Detailed newborn characteristics

1. CHARACTERISTICS
OF
HEALTHY NEWBORN
PREPARED BY:
RITTIKA DAS NEOGI,
1ST YEAR M.Sc.
NURSING

2. DEFINITION:
1. Born at term (between 38 to 42 weeks)
2. Avg. birth weight of above 2.5 kg
3. Cries immediately after birth
4. Establishes independent respiration
5. Adapts to the extra-uterine
environment
6. No congenital anomalies

3. TERMINOLOGIES:
NEONATAL PERIOD
 The period from birth to 28 days of life
NEWBORN OR NEONATE
 the infant in this neonatal period

4. OBJECTIVES OF NEWBORN EXAMINATION
1. For early detection of problems & initiation of prompt
management
2. To collect information about the newborn.
3. To inform parents about current health status of the newborn.
4. To ensure health of the newborn in future.

5. SET-UP FOR NEWBORN EXAMINATION:
 Warm comfortable room, temp : 25 to 30° C, draught free.
 Baby completely undressed and rested on warm flat surface.
 Height of surface should be convenient for the examiner.
 A good source of light.
 Examiner’s hand should be clean and warm.
 Absence of unnecessary personnel to avoid infection.

6. PHYSICAL CHARACTERISTICS
OF
HEALTHY NEWBORN

7. WEIGHT
Varies between 2.5 to 3.9 kgs,
average is 2.9 kgs.

8. LENGTH: Average crown heel length is 50 cm
(avg 48-53 cm)

9. HEAD CIRCUMFERENCE: Avg 35 cm, varies 33-37 cm.
Bi-parietal dia is 9.5 cm.

10. CHEST CIRCUMFERENCE: Approximately 3 cm less
than Head circumference at birth. Avg is 32 cm.

11. GENERALAPPEARANCE
 Body ratio is 1.8:1
 Midpoint at the umbilicus
 The trunk is larger & extremities shorter
 Abdomen is prominent
 Head large with short neck
 posture is partial flexion as in utero

12. VITAL SIGNS
a. Temperature: 36.5 – 37.5° C
b. Respiration: 30 – 60 breaths/ min
c. Pulse: 140 ± 20 beats / min
d. Blood Pressure:
Systolic: 60-80 mm of Hg.
Diastolic: 25-40 mm of Hg.
Average: 60-40 mm of Hg.

13. SKIN
Skin is pinkish
Covered with Vernix Caseosa
 Covered with Lanugo.

14. SKIN
Mongolian spot
Erythema Toxicum

15. HEAD
FONTANELLES: Anterior &
posterior fontanelles are
palpable.
It must be checked for
Bulging, depressed, large or
small.

16. CAPUT
SUCCEDENUM
 It is the swelling due to
stagnation of fluid in layers
of scalp.
 Formed due to compression
on descending head by
vulval ring.
 It reduces spontaneously
within 24 hrs. of birth.

17. CEPHALHEMATOMA
It happens due to sub-
periosteal hemorrhage
resulting from traumatic
delivery.

18. MOULDING
 It is the alteration of
shape of the fore-
coming head while
passing through birth
canal during labour.

19. HAIRS
 It is silky and black
in appearance and
each fiber is easily
understandable.

20. NECK
 Neck must be checked
for mobility, fracture
clavicle, rigidity,
hyperextension,
sternomastoid
hematoma, webbing,
etc.

21. FACE
 Face is symmetrical,
without frontal
bossing, facial
paralysis, swelling or
abnormal twitching.

22. MOUTH
 Mouth is
checked for
thrush, natal teeth,
cleft lip or palate,
micro or
macroglossia,
tongue tie.

23. EAR
The ear cartilage is
firm, fully curved &
shows good elastic
recoil. Low set ears,
discharge,
audiometry are
checked for.

24. EYES
Eyes remain mostly covered
with eyelids & closed as the
newborn is asleep almost for 20
hours a day. Pupils are reactive
to light.

25. EYES
 Eyes are checked for
edema, conjunctivitis,
discharge, sub-
conjunctival hemorrhage,
yellowish discoloration of
sclera, hypertelorism.

