1. The document provides guidance on assessing the normal newborn in the nursery or maternity floor. It outlines admission care including history taking, identification, and physical assessment. 2. Assessment includes APGAR scoring initially and monitoring transitional periods. A systematic physical exam is described covering all body systems. 3. Immediate newborn care priorities are outlined as clearing airways, establishing breathing, maintaining temperature, preventing hypoglycemia, and identification. Common reflexes are also reviewed.

1. Mrs. AshA BhAt
Asst. Prof.
KLEU INS,
1
AssEssMENt OF
NOrMAl NEwBOrN

2. 2
Introduction:
1. Definition of neonatal period:
• A period from birth 4 weeks
postnatal.
After the initial observation for
neonatal condition requiring immediate
intervention, the baby is sent to the
normal newborn nursery or maternity floor for
the purpose of follow up and stabilization.

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The role of the neonatal
nurse & physician inside the
normal newborn nursery or
maternity floor:

4. Admission Care:
The role of the nurse is:
• To carry out good interpersonal communication.
• To take complete history about the mother and
neonate.
• To be sure that the neonate has identification
band.
• To perform complete physical assessment
• Prevention of hemorrhage (administer Vit. K if not4

5. Assessment:
• The initial assessment:
APGAR scoring system
Purpose
Is to assess the newborn’s
immediate adjustment to extra uterine life
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6. 6
Transitional assessment (Periods of
reactivity):
I) First period of reactivity:
Stage 1: During the first 30 min. through
which the baby is characterized as
Physiologically unstable , very alert, cries
vigorously, may suck a fist greedily, &
appears very interested in the environment.

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Stage 2: It lasts for about 2-4 hours,
through this period; all Vital Signs & mucus
production are decreased. The newborn is
in state of sleep and relative calm.

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II) Second period of reactivity: it lasts for
about 2-5 hours, through which the newborn
is alert and responsive, heart & respiratory
rate, gastric & respiratory secretions are
increased & passage of meconium commonly
occurs.
Following this stage is a period of
stabilization through which the baby becomes
physiologically stable & a vacillating pattern
of sleep and activity.

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Passage of meconium

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Systematic Physical examination:
- Growth measurements
- Vital Signs
- General appearance:
. Posture:
Flexion of head &
extremities, taking them toward chest &
abdomen

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Posture

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Head Circumference

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 Skin: General description:
At birth;
Color: bright red,
Texture: soft and has good elasticity
Edema: is seen around eye, face, and
scrotum or labia
Cyanosis: of hands & feet
(Acrocynosis)

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General description of the skin

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Acrocyanosis

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1. Vernix Caseosa: Soft yellowish cream
layer that may thickly cover the skin of
the newborn, or it may be found only in
the body creases and between the labia.
The debate of wash it off or to keep
it.

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Vernix Caseosa

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2. Lanugo hair:
- Distribution
a. The more premature baby is, the heavier
the presence of Lanugo is.
B. It disappears during the first weeks of
life

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Lanugo hair

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3. Mongolian spots:
Black coloration on the lower back, buttocks,
anterior trunk, & around the wrist or ankle.
They are not bruise marks or a sign of mental
retardation, they usually disappear during
preschool years without any treatment.

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Mongolian spots

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Mongolian spots

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Mongolian spots

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4. Desquamation:
Peeling of the skin over the areas of
bony prominence that occurs within 2-4
weeks of life because of pressure and
erosion of sheets.

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Desquamation

26. 5. Physiological Jaundice
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27. 6. Milia:
• Small white or yellow pinpoint spots.
• Common on the nose, forehead, & chin of
the newborn infants due to accumulations
of secretions from the sweat & sebaceous
glands that have not yet drain normally.
• They will disappear within 1-2 weeks, they
should not expressed.
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Milia

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7.Head:
The Anterior fontanel: is diamond in shape,
located at the junction of 2 parietal & frontal
bones. It is 2-3 cm in width & 3-4 cm in
length. It closes between 12-18 months of
age.
The posterior fontanel: is triangular in shape,
located between the parietal & occipital
bones.

30. • Fontanels should be flat, soft, & firm.
• It bulges when the baby cries or if
there is increased in ICP.
• Two conditions may appear in the
head:
- Caput succedaneum &
- Cephalhematoma
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Caput succedaneum

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Caput succedaneum

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Caput succedaneum

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Cephalhematoma:
Cephalhematoma is a subperiosteal collection
of blood secondary to rupture of blood vessels
between the skull and the periosteum, in which
bleeding is limited by suture lines (never cross
the suture lines).

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Cephalhematoma

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Cephalhematoma

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8. Eyes:
- Usually edematous eye lids
- Gray in color. True color is not determined
until the age of 3-6 months.
- Pupil: React to light
- Absence of tears
- Blinking reflex is present in response to
touch
- Can not follow an object (Rudimentary

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Normal Eye

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Eyelid Edema

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Dysconjugate Eye Movements

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Subconjunctival Hemorrhage

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Congenital Glaucoma

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Congenital Cataracts

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9. Ears:
Position:
Startle Reflex:
Pinna flexible, cartilage present.

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Normal Ears

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Ear Tag

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10. Nose:
Nasal Patency
Nasal discharge – thin white mucous

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Normal Nose

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Dislocated Nasal Septum

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11. Mouth & Throat:
- Intact, high arched palate.
- Sucking reflex – strong and coordinated
- Rooting reflex
- Gag reflex
- Minimal salivation

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12. Neck: Short, thick, usually surrounded
by skin folds.

