This will help the students to know the assessment of newborn baby

1. ASSESSMENT
OF
NEWBORN
Manisha Praharaj
SUM NURSING COLLEGE

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 wisp
• 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.

8. VITAL SIGNS
1. RESPIRATION: 40- 60breaths/min
2. HEART RATE: 120-140 beats/min
3. TEMPERATURE: 36.5 – 37.5 degree C

9. 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.

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

11. • POSTURE:
Supine position with partial flexion of arms, legs and hand
commonly turned a little to one side. Hip joints are partially
abducted.

12. 2. SKIN:
Most newborns have ruddy complexion. This is due to
increased concentration of RBC and decreased
amount of subcutaneous fat. This ruddiness fades
after one month.

13. • Cyanosis:
Peripheral cyanosis – appear
due to immature peripheral
circulation. This is normal in the
1st 24 to 48 hours after birth.
Central cyanosis – it indicates
decreased oxygen. May cause
due to respiratory distress or any other diseases.

14. • 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. It offers protection from the watery
environment of the uterus, is absorbed in the skin after birth,
and serves as a natural moisturizer.

15. Lanugo
• This is a long, soft growth of fine hair on
the infant's shoulders, back, and
forehead. It disappears early in postnatal
life.
Desquamation
• Peeling of the skin takes place few days
after birth and most marked on the
hands and feet.

16. 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. They are of
pin head size and
opalescent.

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

18. Mongolian Spots
• These are blue-black colorations on the infant's lower back,
buttocks, and anterior trunk. The spots are not bruises nor
are they associated with mental retardation. They disappear
in early childhood

19. 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.

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

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

23. 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.

24. 5. EARS:
The infant's ears tend to be folded and creased. 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.

25. 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.

26. 7. NECK:
The neck of newborn is short, often chubby 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)

27. 9. ABDOMEN:
• Bowel sound present.
• Edge of liver palpable 1-2cm
below right costal margin.
• Stomach: The capacity of the
infant's stomach is about 30-60ml
at birth, but increases rapidly.

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

29. 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.

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

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

32. 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.
• Disappears as fixation develops.

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

34. 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.

35. • 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.

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

37. 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. heads 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.

38. 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 respond
similarly. It disappears at 7
months.

39. 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.

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

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

42. 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.

43. 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.

44. 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.

45. 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.

46. 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.

47. ASSIGNMENT
What are the things to assess in skin
of a new born.

48. THANK YOU