new born assessment

1. Chair Person
Maj BK Singh
Presented by
Capt Reema Kumari
NEW BORN
ASSESSEMENT

2. INTRODUCTION
• Monitoring of neonates is the keynote to successful outcome.
• Accurate observation is a vital factor in the survival and future
development of newborn.
• The initial physical examination should be performed as soon as after the
birth.
• All newborns should bethoroughly examined in the first 24-48 hrs of age.

3.  To provide an assessment of new born state of development
of well being.
 To detect any deviation from normal.
 To assess progress of the new born.
OBJECTIVES

4. GROUPS GESTATION AGE
PRE TERM LESS THAN 37 COMPLETED WEEKS(259
DAYS)
MODERATE PRE TERM BETWEEN 32 AND 36 COMPLETED WEEKS
VERY PRETERM BETWEEN 28 AND 31 COMPLETED WEEKS
EXTERMELY PRETERM LESS THAN 28 COMPLETED WEEKS
TERM BABIES BETWEEN 37 AND 41 WEEKS
POST-TERM 42 WEEKS OR MORE

5. TERMONOLOGIES
SMALL FOR GESTATIONAL AGE (SGA)
LESS THAN 10% FOR WEIGHT AT THE TIME OF BIRTH.
LARGE FOR GESTATIONAL AGE (LGA)
MORE THAN 90% FOR WEIGHT AT THE TIME OF BIRTH
APPROPRIATE FOR GESTATIONAL AGE (AGA)
BIRTH WEIGHT BETWEEN 10-90%

6. FENTON
CHART
BOYS

7. FENTON
CHART
GIRLS

8. Immediate response of newborn can be determined by…
- APGAR score at one and five minutes.
- Birth weight
- Length
- Temperature
- Immunization at Birth

9. • For assessment of baby immediately after birth, APGAR scoring is done.
• APGAR scoring is a quantitative method of assessing infant’s respiratory ,
circulatory and neurological status.
• APGAR scoring is done at 1 min & 5 minutes after birth.
• Maximum APGAR score is 10 & the score of more than 7 is considered
satisfactory & indicates absence of difficulty in adjusting to extra uterine life.
APGAR ASSESEMENT

11. BIRTH WEIGHT
• Preparing and weighing
the baby
 Remove all clothing
 Wait till the baby
stops moving
 Read and record

12. LENGTH
Length
Measured from crown to heel
Normal: 47-50 cm
Head Circumference
Measured across the centre of
forehead
Normal : 33 to 35 cms

13. TEMPERATURE
• At birth keep the baby in skin to skin contact with the
mother.

14. The umbilicus: Which one is normal?
Normal vs Abnormal

15. UMBILICUS
The NORMAL umbilicus is:
Bluish-white in colour on day 1.
It then begins to dry and shrink and
If falls off after 7 to 10 days
No discharge
LOCAL UMBILICAL INFECTION
RED umbilicus or
RED skin around the umbilicus
POSSIBLE SERIOUS INFECTION
Umbilicus draining pus or
Umbilical redness,

16. IMMUNIZATION AT BIRTH
VITAMIN-K
HEPATITIS-B

17. Neonatal assessment is done systematically from
birth till discharge of neonate.
Examination at birth includes assessment of
certain important parameters, to evaluate the
adjustment of newborn to the life processes.
SYSTEMATIC ASSESSMENT OF NEWBORN

18. WHAT TO
ASSESS?
TECHNIQUE
FOR
ASSESSMENT
SKIN
i) Skin color Observe
color of skin
especially of
hands, feet
and nails.
Normal vs Abnormal

19. JAUNDICE
 Yellow discoloration of a newborn skin and eyes.
 Excess of bilirubin in blood.
 Particularly in babies born before 38 weeks' gestation.

