The document provides details from a newborn assessment of Elisha Jr. It includes sections on Apgar scoring, birthweight measurements, vital signs measurements, physical exam findings for various body systems, and developmental assessments. Key findings included normal Apgar scores, appropriate birthweight, clear lung sounds, normal heart rate, no dysmorphic features or abnormalities detected.

1. NEW BORN ASSESSMENT
ELISHA JR
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2. Apgar scoring
• The Apgar score is one of the first checks of your new baby's health. The
Apgar score is assigned in the first few minutes after birth to help identify
babies that have difficulty breathing or have a problem that needs further
care. The baby is checked at 1 minute and 5 minutes after birth for heart
and respiratory rates, muscle tone, reflexes, and color.
• Each area can have a score of 0, 1, or 2, with 10 points as the maximum. A
total score of 10 means a baby is in the best possible condition. Nearly all
babies score between 8 and 10, with 1 or 2 points taken off for blue hands
and feet because of immature circulation. If a baby has a difficult time
during delivery, this can lower the oxygen levels in the blood, which can
lower the Apgar score. Apgar scores of 3 or less often mean a baby needs
immediate attention and care.
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3. 3
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
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4. Birthweight
• A baby's birthweight is an important indicator of health. The average
weight for term babies (born between 37 and 41 weeks gestation) is
about 7 lbs. (3.2 kg). In general, small babies and very large babies are
at greater risk for problems. Babies are weighed daily in the nursery
to assess growth, fluid, and nutrition needs. Newborn babies
may often lose 5% to 7% of their birthweight. This means that a baby
weighing 7 pounds 3 ounces at birth might lose as much as 8 ounces
in the first few days. Babies will usually gain this weight back by 2
weeks of age. Premature and sick babies may not begin to gain weight
right away.
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5. Measurements
• Head circumference. The distance around the baby's head.
• Abdominal circumference. The distance around the abdomen.
• Length. The measurement from crown of head to the heel.
• Vital signs:
• Temperature (able to maintain stable body temperature in normal room
environment)
• Pulse (normally 120 to 160 beats per minute in the newborn period)
• Breathing rate (normally 40 to 60 breaths per minute in the newborn period
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6. 6
Head Circumference:
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7. Physical exam
• General appearance. Physical activity, tone, posture, and level of consciousness
• Skin. Color, texture, nails, presence of rashes
• Head and neck:
• Appearance, shape, presence of molding (shaping of the head from passage through the birth canal
• Fontanels (the open "soft spots" between the bones of the baby's skull
• Clavicles (bones across the upper chest
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8. • Face. eyes, ears, nose, cheeks.
• Mouth. palate, tongue, throat.
• Lungs. Breath sounds, breathing pattern.
• Heart sounds and femoral (in the groin) pulses.
• Abdomen. Presence of masses or hernias.
• Genitals and anus. For open passage of urine and stool
• Arms and legs. Movement and development.
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9. General examination
• Posture: The normal healthy newborn demonstrates flexion of the
legs and arms when supine. Lack of this posture might indicate
hypotonic conditions such as Down Syndrome or neurologic or
muscle disease.
• Cyanosis: Mild cyanosis is normal at birth but after the first few
minutes of life, the child's tongue and mucous membranes should be
pink. Peripheral cyanosis might persist for one to two days. Persistent
central cyanosis suggests an obstructed airway, respiratory disease,
cardiac anomalies, neurologic depression, and rarely
methemoglobinemia.
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10. • Jaundice: Jaundice is common after the second day of life. The
presence of jaundice within the first 24 hours of life suggests a
hemolytic process.
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11. 11
Posture
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12. SKIN
Milia
• The vernix caseosa, a cheesy white covering, is normally present at
birth as our fine hair (lanugo) on the shoulders and back and pinpoint
white papules caused by blocked sebaceous glands (milia) on the
nose and cheeks.
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13. Milia
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14. 14
Milia
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15. Mongolian spots
• Petechiae on the scalp and face are often seen after a vertex delivery.
• Large blue patches of pigment over the lumbar area, buttocks, or
extremities are known as Mongolian spots and are a common
phenomenon in the dark-skinned races. These tend to fade over time.
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16. Mongolian spot
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17. • Capillary hemangiomas, common on the upper eyelids, forehead, and
the nape of the neck are known as stork bite nevi and also tend to
fade with time.
• Erythema toxicum consists of yellow papules on a red base and may
appear between the second and fourth days of life. These papules
contain eosinophils and are seen mostly on the trunk.
