Educative power point presentation for trainees in paediatrics / post graduate students in paediatrics / neonatology.

1. Evaluation of Newborn
Dr Isha Deshmukh
Assistant Professor
BJGMC , Pune
12/06/2021

2. Definitions
Definitions of Newborn
1. Newborn: The infant from Day 0 to 28
days of life
2. Early Neonatal Period: First 7 days of
life
3. Late neonatal Period: From 7th to less
than 28 days of life
4. Newly born: Infant in the first few
minutes to few hours after birth
5. Still Birth: A fetal death at a gestation
age of 20 weeks or more or weighing
more than 500 grams.

3. Catagorization by Birth Weight
 Neonates are classified according to
weight.
 Low Birth Weight – BW < 2.5 kg
 Very Low birth weight – BW <1.5 kg
 Extremely Low Birth weight – BW <1
kg
These classifications help in
establishing the risk level for neonatal
mortality, morbidity, and long term
developmental problems.

4. Categorization by weight for
Gestational Age
 Small for Gestational age – BW <10th
centile for GA
 Large for Gestational age – BW > 90th
centile for GA
 Appropriate for Gestational age – BW
between 10th to 90th centile for GA

5. Timings of Newborn
Assessment
1. At birth to assess need for resuscitation
2. Assessment as the newborn completes
transition from fetal to neonatal
circulation
3.Determination of gestational age
4. General health assessment at 24 to 48
hours after birth
5. Before discharge
6. Evaluation of sick neonate at any time
7. Evaluation of neonate with
dysmorphism or congenital anomalies

6. Anticipation of a Congenital
Anomaly
1. Family history of congenital anomalies
2. Maternal illness in first trimester
3. Maternal GDM
4. Alcohol intake during Antenatal period
5. Maternal drugs in first trimester
6. Maternal age >35 years
7. Polyhydramnios
8. Oligohydramnios
9. Breech presentation
10. Identical twins

7. General Health Assessment
 Temperature stability
 Vital signs
 HR, Perfusion, murmur, pulses, CRT
 Ability of BF – by weight change since
birth, duration of breast feeding,
effective suckling, proper attachment
and positioning.
 Colour- cyanosis,pallor, plethora,
jaundice

8. Danger Signs
• Respiratory distress
• Lethargy
• Poor feeding/ sucking
• Icterus till soles
• Seizures/ abnormal movements
• Repeated vomiting
• Diarrhoea
• Bleeding from any site

9. Components of Neonatal History
 Maternal, paternal and family history
 History of antenatal events
 Details of birth
 History of immediate post natal events
 History of feeding, activity and weight
gain
 Specific complaints if any

10. Paternal history
• Fathers age
• Blood group
• Consanguinity
• Presence of any current infections
• Chronic illness in father
• Socio-economic history
• Inherited genetic disorders
• Any illness in siblings

11. Past Neonatal history
 Details of previous pregnancies
(number, abortions, stillbirths, live
births, any previous infant or child
deaths
 Delivery details
 Birth weight
 Problems encountered during
deliveries
 This defines High Risk Neonate

12. History of Antenatal Events
 LMP, EDD, MBG, Hb level
 Platelet count , WBC count
 Exposure to teratogens
 PIH, Eclampsia, GDM
 Maternal Immune status
 Duration of labour
 State of fetal heart during labour

13. History of antenatal events
• Duration of rupture of membranes
• Presentation of fetus
• Operative delivery
• Drugs or anaesthetics used
• Polyhydramnios
• Abnormalities of placenta
• Abnormal presentation
• Multiple gestation

14. Sequence of Examination
• Before touching observe spontaneous movements, eye
opening and respiratory rate
• Feel the AF and sutures
• Auscultate HS
• Touch or cold stress
• Palpate abdomen for liver , spleen and any mass
• Complete examination for head to toe evaluation
• Systemic evaluation: RS and CVS
• Genitals , anus and femoral pulses
• Back and spine
• Neurological Assessment
• Moro’s reflex
• Hip assessment
• Anthropometry

15. Normal Vital Signs in a
Newborn
 1. Temperature 36.5 to 37.5 degree
Celsius axillary/ rectal
 2. Heart Rate : 120 to 160 beats per
minute
 3. RR – 40 to 60 per minute
 4. BP – Systolic 65 to 95 mmHg
 Diastolic 30 to 60 mmHg

16.  Both feet and abdomen are warm to
touch , baby is at thermal comfort
 Feet cold and abdomen warm – cold
stress
 Both feet and abdomen cold –
hypothermia
 Cold stress – 36.0 to 36.4 degree
Celcius
 Moderate hypothermia – 32.0 to 35.9
degree C
 Severe hypothermia - <32.0 degree C

17. Colour Guide for Newborn
• 1. Red – plethoric – Send Hct, Hb, Plt
• 2. Blue – (cyanosis)
Only hands and feet – peripheral
cyanosis
Lips and mucus membranes-
Central cyanosis
3. Pallor – anemia
4. Grey ashen – asphyxia or septicemia
5. Jaundice – NNH, Send Serum
bilirubin

18. Common Anomalies Noted on
Initial Examination
Anomaly Frequency
Skin tags 10 – 15
Polydactyly 10 – 15
Cleft Lip or palate 1 – 4
Congenital Heart defects 1 – 4
Congenital Hip Dislocation 1 – 4
Downs syndrome 1 – 4
Telipus Equanovarus 1- 4
Spina Bifida / Anencephaly 1- 4 per 10,000 live births

19. Common Birth Injuries
 Cord Prolapse
 Premature placental separation
 Scalp : Cephalhematoma and subgaleal
hematoma , injury from fetal scalp electrodes
or forceps
 Bone injuries: Fracture clavicle, humerus,
skull
 Nerve Injuries: Facial palsy, Erb’s palsy
 Internal organ injuries
 Testicular trauma
 Lacerations or scalped injury

20. Components of Head to Toe
Examination
 1. Skin 10. Neck
 2. Face 11. Chest
 3. Head 12. Abdomen
 4. Skull defects 13. Anus and
Genitalia
 5. Eyes 14. Back
 6. Ears 15. Extremities
 7. Nose
 8. Mouth
 9. Lower face

21. Thank you...!!