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Assessment
of
newborn
Mrs. Malarkodi.S
Assistant Professor
CON, AIIMS, Rishikesh
INTRODUCTION
Assessment of the newborn, as soon as possible after &
subsequent assessment in the postnatal period are vital
responsibility of the nurses working in hospital or in the
community.
The assessment include the details history of
Prenatal
Intranatal
Genetic & family history
With head to foot examination & review of maternal
investigation
Purpose of assessment
 To Assess The Need For
Resuscitation
 To Ascertain Gestational Age
 To detect presence of any congenital
anomalies or any disorders
Assessment of newborn
Physical assessment of newborn following
delivery can be
divided into four phases:
1. The initial assessment using the Apgar score
system.
2. Transitional assessment during the period of
reactivity.
3. Assessment of gestational age.
4. Systematic physical assessment.
1.Initial assessment
The initial assessment of newborn is important activity
immediately after birth. By using of apgar score
The most frequently used method to assess the newborn's
immediate adjustment to extra uterine life.
The score is based on observation of :
1. Heart rate.
2. Respiratory effort.
3. Muscle tone.
4. Reflex irritability.
5. Color.
Each item is given a score of 0, 1,or 2
Evaluation of all five categories are made at 1 and 5 minutes
after birth and repeated until the infant's condition stabilized.
Virginia Apgar
The Apgar score is affected by the degree of :
Physiologic immaturity.
Infection.
Congenital malformations.
Maternal sedation or analgesia.
Neuromuscular disorders.
2.Transitional assessment
Periods for reactivity:
1.First period of reactivity: For 6-8 hours after
birth.
Initial stage of alertness and activity:
During the first 30 minutes.
The infant is very alert, cries vigorously, very
interest in the environment.
Neonate's eyes are usually open
The newborn has a vigorous suck; this is an
opportune time to begin breast-feeding.
physiologically, the resp rate is high as 80
breath/min, crackles may be heard, heart rate
reach 180 beat/min, bowel sound are active ,
mucus secretions are increased, and temp
may decrease.
Second stage:
Lasts to 2-4 hours,
Heart and resp rate decrease, temp continues
to fall, mucus production decreases ,and urine
or stool is usually not passed.
The infant is in state of sleep and relative
calm.
Undressing or bathing is avoided during this
time
The second period of reactivity: begins when the
infant
awakes from this deep sleep.
It lasts about 2-5 hours and
The infant is again alert and responsive,
Heart and resp rates increase.
The gag reflex is active gastric and respiratory
secretions are increased,
Passage of meconium frequently occurs.
This period is usually over when the amount of
respiratory mucus has decreased.
After this stage is a period of stabilization of
physiologic systems and a vacillating pattern of sleep
and activity.
3.Clinical assessment of gestational age
A frequently used method of determining
gestational age is the simplifies Assessment
of Gestational Age by Ballard(1979)
It assess six external physical and six
neuromuscular signs.
Each sign has a number score, and the
cumulative score correlate with a maturity
rating of from 20 to 44 weeks of gestation.
Classification of infants gestational age at birth by birth
weight , provides more satisfactory method for
predicting mortality risks & management of the neonate .
Appropriate for gestational age (AGA) :the infant
whose weight is between 10th and 90th percentiles. Can
be presumed to have grown at a normal rate regardless
of the time of birth preterm, term, or post term.
Large for gestational age (LGA): above 90th percentile
can be presumed to have grown at an accelerated rate
during fetal life .
Small-for-gestational-age (SGA): infant below 10th
percentile can be assumed to have intrauterine growth
retardation or delay.
4. Physical assessment of the newborn
 Vital signs: temp, resp, heart rate, bld pressure
General behavior: Posture, position, general
alertness, activity, movements of limbs, crying,
response to stimulation, sleeping pattern etc.
 Feeding behavior: Sucking & swallowing reflex,
vomiting, regurgitation, chocking, frothiness.
 Pattern of elimination: Passage of meconium &
urine
measurements: Ht, wt, head circumference, chest
circumference, abdomen circumference
Skin: Color, Texture , Vernix Caseosa, Other
Abnormalities
Head: Size, Shape Other Abnormalities.
Face: Symmetry, paralysis, shape, swelling,&
abnormal movements.