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19. 19
Acrocyanosis
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20. 20
Cleft Palate
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21. 21
Cleft Lip
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22. 22
Desquamation
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23. 23
Eyelid Edema
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24. 24
Ear Tag
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25. 25
Natal Tooth
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26. HEAD
• Molding of the head by pressure of the maternal pelvis is common after vaginal
delivery. Caput succedaneum, a round boggy swelling of the soft tissues of the
scalp from accumulation of fluid within the area of pressure from the pelvis
during delivery is common. This should be distinguished from a
cephalohematoma, which is a sub-periosteal hemorrhage. The former will cross
suture lines; the latter does not.
• The anterior and posterior fontanelle should be soft to palpation. The anterior
fontanelle should be between 1 and 3 cm in size and the posterior fontanelle
should admit a fingertip. Following a vaginal delivery, over-riding of the skull
bones may temporarily reduce the size of the anterior fontanelle.
• The head circumference should be between 33 and 35cm for a full-term infant.
• The slant and size of the eyes should be examined. Eyes that slant upward might
be a sign of Down Syndrome
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27. Down Syndrome
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28. Eyes
• Large eyes suggest congenital glaucoma, a condition that requires
early treatment to preserve vision. Eyes that are too close together
are suggestive of fetal alcohol syndrome.
• Hemorrhage in the subconjunctival and retinal area is common with
vertex delivery and has no significance. The pupillary light reflex and a
red reflex of light from the retina should be checked with a flashlight
or ophthalmoscope. Pupillary opacity indicates congenital cataracts
and a white reflex suggests retinoblastoma.
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29. red reflex
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30. Ears
• The pinna of the ear usually joins the head above a horizontal line from the
external canthus of the eye. A low-set ear suggests chromosomal anomaly
and malformed ears are associated with renal abnormalities. Babies with
Down Syndrome also may have small ears that fold over on top. However, a
pre-auricular skin tag is usually of no significance.
• The nose should be checked for patency by auscultation with a
stethoscope. Babies are obligate nose breathers for the first few months of
life and blockage of the nasal canal, or choanal atresia, can be life-
threatening. The nose in Down Syndrome may be small, with a flattened
nasal bridge.
• A neonatal tooth is occasionally visible but requires extraction. The palate
should be examined for the presence of a cleft. The neck should be
checked for webbing, mass, or goiter.
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31. Physical maturity
• Skin textures (for example, sticky, smooth, or peeling).
• Lanugo (the soft downy hair on a baby's body). Absent in immature babies, then
appears with maturity, and then disappears again with postmaturity.
• Plantar creases. These creases on the soles of the feet range from absent to
covering the entire foot, depending on the maturity.
• Breast. The thickness and size of breast tissue and areola (the darkened ring
around each nipple) are assessed.
• Eyes and ears. Eyes fused or open and amount of cartilage and stiffness of the
ear tissue.
• Genitals, male. Presence of testes and appearance of scrotum, from smooth to
wrinkled.
• Genitals, female. Appearance and size of the clitoris and the labia.
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32. Neuromuscular maturity
• Posture. How does the baby hold his or her arms and legs.
• Square window. How far the baby's hands can be flexed toward the
wrist.
• Arm recoil. How much the baby's arms "spring back" to a flexed
position.
• Popliteal angle. How far the baby's knees extend.
• Scarf sign. How far the elbows can be moved across the baby's chest.
• Heel to ear. How close the baby's feet can be moved to the ears.
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33. Chest and respiratory system
• The respiratory rate in the newborn range is between 40 and 60
breaths/minute. Respiration might be periodic with short periods of
apnea. There should be no nasal flaring or intercostal of subcostal
retractions.
• The breasts are palpable in term infants and may secrete a small
amount of milk because of estrogenic effects from the mother
(witch's milk). Unusually widely spaced nipples may be suggestive of a
chromosomal anomaly.
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34. Cardiovascular system
• The normal pulse rate of a newborn is 120 to 140 beats/minute. A
persistent heart rate of less than 100 or more than 160 beats/minute
is a cause for concern.
• Absence of peripheral pulses, especially the femorals, suggests
coarctation of the aorta.
• Normal blood pressure is about 60/30 mm of Hg at term.
• Transient murmurs are often heard after birth, but the presence of a
loud murmur, heart sounds that are difficult to hear or are heard
louder on the right side of the chest, or central cyanosis suggest a
significant cardiac abnormality.
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35. Abdomen & Back
• The umbilical cord should have two arteries and one vein. A single umbilical
artery is seen in 1% of babies and is sometimes associated with other congenital
anomalies.
• Umbilical hernia is common and usually closes spontaneously before two years of
age.
• The liver normally extends 2 cm below the costal margin, and the tip of the
spleen can sometimes be felt. Both kidneys can be palpated. Abnormal masses
such as Wilm's tumor, neuroblastoma, hydronephrosis or a multicystic-dysplastic
kidney or renal vein thrombosis can be easily palpated. A tight abdomen or
persistent abdominal distention suggests intestinal obstruction or ascites.
