RECTUM
Patency-Good sphincter tone of anus.
22. Spine
Straight, posture flexed, supportive,
easily moveable
Feel neck of sacrum (any dimple/ mass)
called Mangoliyan’s part (discoloured
area of blue/black part)
Back of leg and folds of skin matched
from another
23. Pinkish red/brown/yellow,
Assess Vernix caseosa (cheesy white substances on entire
body, more prominent between folds of skin or may be absent
after 24 hrs)
Lanugo present (fine body hair especially on back)
Milia (small white sebaceous gland appear on forehead, nose & chin)
Assess cyanosis or Acrocyanosis
Assess skin turgor over abdomen to detect hydration
status
Assess Harlequin’s sign- (deep pink/red colour develops over
one side of newborn’s body while other side remains pale/normal)
Harlequin’s sign present due to shunting of blood with
cardiac problems
Assess birth marks (if any)
24. Keep newborn warm
Measure apical pulse for full 1 min
Listen murmurs; Oxygen saturation via pulse
oximetry
Palpate pulses in both hands
Assess cyanosis
25. Observe resp. distress or hypoxemia
Nasal flaring; grunting; cyanosis;
bradycardia or apnea
Suction airway (if nacessary) with bulb
syringe for upper airway and “French
catheter” for deep suctioning
Administor oxygen if nacessary
Count respiration for 30 sec to full min.
26. Observe tone, behaviour, movements and
posture.
Assess newborn reflexes only if there is cause
for concern-
Rooting Reflex
Gagging Reflex
Sneezing and coughing Reflex
Blinking Reflex
Palmer grasp Reflex
Planter grasps Reflex
27. VITAL SIGNSAND GENERALMEASUREMENTS
Temperature(Range 36.5 to 37*C, axillary)
Common variations:
Crying may elevate temperature
Stabilizes in 8 to 10 hours after delivery
Heart rate (120 to 160 beats per minute)
Common variations:
Heart rate range to 100 when sleeping to 180
when crying
Color pink with acrocyanosis
Heart rate may be irregular with crying
28. Cont...
Respiration (30 to 60 breaths per minute)
Common variations:
Bilateral bronchial breath sounds
Moist breath sounds may be present shortly after birth
29. ANTHROPOMETRICMEASUREMENT
Head Circumference - 33 to 35 cm
Expected findings
(Head should be 2 to 3 cm larger than the chest)
Chest circumference – 30 to 33 cm
Common variations:
Moulding* of head may result in a lower head
circumference measurement
Head and chest circumference may be equal for
the first 24 to 48 hours of life
Weight range - 2500 - 4000 gms
Length range - 48 to 53 cm (19 - 21 inches)