The document discusses the newborn period from birth to 4 weeks of age. It covers the physical exam and assessment of a newborn, including vital signs, measurements, skin characteristics, and examination of individual body systems. The key points are that the newborn period is a critical time of transition from intrauterine to extrauterine life and newborns require close monitoring and management to support this adaptation. A thorough physical exam provides important information about the newborn's health, growth, and maturity.

2. ◦ Newborn period is an important link
in the chain of events from
conception to adulthood. The
physical and mental wellbeing of an
individual depends on the correct
management of events in the
perinatal period.

3.  Newborn period –first 4 weeks
of extrauterine life.
 Early neonatal period-7 days
 Late neonatal period-7 to 28
days

4. By weight
 Low birth weight(LBW)=<2500
gm
 Very low birth
weight(VLBW)=<1500GM
 Extremely low birth
weight(ELBW)=
Under 1000gm

5. By gestational age
Relation ship between weight(for
assessment of growth) &gestational
age(assessment of maturity)plotted on
centile chart.

7. Examination of the newborns physical
and neurologic characteristics to
determine the no: of weeks from
conception to birth.

8.  NEW BALLARD SCORE
- It includes the examination of
Neuromuscular characteristics & physical
characteristics of newborn.
-It provides accurate information
within 2 weeks & the most accurate result
within 12 hours after birth.

9. o Posture :-degree of flexion of the extremities
& posture.

10. oSquare window:-flexing the
hand at the wrist until the palm
is as flat against the fore arm.

20. -1 0 1 2 3 4 5 SCOR
E
LIDS
OPEN,LOOSE
LY
-1,TIGHTLY
LIDS OPEN
,PINNA
FLAT,STAYS
FOLDED
CURVED
PINNA,SOFT,
SLOW
RECOIL
WELL
CURVED
PINNA,SOFT
BUT READY
RECOIL
FORMED &
FIRM,INSTAN
T RECOIL
THICK
CARTILAGE
EAR STIFF

26. CLASSIFICATI
ON
WEIGHT PERCENTILE
SMALL FOR
GESTATIONAL
AGE(SGA)
<2500GM 10TH
PERCENTILE
APPROPRIATE
FOR
GESTATIONAL
AGE(AGE)
2500-4000GM 10-90TH
PERCENTILE
LARGE FOR
GESTSTIONAL
>4000GM >90TH
PERCENTILE

27.  RESPIRATORY SYSTEM
The most critical and immediate
physiologic change required of the newborn is
onset of breathing.
Stimuli for the initiation of respiration
is chemical & thermal factors.
Chemical- ↓O2,↑CO2,↓ph
Thermal- sudden chilling of the
baby who leaves the warm environment .

28.  Tactile stimulation and delayed cord
clamping also have some effect in initiation
of respiration.
 Periodic breathing:-shallow irregular
breathing with brief 10-15 second periods
of apnoea.

29.  Transition from fetal to post natal
circulation.
 Functional closure of shunts.
 Allows blood to flow through lungs.

32.  Foramen ovale:-Functional closure will occur
at birth. Anatomic closure may take several
weeks(4 months).Once it permanently closed
it is called fossa ovale.
 Ductus arteriosus:-functional closure during
first few days(3-12) days. Anatomic closure
by 2 months. Once it closed it is called the
ligamentum arteriosum.

34.  Ductus venosus:-when the umbilical cord is
clamped at birth, little blood enters the
ductus.The vessel will constrict and
permanent closure occurs by 7 to 14 days
after birth.

35.  Closure of umbilical vessels:- These are
obliterated within few days after birth.
Umbilical vein can remain patent up to 5-
6 days if cord is kept moist.
 Umbilical arteries:- obliterated after 2-3
months, distal part form as lateral
umbilical ligaments and proximal part as
superior vesical arteries.