• The back should be checked for midline defects; a shallow sacral dimple is a
common and normal finding. However, a deep dimple needs to be further
investigated.
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36. Genitalia and anus
• In the female infant, the vaginal opening is visible and a mucoid discharge,
which might be bloody secondary to estrogen withdrawal, is not
uncommon. The labia minora and clitoris are prominent, but the clitoris
should be contained within the prepuce.
• In the male newborn, the testes might not be fully descended at birth,
especially if the baby is premature. Hydroceles and inguinal hernias are
common. The prepuce adheres to the glans penis and should not be
retracted. The meatus should be located at the tip of the penis.
• Any apparent abnormality in the size or shape of the genitalia mandates a
consultation with the pediatric urologist and/or endocrinologist.
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37. ambiguous genitalia
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38. • The anus should be checked for patency, position, and the anal reflex.
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39. Extremities
• Each extremity should be carefully examined for polydactyly or
syndactyly. Most babies have three palmar creases. A single palmar
crease crossing the hand is present in about 4% of normal babies but
may also be associated with chromosomal anomalies such as Down
Syndrome.
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40. single palmar crease
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41. • Bowing of the legs is a normal variation, as are positional
abnormalities such as metatarsus adductus which result from
intrauterine compression, but one should be able to place the
extremity easily in the normal position. Inability to do so suggests
pathology.
• HIPS. Developmental hip dysplasia (congenital dislocation) occurs in
1-3/1000 live births. It is more common in females by a 9:1 ratio, and
is more common in children who have been in a breech position in
utero. Suspicion of hip dysplasia requires immediate consultation with
a pediatric orthopedic surgeon.
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42. • To check for this condition, the baby should be placed supine with the
hips and knees flexed to 90°. The middle finger of each hand is placed
over the greater trochanter of the tibia and the thumb on the
opposite side of the hip joint, over the lesser trochanter. First a
posterior pressure is applied; if the hip is dislocatable, it will snap out
of the acetabulum with a click or a clunk. However, if the head of the
femur is already dislocated, abducting the hips will result in a click as
the head of the femur slips forward into the acetabulum. These
maneuvers can best be performed on both hips simultaneously or
while stabilizing the other hip with the opposite hand.
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43. Neurological evaluation
• Useful information can be gained simply by observation of the baby's
posture, alertness, and level of activity. A normal term baby lies folded up
in the fetal position with the hands closed, whereas a premature baby
sprawls out with the hands open.
• A normal baby is easily awakened by taking off the covers or by stimulating
the foot or the cheek, while a depressed baby quickly goes back to sleep.
And asphyxiated baby might be either depressed or irritable.
• A full-term baby who is not demonstrating flexor tone and is lying with the
limbs extended may either be floppy or have increased extensor tone. This
calls for immediate further evaluation for intracranial pathology, muscle
disease, or a systemic disorder such as hypotension or infection.
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44. • Cranial nerves may quickly tested by eliciting the pupillary responses
and blink reflex to light (II), doll's eye phenomenon (III, IV, VI),
corneal, sucking, and rooting reflexes (V, VII), response to the noise or
sound (VIII), and the gag reflex (IX, X).
• The integrity of the lower brain centers can be checked by eliciting
the neonatal reflexes: Moro reflex, grasp reflex, sucking and rooting
reflex, and the stepping reflex. In addition, the Moro reflex is useful in
establishing that movements of the extremities are symmetrical.
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45. Reflexes
Root reflex :
when the corner of the baby's mouth is stroked or touched.
The baby will turn his/her head and open his/her mouth to
follow and "root" in the direction of the stroking.
This helps the baby find the breast or bottle to begin
feeding.
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46. 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.
 This reflex does not begin until about the 32nd week of
pregnancy and is not fully developed until about 36 weeks.
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47. Premature babies may have a weak or immature sucking
ability because of this.
Babies also have a hand-to-mouth reflex that goes with
rooting and sucking and may suck on fingers or hands.
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48. Moro reflex:
The Moro reflex is often called a startle reflex because it
usually occurs when a baby is startled by a loud sound or
movement.
In response to the sound, the baby throws back his/her
head, extends out the arms and legs, cries, then pulls the
arms and legs back in.
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49. A baby's own cry can startle him/her and begin this reflex.
This reflex lasts about five to six months.
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50. 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.
This is often called the "fencing" position. The tonic neck
reflex lasts about six to seven months.
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51. Grasp reflex:
Stroking the palm of a baby's hand causes the baby to close
his/her fingers in a grasp.
 The grasp reflex lasts only a couple of months and is
stronger in premature babies.
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52. Babinski reflex:
When the sole of the foot is firmly stroked, the big toe
bends back toward the top of the foot and the other toes
fan out.
 This is a normal reflex up to about 2 years of age.
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53. 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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