The document outlines the systematic examination of newborns to assess their development, well-being, and detect any abnormalities. It describes essential procedures, vital signs, physical examination details, and neurological reflexes, as well as specific assessments for health indicators like weight, hydration, and skin condition. Key elements include the APGAR score, initial assessments, and techniques for monitoring the infant's growth and health status.

1. ASSESSMENT
OF
NEWBORN

2. NEWBORN EXAMINATION
DEFINITION:
It is a systematic examination i.e. both (physical and
neurological) of newborn.

3. OBJECTIVE:
• To know infant’s state of
development and wellbeing.
• To detect any deviation from
normal
• To assess the progress of the child.

4. INDICATIONS:
• 1st
examination: in labor room
within 2 hours of birth.
• 2nd
examination: before discharge.
• 3rd
examination: 6- 8 week

5. ARTICLES
• TPR tray.
• Stethoscope
• Measuring tape
• Torch
• Cotton wipe
• Weighing machine
• Mackintosh
• Kidney tray
• Paper bag
• Bowl with cotton

6. INITIAL ASSESSMENT
1. IDENTIFICATION
Check and identify the sex of the infant and record
with name, sex and regd. Number.
2. Identify gestational age, full term/pre term/post
term.

7. VITAL SIGNS
1. RESPIRATION: 40- 60breaths/min
2. HEART RATE: 120-140 beats/min
3. TEMPERATURE: 36.5 – 37.5 degree C
4. Blood Pressure:60-80/40-60 mmhg

8. APGAR SCORE
• IN 1952,DR.Virginia Apgar developed the Apgar score.
• The Apgar score is done twice following the birth of
new-born.
• It is done a 1 min and 5 minute after birth.
• A score of 8-10= normal
• A score of 5-7=mild neurological and respiratory distress.
• A score less than 5= indicate neonatal resuscitation.

9. APGAR SCORE

12. PHYSICAL EXAMINATION
• LENGTH (47- 50cm): crown to heel
length with baby supine position with knee
slightly pressed down to get maximum
leg extension.
• HEAD CIRCUMFERENCE(33-35CM):
it measured with a measuring tape across
the center of the forehead and most
prominent portion of the posterior head.

13. • CHEST CIRCUMFERENCE (30-33CM):
It is measured at the level of nipple and
about 2cm less than head circumference.
• WEIGHT: 2.5kg -3.5kg

14. • POSTURE:
Supine position with partial flexion of arms, legs and hand
commonly turned a little to one side.

15. 2. SKIN:
The skin of a healthy newborn at birth has deep red.
This is due to increased concentration of RBC and
decreased amount of subcutaneous fat. This redness
fades after one month.

16. • Cyanosis:
Peripheral cyanosis –This is normal in
the 1st
24 to 48 hours after birth.
Central cyanosis – it indicates
decreased oxygen. May cause
due to respiratory distress.

17. • Vernix caseosa:
This is a soft, white, cheesy, yellowish cream on the infant's
skin at birth .It is caused by the secretions of the sebaceous
glands of the skin.

18. Lanugo
• This is a long, soft growth of fine hair
on the infant's shoulders, back, and
forehead. It disappears early in
postnatal life.

19. Milia
• These are tiny sebaceous retention cysts. They
appear as small white or yellow dots and are
common on the nose, forehead, and cheeks of
the infant.

20. • Erythema toxicum:
It begins as papule, increasing in severity to become
erythema by the 2nd
day and then disappearing by 4th
day onwards.

21. Mongolian Spots
• These are blue-black colorations on the infant's lower back,
buttocks, and anterior trunk. They disappear in early
childhood.

22. 3. HEAD:
• Newborn’s head appears disproportionately large because it
is one fourth of the total length.
• Fontanells: The anterior fontanel is diamond-shaped and
strongly pulsatile. It normally closes at 9 to 18 months of
age.
• The posterior fontanel is small, triangular shaped, and less
pulsatile. It normally closes at 1 1/2 to 3 months of age.

24. • Caput succedaneum:
It is edematous swelling on the babies scalp due to
infiltration of serous fluid by the pressure. It disappear
in few days.

25. • Cephal hematoma:
It is collection of blood in between
periosteum and flat bone of skull.

26. 4. EYES:
• When new born cries, tears may not be seen.
Lacrimal ducts are not fully mature until 3 months.
• Eyes should appear clear without any redness or
purulent discharge.

27. 5. EARS:
The infant's ears tend to be folded .A line drawn through the
inner and outer canthi of the eye should come to the top notch
of the ear where it joins the scalp. The infant usually responds
to sound at birth.

28. 6. MOUTH:
• The infant's lips should be pink and the tongue smooth and
symmetrical. Mouth should be observed for cleft lip, cleft
palate and tongue tie.
• Occasionally small round, glistering
cysts (Epstein pearls) are present on
palate due to extra calcium deposited
in utero.

29. 7. NECK:
The neck of newborn is short, and creased with
skin fold. Head should rotate freely on it.
8. CHEST:
• Looks small because the infant’s head is large
in proportion.
• Possible breast engorgement with secretion of
thin watery fluid (witch’s milk)

30. 9. ABDOMEN:
• Bowel sound present.
• Stomach: The capacity of the
infant's stomach is about 30-60ml
at birth, but increases rapidly.