36.  Heat regulation is most critical for newborns.
 Factors predispose the newborn to excessive
heat loss
-newborns large body surface area
-thin layer of subcutaneous fat
-non shivering thermogenesis

37.  Blood volume-80 to 85 ml ∕kg
 Hemoglobin- 14.5 to 22.5 g∕dl
 Erythrocytes -4.8 to 7.1 million ∕mm3
 Hematocrit-48% to 69%
 Leucocytes-9000-30,000mm3

38.  At birth-total weight of newborn is 73% of
fluid
 High extra cellular fluid, sodium, and
chloride
 Decreased level of K+ ,Mg2+ ,& PO4-

39.  Stomach- capacity at birth 6ml∕kg
later 90ml∕kg
Enzymes-deficiency of pancreatic lipase
 Liver- immature, deficiency of gluconoryl
transferase
 Intestine- longer in relation to body size

42.  Stool pattern
-meconium
amniotic fluid,lanugo,
mucus, bile etc
-transitional stool

43.  First voiding within 24 hours.
 About 15 ml per voiding, around 15 – 20
voidings, by the end of the first week.
 200-300 ml over 24 hours by the end of
first week

44.  First 2 days of life
intake :-40 to 60 ml ∕kg
output:-at least 1 to 2 days of voidings
 After 2 days
intake:-100 to 150 ml∕kg
output:-at least 6 voidings by the 4th day

45.  All structures are present but the function is
immature
 Epidermis and dermis is loosely bound
 Sebaceous gland:-on scalp, face& genitalia
producing vernix, plugging of gland causes
milia.
 Eccrine gland:-producing sweat
 Apocrine gland:-small and non functional
until puberty
 Growth phases of hair follicles will occur at
birth

46. • Ossification process during the first year.
• Nose is predominantly cartilage at birth
• Growth in size of muscular tissue by
hypertrophy

47.  First line of defense-skin and mucus
membrane
 Second line of defense-cellular elements of
immunologic system( neutrophils ,
monocytes , eosinophils &lymphocytes)
 Third line of defense- formation of antibodies
such as Ig G, Ig M ,Ig A

48.  Function of the system is immature
eg:limited production of vasopressin leads
to diuresis
 Effect of maternal sex hormones is evident (
witch milk ,pseudo menstruation etc)

49.  Most neurologic functions are primitive
reflexes
 ANS is crucial during transition period
because it stimulates initial respirations,
maintain acid base balance &partially
regulates temperature control
 Myelination progress

50.  Vision-tear glands do not begin function
until 2 to 4 weeks of age
 Ciliary muscles are immature
 Ability to focus object within 20 cm
 Visual preferences

51.  Hearing:-reacts to loud sound of about 90
dbls with startle reflex
 Low frequency sound tends to decrease
crying or newborns motor activity
 External ear canal is short & not developed
properly , tympanic membrane & facial nerve
is very close to the surface & can be easily
damaged

53.  Taste:-ability to distinguish between tastes
 Various types of solutions elicit different
gusto facial reflexes
 Touch:-newborn is able to perceive tactile
sensation in any part of the body
Smell:-reacts to strong odour by turning
the head
Are able to smell breast milk

54.  At 1 minute & 5 minutes after the newborns
birth five objective criteria should be
evaluated to determine the need for life
saving support.

56. Measurements
 LENGTH:-
NEWBORN BOY-20 inches(50 cm)
NEWBORN GIRL-19.6 inches( 49cm)
NORMAL RANGE:-19 to 21.5inches
(47.5 to 53.75 cm)
By using :- -Ruler printed/scale
-Tape measure

57.  Weight
Ranges between 2500-3999 gm
Average weight:-3400 gm

58.  Head and chest circumference
H.C=32 to 38 cm
C.C=30 to 36 cm

59. Crown to rump length :-31 to 35 cm(12.5-
14 inches)
Head to heel length :-48 to 53 cm(19-21
inches)

60.  Vital signs
temperature:-36.5 to 37°c(97.9-98°f)
pulse :-120 to 150 beats/ mt
respiration :- 30 to 60 breaths/ mt
B.P :-65/41 mm Hg(by oscillometric
method)

61. • Posture
flexion of head & extremities ,which rest on
chest & abdomen.
-at birth, bright red, puffy and smooth

62.  Integument
 lanugo-slight distribution of hair over the
body, on the head, shoulders
extremities, forehead & temples
 vernix caseosa-cheese like greasy, yellowish
white substance, which covers the newborn
skin
 tissue turgour-elasticity of the skin
 Miliaria-distended sweat glands that appear as
minute vesicles,esp: on face.

