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Newborn Assessment

This document provides guidance on newborn examination including the purpose, procedures, vital signs, measurements, physical characteristics and abnormalities to examine for, as well as common reflexes. The examination should be done swiftly within 8-10 minutes while keeping hands clean and warm, and protecting the newborn from unnecessary exposure and drafts. Abnormalities of the skin, head, eyes, ears, nose, mouth, neck, chest, abdomen, genitals, rectum, back, and extremities should all be examined and noted. Common reflexes like rooting, sucking, Moro's, and tonic neck should also be tested. Any deviations from normal should prompt immediate action.

Health & Medicine◦
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 To identify normal characteristics in the newborn.  To identify existing abnormalities, if any  To carry out immediate action if there is any deviation.  To establish a baseline for future physiological changes.
 Keep your hands clean, dry and warm.  Keep your nails short and free of nail polish.  Do not expose the baby unnecessary.  Do not expose the baby to drafts and chills.  Examine the baby swiftly not more than 8 to 10 minutes.  If newborn is irritable/crying during examination allow him to suck on a nipple.  Inform mother about outcome of examination.
 Take temperature: (37˚C ± 0.5˚C)  Count heart rate: 120-160 beats/minute  Count respiratory rate: 30-60 breaths /minute
 Weight: 2.7 kg (with a variation of 2.5-3.9 kg or more)  Length: 50 cm (with the range of 48-53cm)  Head Circumference: 33-35.5 cm  Chest Circumference: 30.5-33 cm
 Color: skin is pink  Cry: loud and vigorous, immediately after birth.  Activity : good activity.  Lanugos: fine hair on the body.  Skin: smooth and velvety—rose petals.
 Cyanosis  Skin: Check for …..
 Petechiaes Jaundice  Vernix
 Erythma Toxicum  Milia Mongolian Spots
 Fontanels : check for size and shape of fontanels, or any other abnormality like enlarged, bulging or sunken. Anterior Fontanel Posterior Fontanel Diamond shape Triangular shape Size :2.5 x 4.5 cms Size : 0.5 to 1 cm Closes : 18 month (1.5 year) Closes : 4-6 week (1.5 month)
 Head: Check for …..  Caput succedaneum Cephalhematoma
 Molding  Hydrocephalus  Anencephaly  Encephelocele  Over riding of cranial suture etc.
 Eye : Check for…..  Conjunctivitis.  Epicanthal fold  Inner canthus  Protrusion of eye ball  Pupilary reflex to light  Congenital cataract
 Ear : Check for……  Shape, position of ear.  Check for any accessory lobules.  Check for hearing. NB : Low set of ear indicates Down’s syndrome.
 Nose : Check for……  Flaring of nose.  Depressed nose bridge.  Patency of nasal canal NB : Depressed nasal bridge sign is the indicator of Down’s Syndrome.
 Mouth : Check for……  Cleft lip and Cleft palate.  Epstein Pearl
 Tongue tie.  Aglossia  Hypoglossia.  Size of chin. NB : Small chin is indicative sign of Pierri Robin’s syndrome to be confirmed if associated with small head and pigmy appearance.
 Neck : Check for……  Any mass in neck.  Torticolis.  Lymph nodes.  Range motion of Neck. NB: If neck is short & webbed it indicates Turner’s syndrome.
 Chest : Check for……  Retraction of the intercostals space.  Breast for size, symmetry, color & any discharge. (Witch’s Milk)  Auscultate air entry in the lungs.  Respiratory rate.  Auscultate heart sound. NB : Chest retraction shows Sever Respiratory Distress.
 Abdomen : Check for……  Contour of abdomen. (Scaphoid Abdomen)  Omphalocele.
Umbilical cord ( 2 Arteries, 1 Vein). Check for lever, spleen Enlargement, any mass or Lump. Femoral artery pulsation in both side of groin.  Inguinal hernia.
 Genitals : Ambiguous Genitals
Genitals : Check for……(Female)  Labia majora covers labia minora..  Discharge from vagina. (Pseudomenstruation)  Size and shape of clitoris. NB : Premature infant’s labia is not full covered.
 Genitals : Check for…(Male)  Scrotal Swelling (Hydrocele)  Location of Testis
 Prepuce retraction without any problem to rule out Phimosis  Urethral opening to rule out Epispadias And Hypospidiasis
 Rectum : Check for……  Anal patency.  Passage of Meconium.  Fistula or any abnormal opening.
Back : Check for……  Curvature.  Mongolian spot on sacrum.  Spina bifida  Meningocele or Meningomyelocele  Tuft of hairs(if Conceled Spina bifida occulta)
Extremities : Check for……  Any Fracture Fingers and toes for missing digits, extra digits(polydactyly), Fused digits(syndactyly)
 Feet to be looked for any positional abnormalities mainly club foot.  Range of motion ,Congenial Dislocation of hip or any irregular position.
REFLEXES OF THE NEWBORN: Rooting reflex: If cheek of infant is rubbed, the infant will turn his head on that side. Sucking reflex : Developed at 32-36 Weeks of gestation.
Moro’s reflex: Grasp the wrist of infant and draw it forward and than drop back on to the bed, the baby’s body will shows all extremities extending and flexing. OR  Make a loud sound by banging the examination table, the limb will extend and flex. NB : It disappear by the 3-4 months
Dancing reflex: Place the child in standing position near the table, the feet will touch the table and flex alternately both the legs giving an appearance as baby is dancing. NB : It disappear by the 1-2 months
Doll’s eye reflex: Turn the head of the infant the eye moves in the opposite direction. NB : It disappear once the child is able to focus.
Tonic neck reflex : When infant neck is quickly turned to one side, the extremities on that side extend and opposite side flex.
Grasping reflex: Put your finger near the child’s palm, the child closes its finger around it.
Gag reflex: Reflex contraction of back of throat which makes immediate return of undigested food. Extrusion reflex: When tongue is touched or depressed child respond by Forcing it outwards. NB : It disappear by the 4 months
Yawning reflex: Spontaneous response to decreased oxygen by increasing amount of inspired air. Sneezing and coughing reflex: Babies cough and sneeze for clearing their Nasal passages of something irritating, such as dust, or to move mucus or saliva out of their throats.
Glabellar reflex: Tapping briskly on Glabella causes eyes to close tightly or blinking. Crawl reflex: Baby placed on abdomen baby flexes leg under as if to crawl.
Newborn Assessment