31. 10. UMBILICAL CORD:
• It has 2 arteries and 1 vein.
• After clamping it begin to dry and falls after 6-10
days.

32. 11. BACK:
• The spine of newborn typically appears flat in lumber and
sacral areas.
12. GENITAL:
• Anus must be inspected for patent and not covered by a
membrane.
• In male baby both testes are present in scrotum.
• In female labia majora fully cover labia minora.

33. 13. EXTRIMITIES:
Observe for syndactyly or polydactyly. A
full term baby have creases covering
the entire sole.

34. NEONATAL REFLEXES
1. BLINKING/CORNEAL REFLEXES:
• Infant blinks at sudden appearance of
light.
2. PUPILLARY REFLEX:
• Pupil constricts when bright light shines
towards it.

35. 3. DOLL’S EYE REFLEX:
• As head move slightly to left or
right, eyes lag behind and do not
immediately adjust to new
position of head.

36. GLABELLAR REFLEX
• Tapping briskly on glabella causes eyes to close tightly.
Disappears as brain mature.

37. SUCKING REFLEX:
Rooting helps the baby become
ready to suck. When the roof of the
baby’s mouth is touched, the baby
will begin to suck.

38. • ROOTING REFLEX:
The infant turns his head and open
his mouth to the side when the side
of his face is touched. Disappears at
3-4 months.

39. GAG REFLEX:
Stimulation of posterior pharynx by
food, suction or passage of tube
causes infant to gag.

40. MORO REFLEX:
Hold the baby so that one hand support
head and another supports buttocks.
The reflex is elicited by sudden dropping
of the head in her hand. The baby
responds with series of movements i.e. hands open and there is extension
and abduction of the upper extremities. This is followed by anterior
flexion of upper arm and audible cry. This disappears at 6 months.

41. TONIC NECK REFLEX:
This elicited by rotating
the infant’s head from
midline to one side. The
baby should respond by
extending the arm on the
side to which the head is
turned and flexing the
opposite arm. The lower
extremities responds
similarly. It disappears at 7
months.

42. PALMAR GRASP REFLEX:
Elicited by examiner placing her finger on
the palmar surface of the infant’s hand and
baby will grasp the finger. Disappears in 2-
3 months.

43. EXTRUSION REFLEX:
When tongue is touched or depressed the baby
responds by forcing it outwards.
Disappears by age of 4-5 months.

44. YAWN:
Spontaneous response to decreased
oxygen by increasing amount of
inspired air.

45. STEPPING REFLEX:
Elicited by touching the
top of the baby’s foot to
the edge of a table while
the baby is held
upright. The baby
makes movements that
resemble stepping.
Disappear in 3-4 months.

46. SNEEZING REFLEXES
• Spontaneous response
of nasal passage to
irritation or obstruction
persists throughout the
life .

47. GALANT REFLEX:
It is named after neurologist Johann Susmann Galant.
It is elicited by holding the newborn in ventral
suspension (face down) and stroking along the one
side of the spine. The normal reaction is for the
newborn to laterally flex toward the stimulated side.

48. BABINSKI REFLEX:
Elicited by stimulating the edge of the sole of
the foot. The baby will respond by planter
flexion and either flexion or extension of
toes.

49. TORTICOLLIS (WRY NECK)
• The head held to one side with chin pointing to
the opposite side due to positioning in the
womb.
• Exercise the neck gently
on opposite direction.

50. HARLEQUIN COLOR CHANGE
• The color changes as the baby lies on the side, lower
half of the body becomes pink or red and upper half
is pale.
• It is harmless and
never been associated
with permanent problem.

51. DAILY ASSESSMENT

52. Obtain Vital Sign
Temperature
• In neonate the temperature can be taken from groin, axilla from
mouth.
 Normal temperture:36.5-37.5 degree C
 Hypothermia: <36 degree C
 Hyperthermia: >41degree C
Respiration: count by observing the abdominal movement in infant.
• Normal rate is : 40-60 breath/min

53. Conti……..
PULSE : Apical pulse are more reliable for infants (between 4th
and 5 th intercostal space.
Blood pressure :
Manual blood pressure monitoring is not routinely done in
neonatal nursery but in certain circumstances with Oscillometry.
The average systolic /diastolic pressure is 65/44 mmhg at 1 to 3
days of age

54. Head to toe examination

55. Assessment of Breast feeding pattern
• Weight pattern – consistent weight gain(20-30g/day).
• Voiding –wet diaper/dry, soaked?
• Feeding demand –every 2-3 hour
• Duration of feeding-generally
10-20min/side
• Activity of infant.
• Sleeps 16-18 hours per day

56. Check skin condition
• Skin color
• Skin lesion

57. Help in bedding in / rooming -in

58. Assess bathing and hygiene and grooming.

59. Elimination Pattern
• 6-8 times pale/colorless voides/day.
• 3-4 times loose ,yellow ,curd like stool per day.
Note For any abnormalities:
e.g Cleft palate,cleft lip,hydrocephalus.

60. Neurological assessment:
• Useful information can be gained simply by observation of the baby’s posture,
alertness and level of activity. Cranial nerves may quickly tested by reflexes.
Blood volume
• 80ml/kg of body weight
• RBC: 6 to 8 million/cmm
• Hb%: 18 g%
• Platelets: 350000/cmm
• WBC: 10000 to 17000/cmm

61. THANK YOU