 Eyes: Edema, conjunctivitis, or discharge,
sub conjunctival hemorrhage, color of the
sclera, brush field spots, strabismus,
congenital cataract, pupillary size, & reflex,
abnormal placement of eyes, abnormal
distance b/w 2 eyes.
 Nose: Nose is examines foe patency, low
nasal bridge, nasal discharge, nasal flaring.
Ears: Size, shape, position, skin tags,
 Mouth: Cleft palate, size of tongue, presence
of nasal teeth, Epstein's pearls, frenulum of
tongue ( tongue tie) blisters, oral infections
 Neck: mobility, fracture, stiffness or rigidity,
hyperextension, torticollies, any cyst or mass, webbing.
 Chest: shape, size, breast engorgement, rate & rhythm
of respiration, chest retraction, & abnormal respiratory
sound.
 Abdomen: shape, size, umbilical cord infection, hernia,
& other congenital anomalies. all the 4 method shulod
be used to detect anomalies.
Genitalia:
 female child: whether the labia majora covered the labia
minora & clitoris. Hymenal tag or imperforate hymen may
present. Vaginal white mucoid discharge
For male child: whether the both tests in the scrotal sac,
penis should be examined for the hypospadias, epispadias,
phimosis, ambiguous genitalia, hydrocele, inguinal hernia,
BACK: Checked for abnormal spinal curvature, tufts of hair of
skin, meningocele, meningomyocele, meningoencephalocele,
anencephaly.
 Buttocks: it should observed mass( sacrocoyygeal tertoma),
perianal should be examined for anal fissures or any
abnormalities.
 Hips: congenital hip dislocation
 Extremities: for fracture, paralysis, range of motion & irregular
position, fingers & toes missing for digits,
Summary
• Newborn assessment is the easiest and
simplest assessment through which we can
anticipate congenital or impending diseases or
disorders of the child.
References
Assuma Beevi (2009). Concise Textbook of Pediatric
Nursing. 2nd Edition. Elsevier Publication
OP Ghai (2013) Essentials of Pediatrics. 8th Edition.
CBS Publishers and distributors.
Datta Parul (2010). Paediatric Nursing. 3rd Edition.
JAYPEE publication

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Assessment of New Born.pptx

  • 2. INTRODUCTION Assessment of the newborn, as soon as possible after & subsequent assessment in the postnatal period are vital responsibility of the nurses working in hospital or in the community. The assessment include the details history of Prenatal Intranatal Genetic & family history With head to foot examination & review of maternal investigation
  • 3. Purpose of assessment  To Assess The Need For Resuscitation  To Ascertain Gestational Age  To detect presence of any congenital anomalies or any disorders
  • 4. Assessment of newborn Physical assessment of newborn following delivery can be divided into four phases: 1. The initial assessment using the Apgar score system. 2. Transitional assessment during the period of reactivity. 3. Assessment of gestational age. 4. Systematic physical assessment.
  • 5. 1.Initial assessment The initial assessment of newborn is important activity immediately after birth. By using of apgar score The most frequently used method to assess the newborn's immediate adjustment to extra uterine life. The score is based on observation of : 1. Heart rate. 2. Respiratory effort. 3. Muscle tone. 4. Reflex irritability. 5. Color. Each item is given a score of 0, 1,or 2 Evaluation of all five categories are made at 1 and 5 minutes after birth and repeated until the infant's condition stabilized.
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  • 9. The Apgar score is affected by the degree of : Physiologic immaturity. Infection. Congenital malformations. Maternal sedation or analgesia. Neuromuscular disorders.
  • 10. 2.Transitional assessment Periods for reactivity: 1.First period of reactivity: For 6-8 hours after birth. Initial stage of alertness and activity: During the first 30 minutes. The infant is very alert, cries vigorously, very interest in the environment. Neonate's eyes are usually open The newborn has a vigorous suck; this is an opportune time to begin breast-feeding.
  • 11. physiologically, the resp rate is high as 80 breath/min, crackles may be heard, heart rate reach 180 beat/min, bowel sound are active , mucus secretions are increased, and temp may decrease.