26. CHEST
Chest is checked for
abnormal shape &
size, asymmetry, rate
& rhythm of
respiration,
retraction, abnormal
respiratory and heart
sounds.

27. Breast tissue is palpable & over 5mm in
diameter. Development of nipple & breast
tissue is checked for gestational age
assessment. Enlargement of breast tissue &
& white discharge from nipple may be
caused by effects of maternal estrogen.

28. ABDOMEN
 Abdomen is smooth &
rounded, auscultation of
abdomen reveals bowel
sounds in quadrants of
abdomen

29. Abdomen must be observed for distension,
abdominal mass, enlargement of organs.

30. UMBILICUS: Cord stump looks white, shiny & feels
damp. As the stump dries and heals, it turns black or
brown.

31. UMBILICUS: Observed for signs of infection,
discharge, redness around insertion, greenish yellow
coloured cord, single umbilical artery, omphalocele.

32. BACK
Spine is shaped as ‘C’
as the newborn sleeps
in fetal position,
tucking knees beneath
the chest in good
flexion.

33. Back is checked for abnormal spinal curvature, tufts
of hair or skin, disruption in continuation.

34. GENITALIA
(MALE)
• Full term baby will have both
testes in scrotal sac, scrotum is
pigmented, wrinkled with
rugae.

35. Penis is examined for Hypospadias, Epispadias,
phimosis.

36. GENITALIA
(FEMALE)
Labia majora will cover
the labia minora.

37. Check for clitoral enlargement, fused labia &
clitoris, blood stained vaginal discharge etc.

38. BUTTOCKS: Assessed for abnormal mass, anal
fissure, imperforation, etc.

39. EXTRIMITIES
Limbs are examined for fractures,
paralysis, range of motions, missing
digits, polydactyl, syndactyl, talipes

40. PHYSIOLOGICAL CHARACTERISTICS
Cries immediately after birth & establishes spontaneous respiration.
Neonates breath with nose & mouth.
Respiration is periodic, shallow, irregular, thoraco-abdominal.
Heart rate may be irregular & increased during crying.
Breastfeeding done within one hour of birth preferably.
Newborn spends 80% of time in sleeping.

41. PHYSIOLOGICAL CHARACTERISTICS
Energy requirement increases from 55kcal/kg/day to 120 kcal/kg /day
within a week.
Protein & carbohydrate are easily digested.
Imperfect control over cardiac sphincter causes regurgitation & vomiting.
Neonates loses 7-8% of body weight by first week of life & regains in 10th
day.
Baby passes urine within 24 hours of birth and 7-8 times a day.
Meconium is passed within 48 hours and 3-4 times a day and till 3-4 days.

42. PHYSIOLOGICAL CHARACTERISTICS
 Blood volume: 80 ml/ kg of body weight.
 RBC: 6-8 million/cu mm.
 WBC: 10,000-17,000/ cu mm.
 Platelets: 35,000/ cu mm.
 HB %: 18 gm %
 Increased ESR RBC are easily destructible.
 Deficit of Vitamin K causes poor blood clotting.
 Blood sugar & calcium level is low.
 IgG level is high. IgM is absent. T lymphocyte functions are reduced.

43. PHYSIOLOGICAL CHARACTERISTICS
Immature neurological development causes poor temperature
regulation, poor muscular control & uncoordinated movements.
Limited hepatic functions lead to decreased ability to conjugate
bilirubin level, regulate blood glucose levels & produce coagulation
factors.

44. NEWBORN REFLEXS

45. ROOTING REFLEX

46. SUCKING REFLEX

47. SWALLOING REFLEX

48. SNEEZING REFLEX

49. GAGGING REFLEX

50. EXTRUSION REFLEX
If a Substance is placed in the anterior aspect of tongue, the
substance is pushed out by tongue.
Extrusion of substance to prevent swallowing.
Disappears in about 4 months.

51. DOLL’S EYE
REFLEX
Turn the newborn’s head
slowly to the right or left
side.
Normally eyes do not
move.
When fixation develops.

52. PALMAR AND PLANTER GRASP

53. MORO REFLEX

54. BABINSKI REFLEX

55. TONIC NECK REFLEX

56. DANCING STEPS REFLEX

57. THANK YOU