64.  desquamation – peeling of the skin during
the first 2 to 4 weeks of life
 milia –distended sebaceous gland appears
as tiny white papilae,occuring in the nose &
chin ,it will disappear in a week or two

65. • Physiologic jaundice-b/w third & seventh
day
• Telangiectatic nevi(stork bites)-flat, red
localized area of capillary dilatation on the
upper eye lids b/w eyebrows, on the
nose,upperlip& back of the neck

66. • Erythema toxicum –a pink papular rash on which
vesicles may be superimposed.
 Cutis marmorata –transitory mottling of the skin
Cutis marmorata Erythema toxicum

67. • Acrocyanosis –symmetric cyanosis of the
extremities.

68. •Harlequin color change – a rare
discrepancy in color between the two
longitudinal halves of the body ,when
neonate placed on the same side for
several minutes

69. • Mongolian spot-slate colored spot occurred
on the buttocks or lower portion of back of
the baby

70. • Fontanelle
.anterior fontanale:-diamond shape,
located at the junction of two parietal and
two frontal bones,2 to 3 cm in width & 3 to
4 cm in length. it is closed by 12-18
months
. posterior fontanele:-triangular ,between
occipital & parietal bones, 0.5-1cm length
closed by 4-6 weeks

72. -swelling or edema in the presenting
portion of the scalp, disappears by 3rd day

73. accumulation of blood b/w the periosteum &
a flat skull bone, clears within few weeks.

75. • Eyelids may edematous for first 2 days
• Lacrimal fluid is present
• Sclera-white & clear
• Subconjunctivital hemorrhage-disappears
within 2 to 3 weeks
• Cornea-transparent & clear
• Iris –round in shape

76. • Examine for position, structure & auditory
function
• Top of the pinna should be in the level of
outer canthus of eyes.
• pinna is very soft until the cartilage calcifies.

78. • nose is usually flattened
• patency of the nasal canals should be
checked
• sneezing & thin white mucus is common

79. • Lip is pink and tongue will smooth &
symmetrical
• Palate is normally high arched & narrow
• Precocious dentition may be observed
• Epstein pearls may present
• Uvula in midline
• Look for tongue tie

81. • Short ,thick usually surrounded by skin folds
• While inspecting slightly hyperextend the
neck & support the back
• Observe for range of motion,shape,abnormal
masses, any clavicle fracture etc.

82. • Chest is bell shaped, its circumference is
same as of abdomen
• Thorax of newborn is almost circular
• Anterioposterior and lateral diameter of chest
is same
• Witch's milk:-pale milky fluid produced by the
newborn due to the hormonal activity
originating from mother. It disappears 2 to 3
weeks after birth
• Thymus is located in the upper chest

83. • Vascular system & heart is large in neonate
with their size in adult life
• Blood volume -10 to 12 % of body weight
• High RBC & Hb
• Physiologic jaundice

84. • Cardiac sphincter is not developed as well as
pyloric sphincter
• Stomach. The capacity of the infant's
stomach is about one to two ounces (30 to 60
ml) at birth for 2 weeks, but increases rapidly.
Milk passes through the infant's stomach
almost immediately. The infant is capable of
digesting simple carbohydrates and proteins,
but has a limited ability to digests fats.
 Intestines. Irregularity in peristaltic motility
slows stomach emptying. Peristaltic
increases in the lower ileum, which results in
one to six stools a day.

86. • It appears cylindrical & slightly protuberant
• Bowel sounds can hear
• Umbilical cord:-bluish white at birth with two
arteries and one vein,whartons jelly may present
• Examine the umbilical cord for any bleeding,
abnormal foul discharge,1artery etc
• Umbilical cord should keep dry & clean. It sloughs
off by 6 to 10 days after birth
• Palpate the abdominal organs
liver-2-3 cm below the right costal margin
spleen-tip by the end of first week
kidney-1-2cm above the umbilicus
. femoral pulses-equal bilaterally

87.  Wharton's jelly

88. • Examine for redness or fissure in anal
region
• Passage of meconium within 48 hours

89. • Labia and clitoris is usually edematous
• Urethral meatus behind clitoris
• Vernix present between labia
• Urination within 24 hours
• A hymenal tag may present

90. • Urethral opening at the tip of glans penis
• Testes palpable in each scrotum
• Scrotum usually
large,edematous,pendulous,&covered with
rugae
• Foreskin of the penis may adhere to glans
• Urination within 24 hours

93. • Back is straight &flat when the baby is lying
prone
• Examine for abnormal
openings,masses,dimples or soft areas
• Gluteal folds should be symmetrical