21. PHOTO THERAPY
DOUBLE SURFACE
SINGLE SURFACE

22. WHAT TO
ASSESS?
TECHNIQUE FOR
ASSESSMENT
HEAD
i) Fontannels Palpate anterior and posterior
fontanelles
ii) Sutures Palpate sutures
iii) Hair Observe texture

23. CEPAHALHEMATOMA
 Blood that collects between a
newborn's scalp and skull.
 Hematoma means blood that pools
outside blood vessels.
 Cephalo refers to the head. This type
of birth injury occurs when pressure
on a baby's head ruptures blood
vessels in the scalp.

24. SUCCENDUM
 Swelling (edema) on the top of the the
scalp.
 Most commonly occurs from pressure
on the head as the baby moves
through the birth canal during a
prolonged or difficult vaginal delivery.

25. SUBGALEAL
 Accumulation of blood that forms
between newborn's skull and the skin
on their scalp.
 The condition can occur after a difficult
vaginal delivery, especially if vacuum
extractor is used.
 Subgaleal hemorrhage can lead to
severe hypovolemia.
 One out of four babies who require
neonatal intensive care for this
condition die.

26. WHAT TO ASSESS? TECHNIQUE FOR
ASSESSMENT
EYES
Glabellar Tap
Observe eyes, color of sclera & iris,
discharge etc.
Tap sharply at galbella & look for
closure of eyes.
EARS
i) Location
ii) Ear cartilage
iii) Ear recoil
Draw a horizontal line from outer
canthus of eye.
Assess ear firmness by palpation.
Check ear recoil by folding pinna
forward and releasing it.

27. WHAT TO
ASSESS?
TECHNIQUE FOR
ASSESSMENT
NECK
Tonic Neck
Reflex
Inspect & palpate lymph
nodes in neck & also check
for range of motion.
Place the newborn in supine
position, turn the head to one
side.
CHEST Observe size, shape of
chest, retractions.
Grunting, Cry, Heart sounds

28. CPAP HHHFNC

29. WHAT TO
ASSESS?
TECHNIQUE FOR
ASSESSMENT
8) NOSE
Nasal passage Observe patency of nasal passage.
9) ORAL CAVITY
i) Cleanliness
ii) Rooting reflex
iii) Sucking reflex
Observe oral cavity (lips, gums, teeth, palate, tongue) by
stimulating newborn to cry.
Touch/ stroke the cheek along the side of mouth.
Observe while mother is breast feeding the new born

30. WHAT TO ASSESS? TECHNIQUE FOR
ASSESSMENT
Male Palpate testes
Observe location of
urethral opening.
BACK
Spinal curve Observe spinal curve while newborn is in prone
position.
EXTREMITIES
i) No. of fingers & toes.
ii) Grasp reflex
Count the fingers of toes &
hands
Place a finger across the palm at the base of the fingers.

31. GENERAL INSPECTION
• Vigorous cry is Normal
• Weak cry
– sepsis, asphyxia
• High pitch cry
– CNS causes, kernicterus

32.  BLOOD SUGAR MONITORING
 LGA, SGA
 GDM Mother

33. DDH
Developmental dysplasia of the hip
Condition where the "ball and socket" joint of the hip does not properly
form in babies.

34. DANGER SIGNS
!!!

35. DANGER SIGNS
 Not feeding well
 Less active than before
 Fast breathing (>60/ min)
 Moderate or severe chest in-
drawing
 Grunting
 Convulsions
• Floppy or stiff
• Temperature >37.50C
or <35.50C
• Umbilicus draining pus or
umbilical redness extending to
skin.

36. ON DISCHARGE
Before the new born is sent home,
detailed examination is necessary.
 To identify any anomaly and birth injury
which might have got missed out at
earlier examination.
 To educate the mother about care of new
born and breast feeding at home.
 To record baseline data for future
comparison.

37. CONCLUSION
• All newborn babies must be examined at
– Birth
– 24 hrs
– Before discharge
– Follow-up
• A systematic approach consisting of ‘Ask, Check, Look,
Listen, Feel’ should be followed at each assessment.

38. THANK YOU!