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Neonatal assessment
This document outlines the components and process of neonatal assessment. It discusses the aims of assessment including identifying prenatal influences, potential problems, and needs for intervention. The components include history of the mother and baby, physical examination from head to toe, and potential investigations. The physical examination involves assessing vital signs, appearance, measurements, and neurological and physical systems. The goal is to detect any issues that may impact health and develop appropriate care plans.
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Neonatal assessment
- 1. NEONATAL ASSESSMENT BY DR. AYODELE,NOSRULLAH S. FMC, BIRNIN KEBBI 1
- 2. OUTLINE INTRODUCTION AIMSOF ASSESSMENT COMPONENTS OF ASSESSMENT HISTORY PHYSICAL EXAMINATIONS INVESTIGATIONS CONCLUSION REFERENCES 2
- 3. INTRODUCTION Pregnancy, labourand delivery can greatly affect the health of a neonate. Therefore, effective care of a baby should start right from the antenatal period to the point of delivery The period of transition puts a great risk on the neonate as it needs various adaptations to cope with the extrauterine life Every year nearly 41% of all under 5 deaths occur in the neonatal period 3
- 4. INTRODUCTION Three quartersof these deaths occur in the first week of life Up to two third of newborn death can be prevented if known, effective health measures are provided at birth and during the first week of life Careful resuscitation, examination and assessment of the new born help to detect health challenges which when addressed may avert many of these undue deaths 4
- 5. AIMS OF NEONATAL ASSESSMENT 1.Identify prenatal influences on health status of the baby 2. Identifying potential problems with the newborn 3. detecting adaptation failure and need for immediate intervention e.g. prematurity, asphyxia 4. detecting anomalies and establish baseline for subsequent examination 5. Plan appropriate nursing care for infant and identify teaching needs of parents 5
- 6. COMPONENTS OF ASSESSMENT Assessment involves: History Physical examination 6
- 7. HISTORY Maternal History Parity Obstetrichistory Details of antenatal care Other problems of the current pregnancy Maternal illnesses Details of labour and delivery Use of sedation or anaesthesia Significant family history 7
- 8. HISTORY Perinatal History Events in the delivery room Apgar scores and resuscitation, Feeding and behaviour since birth 8
- 9. PHYSICAL EXAMINATION Itshould be carried out immediately after delivery Must be carried out in a regular sequence so that items are not forgotten A useful approach is the head to toe technique Should not take more than 5-10 minutes and should be done in a quiet warm environment Whenever possible the infant should be examined in the presence of at least one parent 9
- 10. PHASES OF EXAMINATION Initial assessment (Apgar score) General examination Systemic examination 10
- 11. APGAR SCORE Allowsrapid assessment of the baby at birth Usually assessed and recorded in the first and fifth minutes May be used to classify the baby between healthy and diseased Causes of low Apgar may include Asphyxia Maternal drugs Central nervous system disease Congenital muscular disease Prematurity Fetal sepsis 11
- 12.
- 13. INSPECTION Should followinspection, palpation, percussion and auscultation (inspection>>>percussion) Facies Posture: well flexed, partially flexed or limp Behavioral state/spontaneous activity: sleeping, crying, alert Skin: Colour: pallor, plethora, jaundice, cyanosis, other pigmentation Texture: sticky, smooth, peeling, lanugo Rashes 13
- 14.
- 15.
- 16. INSPECTION Respiratory effort Observe pattern – rhythm, grunt, accessory muscle use Count rate (for 1 minute) 16
- 17. PALPATION Vital signs:temperature, respiratory rate, heart rate, pulse(radial, femoral and dorsalis pedis) and ?blood pressure To be measured on admission to the SCBU Every 30 minutes until the condition of the newborn is stable for at least two hours Every eight hours until discharged Signs Rate Heart rate 90-160 b/ min Respiration 30-60 c/min Temperature 36.5 – 37.40C Blood pressure SBP 60-90 , DBP 40-50mmHg 17
- 18. GESTATIONAL AGE ASSESSMENT Can be done by Estimating last menstrual period Early ultrasound scan (dating sound) Newborn physical examination findings ( Ballard, new Ballard, Dubowitz) 18
- 19. NEW BALLARD SCORING Is based on the neonate's physical and neuromuscular maturity and can be used up to 4 days after birth Because the Ballard score is accurate only within ± minus 2 wk, it should be used to assign GA only when there is no reliable obstetrical information about the estimated date of delivery (EDD) or there is a major discrepancy between the obstetrically defined GA and the findings on physical examination 19
- 20.
- 21. NEW BALLARD SCORING Difference between original and new Ballard scoring system Original New Score 5 to 50 Score -10 to 50 Gestational age 26-44wks Gestational age 20-44wks Score starts from 0 Score starts from -1 Inaccurate in extreme preterms More accurate Age of assessment 30-42hrs From birth to 96hrs (up to 7 days postnatal day in preterms Eyes not included Eyes included 21
- 22. PHYSICAL EXAMINATION Head Swellings (caput, cephal hematoma, encephalocele), molding Fontanelle - presence, number, size, shape, tension Large fontanelle Very Small fontanelle Hydrocephalus Microcephaly IUGR Premature craniosynostosis Congenital hypothyroidism Congenital hyperthyroidism Achondroplasia Craniotabes Trisomies 21,18,13 Prematurity Osteogenesis imperfecta Nutritional rickets 22
- 23.
