Newborn

Assessment
By: Ledelle M. De Chavez,
Claudine M. Francisco &
Don Jayric V. Depalobos
A. Introduction

Newborns undergo profound physiologic changes at the moment of birth as tey are released
form a warm, snug, dark, liquid-filled environment that has met all of their basic needs, into a
chilly, unbounded, brightly lit, gravity-based, outside world.

Witin minutes after being plunged into this strange environmeent, a newborn’s body must
initiate respirations and accommodate a sirculatory system to extrauterine oxygenation. Within
24 hours, neurologic, renal, endocrine, gastrointestinal, and metabolic functions must be
oerating competently for life to be sustained.

How well a newborn makes these major adjustments depends on his or her genetic
composition, the sompetency of the recent intrauterine environment, the care received during
the labor and birth period, and the care received during the newborn or neonatal period (from
birth through the first 28 days of life).

Assessment of a newborn or neonate incudes a review of mother’s pregnancy history;

physical examinationof the infant; analysis of laboratory reports such as hematocrit and blood
type,if indicated; and assessment of patient-child interaction for the beginning of bonding.
Assessment begins immediatey after birth ad is continued at every contact during a newborn’s
hospital or birthing center stay, home visits, and well-baby visits. Teching patients to make
assessment s concerning their infant’s temperature, respiratory rate, and over all health is
crucial so tat they can continue to monitor their infant’s health at home.
B. Assessment of a Newborn

 Profile of a Newborn. In getting the profile of a newborn, the following data must be
gathered: Vital statistics, where head has the largest circumference; Weight which
differs from each child, but generaly it decreases due to the decreas of influence of salt-
and fluid-retaining material hormones; Length, which has a ormal range of 46-54 cm for
male and 46-53 cm for females but records show that som babies reach the length of 57
cm; Head circumference, which normally range from 34-35 cm. A mature newborn with
head circumference of lesser than 33 cm and greater thatn 37 cm, must have a
thorough neurologic assessment and investigations; Chest circumference, in a term
newborn is about 2 cm less than the head circumference. This is measured at the level
of the nipples; Anthropometric measurements are aso assessed.

 Vita Signs. Temperature. The newborn is about 99°F (37.2°C at birth bcause they have
been confined in an internal body organ). There are four ways newbrns loses their heat:
convection, conduction, radiation, & evaporation. A newborn can be heated by drying
and wrapping and by kangaroo care. Pulse. The heart rate in utero ranges from 120 to
160. An hour after birth the healrt rate can reach to 180 in compensation to
extrauterine life. Respiration. The respiratory rate of a new born in the first few minutes
of life can reach up t 80 breaths per minute. But as repiration is established, respiratoy
rate can range to 30-60 breaths per minute. Blood Pressure. The blood pressure of a
newborn is aroximately 80/46 mmHg at birht. By the 10 th day, it rises to about 100/50
mmHg. Special considerations must be done to newborns with suspected heart
problems.
 Anatomy, Physiologic Functions with Normals and Abnormals

CARDIOVASCULAR SYSTEM. Changes in the cardiovascular system are necessary after

birth because now the lungs must oxygenate the blood that was formerly oxygenated by
the placenta.
Circulatory events at birth:

Drying or clamping of the umbiical cord and stimulation of cold receptors

↓
Incresed PCO2, decreased PO2, and increased acidosis
↓
First breath
↓
Decreased pulmonary artery pressure
↓ ↓ ↓
Increased Closure of Closure of
PO2 ductus foramen
↓ venosus ad ovale
Closure of umbilical (pressure in
ductus arteries and the left side
arteriosus vein due to of heart
decreased grater than
flow. right side)

Blood Values. A newborn’s blood volume is 80-110 m per kilogram of body weight, or
about 300 m total. Hematocrit level is between to 50%. Hemoglobin level ranges from
17 to 8 g/100 mL of blood. Bilirubin increases in bilirubin will happen due to the altered
coensatry mechanism of the red blood cells. This means that since the newborn has
already established oxygenation through breathing, red blood cells will deteriorate
causing neonatal hyperbilirubinemia. A newborn’s white cell count is 15,000-30,000
cells/mm3. Blood Coagulation. Newborns are born with a lower than normal level of
vitamin K. This makes them have prolonged coagulation or prothrombin time.Vitamin K,
synthesized through the action intestinal flora, is necessary for the formation of factors
2, 7, 9, and 10. Because the newborn’s intestines are sterile, it takes 24 hours for flora to
accumulate and for vitamin K to be synthesized so vitamin K is administered
immediately afer birth.
RESPIRATORY SYSTEM. All newborns have some fluid in their lungs from intrauterine
life that eases the surface tenson. Third of this fluid is forced out of the lungs by the
pressure of vaginal birth. Additional fluid is quickly absorbed by the lung blood vessels
and lymphatics after the first breath. Newborns born by cesarean birth does not have as
much fluid expelled at birth and may have difficulty establishin airway.

GASTROINTESTINAL SYSTEM. A newborn’s GIT may be invaded by bacteria after the 5

hours of being birth. Theses bacteria are commonly came from vaginal secretions and
air-borne. These bacteria are necessary for the synthesis of vitamin K to prevent
clotting. Although a newbor’s stomach holds 60 to 90 mL, a newborn has limited ability
to digest fat and starch because the enzyme, lipase and amylas remain deficient for the
first few months of life. A newborn also regurgitates bcause their cardiac shincter is still
immature. Immature liver functions may lead to lowere glucose and protein serum
levels.

URINARY SYSTEM. The average newbrn voids within24 hours after birth. The kidneys of
newborns do not concenrate urine well, making newborn urine usually light-colored and
odorles. A sigle voiding f a newborn is only about 15 mL. For the first 2 days, the urine is
amounting to average of 0-60 mL total. Bu after week, the voume increases to 300mL.
The first voiding may be pink or dusky because of uric acid crystals that were formed in
the bladder in utero. Diapers can be weighed to determine the amount and timing of
voidings.

IMMUNE SYSTEM. Newborns have difficulty formin antibodies against invading antigens
until about two months of age, hence, newborns are prone to infection.