94. • Inspect for symmetry & range of motion
• Count the fingers,toes,polydactly &
syndactly
• Nail beds are pink
• Equal muscle tone bilaterally, especially
resistance to opposing flexion
• Equal bilateral brachial pulses

95. • Nervous system is immature
• Extremities usually maintain some degree
of flexion
• Extension followed by previous position of
flexion
• Head lag is while sitting ,but momentary
ability to hold head erect
• Able to turn head from side to side when
prone

96. Localized reflexes
-blinking reflex/corneal reflex
infant blinks at sudden
appearance of a bright light or an
approach of an object toward cornea,
persist through out life
-pupillary reflex
pupil constricts when a bright light
shine towards it, persist through out life

97. -dolls eye
as head is moved slowly to right or
left ,eyes lag behind & do not immediately
adjust to new position of head ,disappears
as fixation develops, if persists, indicates
neurologic damage

98.  Nose
-cough/sneezing reflex
spontaneous response of nasal
passages to irritation or obstruction; persist
throughout life
-glabellar reflex
tapping briskly on
glabella causes eyes to close
tightly

99.  Mouth & throat
-sucking reflex
strong sucking movements of
circumoral area in response to stimulation
;persist through out infancy
- gag reflex
stimulation of posterior pharynx by
food ,suction or passage of a tube causes
infant to gag, persist through out life

100. -rooting reflex
touching or stroking the cheek along side
of the mouth causes infant to turn head toward
that side & begin to suck should appear at about
age 3-4 months, but may persist for up to 12
months
-extrusion reflex
when tongue is touched or depressed ,infant
responds by facing it outward ; disappears by
age 4 months

101. -yawn
spontaneous response to decreased
oxygen by increasing amount of inspired
air; persist through out by life

102.  Extremities
-grasp reflex
touching palms of hands or soles of
feet near base of digits cause flexion of
hands & toes
palmar grasp lessens after 3 months
plantar grasp by 8 months of age

103. -babinski
stroking outer sole of foot upward from
heel & across ball of foot causes toes to
hyper extend ,disappears after age 1 year

104. - Moro reflex
sudden jarring or change in equilibrium
causes sudden extension & abduction of
extremities & fanning of fingers, with index
finger & thumb forming a C shape, followed
by flexion & adduction of extremities ;legs
may weakly flex; they may cry & disappears
after 3-4 months ,strongest during first 2
months

105. - startle reflex
a sudden loud noise cause abduction
of the arms with flexion of elbows, hands
remain clenched ;disappears by the age 4
months

106. while infant is prone on a firm surface,
thumb is pressed along spine from sacrum
to neck ;infant respond by crying ,flexing
extremities, & elevating pelvis and
head;lordosis of the spine ,as well as
defecation & urination may occur;
disappears by 4-6 months

107. -Asymmetric tonic neck reflex
when infants head is turned to one side,
arm & leg extended on that side,& opposite
arm and leg flex; disappears b age 3-4
months

108. - Trunk incurvation
stroking infants back alongside spine
causes hips to move toward stimulated
side, disappears by age 4 weeks
-dance or step
if infant is held so that sole of flat
touches a hard surface ,there is a reciprocal
flexion & extension of the leg ,simulating
walking, disappears after age 3-4 weeks

110. -placing reflex
when infant is held upright underarms
& dorsal side of the foot is briskly placed
against hard object ,such as table ,leg lifts as
if foot is stepping on table ;age of
disappearance varies

111. >Newborn exhibits behavioural & physiologic
characteristics that may at first appear to be
sign of stress
> During the initial 24 hours changes in
heart rate, respiration, motor activity, color,
mucus production & bowel activity occur in
an orderly ,predictable sequence that is
normal & indicates lack of stress

112. o During the first 30 minutes; initial stage
newborn is
-very alert
-cries vigorously
-may suck the fist greedily
-vigorous sucking while breast feeding
-appears very interested in the
environment
-eyes are usually open

113. o During the second stage(lasts 2-4 hrs)
-heart & respiratory rate decreased
-temperature begins to fall
-mucus production decreases
-urine or stool not passed
-neonate is in a state of sleep & relative
calm