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 System assessment of the
neonates:
1. Gastrointestinal System:
Mouth should be examined for
abnormalities such as cleft lip and/or cleft
palate.
Epstein pearls are brittle, white, shine spots
near the center of the hard palate. They
mark the fusion of the 2 hollows of the
palate. If any; it will disappear in time.

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Cleft Palate

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Cleft Lip

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Cheeks: Have a chubby appearance
due to development of fatty sucking
pads that help to create negative
pressure inside the mouth which
facilitates sucking.

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Epstein Pearls & cheeks

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Normal Tongue Ankyloglossia

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Ankyloglossia

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Gum: May appear with a quite irregular
edge.
Sometimes the back of gums contain
whitish deciduous teeth that are semi-
formed, but not erupted

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Irregular edges with Natal Teeth

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Natal Tooth

62. 13. Abdomen:
• Cylindrical in
Shape
62

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Normal Umbilical Cord
• Bluish white at
birth with 2
arteries & one
vein.

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Meconium Stained Umbilical Cord

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14. Circulatory system:
Heart:
Apex- lies between 4th
& 5th
intercostal space, lateral to left sternal
border.

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15. Respiratory system:
• Slight
substernal
retraction
evident during
inspiration

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15. Respiratory system Cont.:
• Xiphesternal
process
evident

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15. Respiratory system Cont. :
Respiratory is chiefly abdominal
Cough reflex is absent at birth, present by
1-2 days postnatal.
Possible signs of RDS are:
- Cyanosis other than hands & feet.
- Flaring of nostrils.
- Expiratory grunt-heard with or without
stethoscope.

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16. Urinary System:
Normally, the newborn has urine in the
bladder and voids at birth or some hours
later.

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Female genitalia

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Female genitalia Cont.
• Labia & Clitoris
are usually
edematous.
• Urethral meatus is
located behind the
clitoris.
• Vernix Caseosa is
present between
labia

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Normal Male genitalia
• Urethral opening is at
tip of glans pens.
• Testes are palpable in
each scrotum.
• Scrotum is usually
pigmented, pendulous
& covered with rugae.

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17. Endocrine system:
Swollen breasts:
Appears on 3rd
day in both sex, & lasts for
2-3 weeks and gradually disappears without
treatment.
N.B: The breasts should not be expressed
as this may result in infection or tissue
damage.

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Maternal hormonal withdrawal
• Female genitalia,
normal with
vaginal
discharge

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Extremities
• Nail
beds
pink

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Extremities Cont.
• Meconium
Stained
fingernails

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Extremities
• Creases on
anterior two
thirds of
sole.

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Common feet abnormalities
• Club Feet

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Immediate Care of the
Newborn:

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Immediate Care of the Newborn:
1. Clear airway
2. Established respiration
3. Maintenance of body temperature
4. Protection from Hypoglycemia
5. Identification.

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APGAR Score
Score /
Item
2 1 zero
Heart beats > 100 b/min
Strong
< 100 b/min
Or weak beats
No heart
beats
Cry &
breathing
Strong
crying
weak crying /
irregular
breathing
No cry /
breathing
Color Pink body &
face
Pink body & blue
extremities
Pale or
blue body
Movement &
tone
Active Some movements Flaccid
Grimace Try to keep
cath. away
Grimace of face No
response

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The Four modalities by which the
infant lost his/ her body temperature:
1- Evaporation:
Heat loss that resulted from
expenditure of internal thermal energy to
convert liquid on an exposed surface to
gases, e.g.: amniotic fluid, sweat.
Prevention:
Carefully dry the infant
after delivery or after bathing.

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2- Conduction:
Heat loss occurred from
direct contact between body surface
and cooler solid object.
Prevention:
Warm all objects before
the infant comes into contact with
them.

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3- Convection:
Heat loss is resulted from
exposure of an infant to direct source of
air draft.
Prevention:
· Keep infant out of drafts
· Close one end of heat
shield in incubator to reduce
velocity of air.

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4- Radiation:
It occurred from body
surface to relatively distant objects that
are cooler than skin temperature.

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*) General management:
1- Infant should be warmed quickly by wrapping
in a warm towel.
2- Uses extra clothes or blankets to keep the
baby warm.
3- If the infant is in incubator, increase the
incubator’s temperature.
4- Use hot water bottle (its temperature 50 °C).
5- Food given or even intravenous solution
should be warm.
6- Avoid exposure to direct source of air drafts.
7- Check body temperature frequently.
8- Give antibiotic if infection is present.

87. Neonatal Primitive Reflexes
87

88. Reflexes
Includes :
• The Moro, startle
• Palmer and planter grasps
• Sucking and rooting and swallowing reflexes
• Tonic neck reflex
• Stepping
• Babinski sign

89. Moro Reflex or startle reflex
• Quick change in the infant's position will cause the
infant to throw the arms outward, open the hands, and
throw back the head.
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90. Palmer grasp
• Palmer and plantar grasp - the infant's fingers
or toes will curl around a finger placed in the
area.
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91. Planter grasp
• Palmer and plantar grasp - the infant's fingers or toes
will curl around a finger placed in the area
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92. Babniski reflex
• The infant's foot is stroked, the toes will
extend upward.
Immediate care of newborn 92

93. Rooting reflex
• This reflex begins when the corner of the baby's
mouth is stroked or touched.
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94. Sucking reflex
• When the roof of the baby's mouth is touched, the
baby will begin to suck.
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95. Asymmetric tonic neck reflex
• Tonic neck reflex - When a baby's head is turned to
one side, the arm on that side stretches out and the
opposite arm bends up at the elbow.
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96. Dance or step reflex
• This reflex is also called the walking or dance reflex
because a baby appears to take steps or dance when
held upright with his/her feet touching a solid surface.
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