- 24. PHYSICAL EXAMINATION Anthropometricmeasurements:- Weight = 3.0± 0.5kg (<2.5=LBW, <1.5=VLBW, <1=ELBW, > 4.0 Macrosomia) Classification based on weight and gestational age: Appropriate for gestational age (AGA) – if between 10th and 90th centile Small for gestational age (SGA)- if below 10th centile Large for gestational age (LGA) – if above 90th centile 24
- 25. PHYSICAL EXAMINATION Newbornbabies lose 5 to 10% of the birth weight over the first 2 to 4 days of life and regain the birth weight by 7 to 10 days in term babies OR by 10 to 14 days in preterm babies. SGA babies may not experience this physiologic weight loss. Subsequently term babies gain 30d/day and preterm gain 15-20g/kg/day (1-2 months) 25
- 26.
- 27. PHYSICAL EXAMINATION Predisposingfactors for: Large for GA Small for GA Genetically determined Genetically determined Obesity Congenital infections Diabetes mellitus Placental insufficiency Excessive weight gain in pregnancy Multiple gestation Beckwith-Wiedemann syndrome Maternal malnutrition Sotos syndrome (cerebral gigantism) Low socioeconomic status Marshall, syndrome Illicit drugs in pregnancy Weaver syndrome 27
- 28. PHYSICAL EXAMINATION Anthropometricmeasurements Length = 50 ± 5cm (increases by 2.5 cm/month from 1 to 5 months and 1.25 cm from 6 months to 1 year). Occipito-frontal circumference =35 ± 2cm (<31=microcephaly, >37=macrocephaly) Chest circumference = 31-33cm (<30=?prematurity) Abdominal circumference = as chest circumference 28
- 29. Microcephaly Macrocephaly Chromosomal abnormalitiesRickets Craniosynostosis Haemoglobinopathies Cerebral anoxia Achondroplasia TORCHES infection Hydrocephalus Illicit drugs Subdural hematoma/effusion Severe malnutrition Sotos syndrome Severe neonatal jaundice Brain tumour 29
- 30. PHYSICAL examination Neck- (clavicular fracture, thyroid mass, cystic hygroma, hemangioma, webbing) Face/eye examination - symmetry, facies, eye response to light, colour of the sclera (blue=osteogenesis imperfecta), eye discharge Ear – size, shape, position of pinnae Nose – symmetry, flaring, discharge, patency Mouth – lips, palate, jaw bone, natal teeth, tongue tie (ankyloglossia), oropharynx (uvula, palatal cleft) 30
- 31. PHYSICAL examination Spine- curvature, swellings (spinal bifida, lipoma), depressions, hair tuft, skin discoloration Chest - symmetry, breast (size and number of nipples), breath sound, crepitations, rhonchi, stridor, heart sounds (number and position), murmurs (investigate grade 3/6) Abdomen – Symmetry/shape, movement, cord status, swellings (omphalocele, hernia, other masses), organomegaly, bowel sound 31
- 32. PHYSICAL EXAMINATION Externalgenitalia male- penile size (~2.5cm),meatal opening, testes in the scrotum, rugae on scrotum, scrotal swelling (hernia, hydrocele) Female – labia (fusion), clitoris, urethral meatus, discharge or bleeding Anus – patency, passage of meconium Extremities - symmetry, fracture, polydactyly, syndactyly, club feet, hip dislocation (using Ortolanis and Balow maneuver) 32
- 33. PHYSICAL EXAMINATION Nervoussystem- palsies, fasciculations/ tremors, seizures, Tone Primitive reflexes – grasp (palmar, plantar), rooting, sucking, moro, startle 33
- 34. Rooting reflex Plantar graspreflex 34
- 35. INVESTIGATIONS These willbe directed to the abnormlities noted in the assessment of the baby These may include Blood tests e.g. FBC, E/U Radiological investigations - Xrays Ultrasonography Echocardiography CT/MRI Karyotyping 35
- 36. CONCLUSION The healthof a neonate is very important following delivery and in the rest of the neonatal period as it may determine the subsequent health status of the baby throughout life. Therefore after delivery, a careful examination and assessment of the baby should be carried out to determine signs or complications which need further assessment or management either primarily from the pediatrician or from other specialties in order to ensure proper growth and development of the baby. 36
- 37. REFERENCES Azubuike JC,Nkanginieme KE. Paediatrics and child health in a tropical region. 2nd edition. African Educational Services;. Pp 163-170 WHO. Partnership for maternal, newborn and child health. Online. Available at www.who.int/pmnch/media/press_materials/f s/fs_newborndeath_illness/en Essential Newborn Nursing for Small Hospitals Learner’s Guide, WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, 2004 Maria Loreto, Evangelista-Sia . Infant Care and Feeding 2nd edition. RMSIA Publishing. pp. 38- 57 37
- 38.