114. - Neonate awakens from deep sleep
-good opportunity for child & parent interaction
-alert & responsive
-heart & respiratory rate increases
-gag reflex is active
-gastric & respiratory secretions increased
-passage of meconium frequently occurs
-after this stage is a period of stabilization

115.  Observation of behavior .Main areas of
behavior for newborns are sleep,
wakefulness & activity such as crying
 Brazelton neonatal behavioral
assessment scale (BNBAS)
 Habituation :-ability to respond to and then
inhibit responding to discrete stimulus(
light,bell,rattle,pin prick etc)while asleep
 Orientation :-Quality of alert states & ability
to attend the visual & auditory stimulus
while alert

116.  Motor performance :-quality of movement
and tone
 Range of state :-measure of general arousal
level or arousability of infant
 Regulation of state :- how infant responds
when aroused
 Autonomic stability :-signs of stress( tremors,
startles, skin color )related to homeostatic
adjustment to the nervous system.
 Reflexes :-assessment of several neonatal
reflexes

117. • Infants have 6 distinct sleep –wake states
which represent a particular form of neural
control

118. State behavior Implications for parenting
1. Deep sleep (quiet)
-closed eyes, regular
breathing, no movement except
for occasional sudden body
twitch, no eye movement
-continue usual house noises
because external stimuli do not
arouse infant,; leave infant alone if
sudden loud noise awakens baby &
child cries,; do not attempt to feed
2.Light sleep (active)
-closed eyes, irregular
breathing, slight muscular
twitching of the body,REM
under closed eyelids, may smile
external stimuli that did not arouse
infant during regular sleep may
minimally arouse child,; periodic
groaning or crying is usual,;do not
interpret as an indication for pain or
discomfort
3.Drowsy
-eyes may be open, irregular
breathing, active body
movement variable ,with
occasional mild startles
most stimuli arouse baby but may
return to sleep state,; pick baby up
instead of leaving the child in the
crib,; provide mild stimuli to awaken,;
may enjoy non nutritive sucking

119. Contd…….
4.Quiet alert
-eyes wide open & bright,
responds to environment by active
body movement & staring at close
range objects, minimal body
activity, regular breathing & focus
attention on stimuli
-satisfy infant needs such as
hunger or non nutritive sucking,;
place infant in area of home
activity is continuous,; place toys
in crib,; place objects within 17.5-
20 cm of infants view,; intervene
to console
5.Active alert
-may begin with whimpering or
slight body movement, eyes open,
irregular breathing
-remove intense internal or
external stimuli because has
increased sensitivity to stimuli
6.Crying
-progress to strong, angry
crying and uncoordinated
thrashing of extremities, eyes open
or tightly closed,grimaces,irregular
breathing
-comforting measures that were
effective during alert state are
usually ineffective,; swaddle or
rock to decrease crying,; intervene
to reduce fatigue, hunger or
discomfort

120.  deep sleep state light sleep
drowsiness

121.  quiet-alert state active-alert state
 crying

122.  Position -feet are less dorsiflexed & the
hands are less clenched
 Weight -10 % loss of weight by 4th – 5th
day which is gradually regained by 7thto
10th day,weiegt gain is at the rate of 25-
30gm day

123.  Skin – color changed from pinkish to pale
brown color. Skin becomes dry &scaly.
slight yellowish tinge may appear(disappear
by 7th day, lanugo gradually disappears
 Abdomen-cord becomes dry & falls off by
7th day

124.  Hematological findings- Hb level falls to 13
gm.% bilirubin level falls to 2 mg % at the
end of seventh day
stool – changing stools are passing
Urine –first 24 hour only 60 ml will pass
during the 1st week. Output may increase
up to 200-200 ml/day

125.  Major goal – establish and maintain
homeostasis
 Establishment and maintenance of
respiration

126.  Stabilization and maintenance of temperature
-evaporation
-radiation
-conduction
- convection

128.  Prevention of infection and injury
• Identification
• handwashing
• Clear linen , clothes and equipments
• Vitamin k prophylasis
• Hbv vaccine administration
• Eye care
• Umbilical cord care
• Bathing
• Circumcision
• Universal newborn hearing screening
• Screening for disease

129.  Provide optimal nutrition
Breast feeding
-human milk :
lactose,fat,protiens,immunoglobulin,
digestive enzymes etc
-formula feeding
-feeding schedules

130.  Maternal attachment
 Patternal engrosment
 Siblings and others