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Newbornassessment EDITED FOR LECTURE
Newbornassessment EDITED FOR LECTURE
INTRODUCTION:
Newborn assessment is done as soon as after
birth as possible, the mother should be
allowed to spend some time with the baby
immediately after birth to initiate the bonding
process. Early assessment can assist the
nurse in ascertaining if the newborn is infant is
within the range of ‘normal’.
Definition:
• Health assessment is a thorough inspection or
a detailed study of the entire body or some
part of the body to determine the general
physical or mental conditions of the body.
Purposes:
• To understand the physical and mental
well being of the child.
• To detect disease in early stage.
• To determine the cause and effect of the
disease.
• To teach child and parent.
• To measure the health in future.
• To determine the nature of treatment or
care needed for the child.
• General Points to be Remembered During Examination
of a Newborn:
– examine 1 hour after feeding
– examine in neutral thermal environment – examine the presence
of the mother.
– examine gently, methodically ( from top to bottom)
– examine those system which require a quiet child first and later do
examination that tend to disturb the child. Eg. Reflex testing, ear
examination.
Recommendations for general physical examination is to
examine patient in a supine position from the patient’s
right side. Right side is preferred because;
• Right jugular veins are more reliable for estimating
venous pressure.
• Palpating hand rests more comfortably on apical
impulse.
• A kidney is more frequently palpable.
Health assessment:
Assessment of the newborn as soon as possible after
birth and subsequent assessment in the neonatal
period are responsibility of the mucous working in the
hospital and in the community.
PHASES ASSESSMENT:
Initial
Transitional
Assessment of gestational age
Systemic physical examinations
• INITIAL ASSESSMENT:
• The most frequently used method to assess the newborns
immediate assessment is done in newborn life including Apgar
Scoring System.
Apgar Scoring:
In 1953, virgenia Apgar introduced a simple systematic assessment
of intrapartum stress and neurologic depression at birth.
Causes of low Apgar Score:
• Asphyxia
• Maternal drugs
• Central nervous system disease
• Congenital muscular disease
• Prematurity
• Fetal sepsis
TRANSITIONAL ASSESSMENT:
1 stage: lasts for 6 hours, first 30 minutes awake, remaining hours
baby will be sleeping.
• 2 stage: 6 to 12 hours observation should be made until the vital
signs are stabilized.
ASSESSMENT OF GESTATIONAL AGE:
Dubowitz scale:It is an important criteria because perinatal morbidity
and mortality are related to gestational age and birth weight. A
frequently used method is by the use of determining gestational
age is by the ‘ Dubowitz scale’ a simplified version developed by
Ballard,Novack and Driver (1979).
Ballard scale: the new ballard scale is a revised scale of dubowitz
scale. It can be used with newborns as young as 20 weeks of
gestation. The tool has the same physical and neuromuscular
sections but includes -1 and -2 scores.
Neuromuscular maturity include: posture, square window, arm recoil,
popliteal angle, scarf sign, heel to ear.
Physical maturity: skin, lanugo, plantar surface, breast, eye/ear,
genital(male, female)
• GENERAL PHYSICAL EXAMINATIONS:
Vital signs:
Temperature: --neonates normally respond to infection with low
temperatures.
-- in neonates the temperature can be taken from the groin, axilla or
groin.
Normal temperature 36.5-37.5oC
Hypothermia < 36o C
Hyperthermia > 41oC
Respiration: -- count by observing the abdominal movements in
infants as the movement are primarily diaphgramatic.
-- count for one full minute for accuracy.
normal respiration 35 breath/ min
tachypnea >40 breath/min
bradycardia < 20 breath/min
• Pulse:
apical pulse are more reliable for infants (between 4th and 5th
intercoastal).
Pulse is counted for one full minute in infants and young children.
Nose Neonates are obligatory nose breathers. oral breathing: obstruction by mucus
Nose is usually flattened after birth. Nasal plugs, choanal atresia.
patency should be assessed.
Ears Top of pinna should be in line with outer Low set ears- a feature of genetic
canthus of the eyes. syndrome.
Tympanic membrane will be grey in
newborn. Normal infants hear at birth and
startle or have a complete moro reflex with
a sudden noise.
Areas Normal Abnormal
Mouth or throat Epstein pearls are normally found on Excessive salivation: hare lip ( cleft
both sides of the hard palate. lip ), cleft palate, deviation of angle
Precocious teeth may be present which of mouth – 7th nerve palsy.
fall off soon.(1 in 2000 births)
Genitalia Male: normally prepuce covers the entire Phimosis, hypospadias, epispadias.
glans penis. Sometimes prepuce cannot
be retracted back up to 4-6 months in
normal babies.
Scrotum: varies in size, rugated with
descended testis. Preterm female babies- labia majora
does not cover minora.
Female: normally labia majora covers
labia minora
Spine Normally the curvature of the spine is spina bifida, meningomyelocele.
“C” shaped.
epispadias is a rare type of malformation of the penis in which the urethra ends in an opening on the
upper aspect of the penis.[1] It can also develop in females when the urethra develops too far
anteriorly.
Spina bifida is a birth defect where there is incomplete closing of the backbone and membranes around
the spinal cord. There are three main types: spina bifida occulta, meningocele, and myelomeningocele.
• SYSTEMIC ASSESSMENT:
A careful general examination of a newborn baby provides
more information of the condition of the baby. The system
to be examined includes:
1. Cardiovascular system
2. Respiratory system
3. Central nervous system
Examination of CVS: history of drug and TORCH ( TORCH,
which includes Toxoplasmosis, Other (syphilis, varicella-zoster,
parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes
infections, are some of the most common infections associated with
congenital anomalies) exposure
Anomalies - cleft lip/ cleft palate, cataract, polydactyl ( with extra
fingers or toes )
Respiratory rate - normal/ increased or decreased/ type of breathing
Pulse - 120-160 beats/min apical pulse normally taken
Average BP - term baby: 70/45mmhg
preterm: 60/20mmhg
• Examination of respiratory system:
History of cough - pneumonia
Diabetes mellitus - RDS
Preterm - RDS
Polyhydromnios - asphyxia, respiratory distress
Character:
Dyspnea, tachypnea, apnea, grunting ( abnormal, short, deep, hoarse sounds in
exhalation that often accompany severe chest pain)
REFLEXES OF NORMAL
NEWBORN
Reflexes are involuntary movements or actions. Some movements are spontaneous, occurring
as part of the baby's usual activity. Others are responses to certain actions. Reflexes help
identify normal brain and nerve activity. Some reflexes occur only in specific periods of
development.
Babinski
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 or her head, extends out the arms
and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him or her and trigger this reflex.
This reflex lasts about 5 to 6 months.
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 6 to 7 months.
Grasp reflex. Stroking the palm of a baby's hand causes the baby to close his or her fingers in a grasp.
The grasp reflex lasts until about 5 to 6 months of age.
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 or her feet touching a solid surface.
Rooting
Root reflex. This reflex begins when the corner of the baby's mouth is
stroked or touched. The baby will turn his or her head and open his
or her mouth to follow and "root" in the direction of the stroking.
This helps the baby find the breast or bottle to begin feeding.
Sucking
• Swallowing
Accompanies the sucking reflex.
Food reaching the posterior of the
mouth is swallowed.
• Extrusion
- Substance placed on the anterior
portion of tongue. Extrusion of
substance to prevent swallowing.