  • 12. Second stage: Lasts to 2-4 hours, Heart and resp rate decrease, temp continues to fall, mucus production decreases ,and urine or stool is usually not passed. The infant is in state of sleep and relative calm. Undressing or bathing is avoided during this time
  • 13. The second period of reactivity: begins when the infant awakes from this deep sleep. It lasts about 2-5 hours and The infant is again alert and responsive, Heart and resp rates increase.
  • 14. The gag reflex is active gastric and respiratory secretions are increased, Passage of meconium frequently occurs. This period is usually over when the amount of respiratory mucus has decreased. After this stage is a period of stabilization of physiologic systems and a vacillating pattern of sleep and activity.
  • 15. 3.Clinical assessment of gestational age A frequently used method of determining gestational age is the simplifies Assessment of Gestational Age by Ballard(1979) It assess six external physical and six neuromuscular signs. Each sign has a number score, and the cumulative score correlate with a maturity rating of from 20 to 44 weeks of gestation.
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  • 17. Classification of infants gestational age at birth by birth weight , provides more satisfactory method for predicting mortality risks & management of the neonate . Appropriate for gestational age (AGA) :the infant whose weight is between 10th and 90th percentiles. Can be presumed to have grown at a normal rate regardless of the time of birth preterm, term, or post term. Large for gestational age (LGA): above 90th percentile can be presumed to have grown at an accelerated rate during fetal life . Small-for-gestational-age (SGA): infant below 10th percentile can be assumed to have intrauterine growth retardation or delay.
  • 18. 4. Physical assessment of the newborn  Vital signs: temp, resp, heart rate, bld pressure
  • 19. General behavior: Posture, position, general alertness, activity, movements of limbs, crying, response to stimulation, sleeping pattern etc.  Feeding behavior: Sucking & swallowing reflex, vomiting, regurgitation, chocking, frothiness.  Pattern of elimination: Passage of meconium & urine
  • 20. measurements: Ht, wt, head circumference, chest circumference, abdomen circumference Skin: Color, Texture , Vernix Caseosa, Other Abnormalities Head: Size, Shape Other Abnormalities. Face: Symmetry, paralysis, shape, swelling,& abnormal movements.
  • 21.  Eyes: Edema, conjunctivitis, or discharge, sub conjunctival hemorrhage, color of the sclera, brush field spots, strabismus, congenital cataract, pupillary size, & reflex, abnormal placement of eyes, abnormal distance b/w 2 eyes.  Nose: Nose is examines foe patency, low nasal bridge, nasal discharge, nasal flaring.
  • 22. Ears: Size, shape, position, skin tags,  Mouth: Cleft palate, size of tongue, presence of nasal teeth, Epstein's pearls, frenulum of tongue ( tongue tie) blisters, oral infections
  • 23.  Neck: mobility, fracture, stiffness or rigidity, hyperextension, torticollies, any cyst or mass, webbing.  Chest: shape, size, breast engorgement, rate & rhythm of respiration, chest retraction, & abnormal respiratory sound.  Abdomen: shape, size, umbilical cord infection, hernia, & other congenital anomalies. all the 4 method shulod be used to detect anomalies.
  • 24. Genitalia:  female child: whether the labia majora covered the labia minora & clitoris. Hymenal tag or imperforate hymen may present. Vaginal white mucoid discharge For male child: whether the both tests in the scrotal sac, penis should be examined for the hypospadias, epispadias, phimosis, ambiguous genitalia, hydrocele, inguinal hernia,
  • 25. BACK: Checked for abnormal spinal curvature, tufts of hair of skin, meningocele, meningomyocele, meningoencephalocele, anencephaly.  Buttocks: it should observed mass( sacrocoyygeal tertoma), perianal should be examined for anal fissures or any abnormalities.  Hips: congenital hip dislocation  Extremities: for fracture, paralysis, range of motion & irregular position, fingers & toes missing for digits,
  • 26. Summary • Newborn assessment is the easiest and simplest assessment through which we can anticipate congenital or impending diseases or disorders of the child.
  • 27. References Assuma Beevi (2009). Concise Textbook of Pediatric Nursing. 2nd Edition. Elsevier Publication OP Ghai (2013) Essentials of Pediatrics. 8th Edition. CBS Publishers and distributors. Datta Parul (2010). Paediatric Nursing. 3rd Edition. JAYPEE publication