APGAR SCORING If depressed – dehydration

If bulging – increased ICP/hydrocephalus

Seated upright is the best position to check fontanels

- Check for localized softening of the cranial bone

(craniotabes)
- Macrocephaly/microcephaly
- Capput succedaneum/cephalohematoma

Capput Succedaneum (symmetrical)

- Edema (fluid)
- Appears within 24hrs
- Crosses suture line
- Disappear in 1-4 days

Cephalhematoma (1 sided asymmetrical unilateral)

- Hemorrhage (blood)
- Appears after 24hrs
- Doesn’t cross suture line
- Disappear in 1-4 weeks

Considered both as birth injuries

Both no interventions needed

EYES

- Symmetrical and clear

- + PERRLA (pupils equally, round, reactive to
light accommodation)
- Midline vision, 9-12 inches, contrasting colors;
black and white and favorite color is red
- Visual acuity – 20/100 – 20/150 at birth
- 20/20 – 6yrs
ASSESSMENT, VITAL SIGNS, ANTHROPOMETRIC
MEASURES
EARS
HEAD
- Eustachian tube:
Rule: Least intrusive to the most intrusive
o Infant – short and straight
Inspection – auscultation – percussion – palpation o Adults – long and diagonal
Otitis media: eustachian tube
RR – CR – BP/TEMP Causes: Passive smoking
- 25% of the body length Pulmonary infections
- Fontanels Propping the bottle
o Anterior – (BREGMA) (bigger triangle, Children
12-18months)
o Posterior – (LAMBA) (smaller triangle, 2- Otitis externa – “swimmer’s ear” ear
3months) canal
 Causes: Water activity
Colds and flu
Adults
- Below 3 years old: back and down
- Above 3 years old: back and up
- Low set ears indicated
o Trisomy 21
o Kidney agenesis
o Fetal alcohol syndrome
- Bowel sounds after 1 hour
ANOGENITALIA
- Male: pendulous; testicles, penis – 2cm
- Cremasteric reflex
- Female: swollen – Pseudomenstration due to
estrogen
BACK

- Thoracic only curved

- Flat – lumbar and sacral
NOSE - Check for pinpoint opening (NTD)
Neural tube defects
- Obligatory nose breathers
Failure of neural tube to fuse/close
- Occasional sneezing (to remove obstructions)
Cause: No folic acid intake (B9)
- Check for patency (atresia – blockage)
Taking anti-convulsant
DM
MOUTH
Types:
- Slightly large tongue
- Anencephaly – absent brain/skull
- Check for lip and palate intactness
- Encephalocele – protrusion over brain
o Cleft lip
- Spina bifida – split spine
▪ Lalake
o Occulta – opening/dimpling
▪ Cheiloplasty
o Cystica – protrusion/sac over the spine
▪ 10 weeks
▪ Meningocele
▪ Side lying – unilateral
▪ Myelomeniggele
▪ Supine – bilateral
▪ Little utensils Diagnosis: screening- ultrasound and
▪ Save sucking reflex transillumination
o Cleft palate
▪ Female Confirmatory test: amniocentesis – measures
▪ Palatoplasty/uranoplastic afp/alpha feto protein 10-150ng/dl
▪ 10 months NTD - > 1000ng/dl
▪ Prone
▪ Big utensils Trisomy 21 - <10ng/dl
▪ Save speech Screening – suggestive

Confirmatory – conclusive (100% confirmed the

- Epstein pearls disorder) (gold standard or definitive test)
o Keratin Interventions: AVOID: supine position
- Natal teeth (usually lower incisors) diapers
NECK moisture over sac
latex
- Short broad neck
- Head should rotate freely on it Watch out for- hydrocephalus
- (+) head lag

ABDOMEN EXTREMETIES AND DIGITS

- Slightly protuberant/globular - Normal flat footed
 - Symmetrical gluteal folds 4. Blood Pressure: 60/45 – 80/55mmhg
Asymmetrical – hip dysplasia Possible cause of hpn:
- Polydactyly/syndactyly a. Anxiety
- Phocomelia/Amelia b. Renal anomalies
c. Coarctation of the aorta
1. Weight – 5.5 – 7.5lbs (2.5-4kg)
Thigh BP = <1year old; arm = >1year old
Physiologic weight loss is normal for preterm for
the first few days due to meconium and urine
passage
Weight increase: 6months 2x 12 months 3x 2 ½ NEWBORN CARE, TEACHINGS, AND INTERVENTIONS
years 4x BATHING
2. Length: 24-52cm/ 18-22 inches
3. Head conference 33-35cm 1st – oil bath
4. Chest circumference 31-33cm Done to: spread vernix caseosa
5. Abdominal circumference: 31-33cm
vernix caseosa (5th month of pregnancy)

a. Uses as bacteriostatic
b. Uses as an insulator
c. Uses as moisturizer

2nd – sponge bath

Done when: cord is still present

3rd – full bath

Done when: cord falls off

*Time band done at least 6 hours after delivery; at

stable vital signs

VITAL SIGNS
CORD CARE
1. Temperature: 36.5 – 37.5 (97.7 – 99.5)
Best site: rectal – most accurate (not - Check for AVA ARTERY – AWAY
recommended) VEIN – BACK
(safest) Tympanic and axillary for <4 years old - Time band: cut after pulsation have stopped at
Oral for >4years old 1-3 minutes
Contraindications: - Clamp twice
1. Diarrhea o 1st plastic clamp/sterile tie at 2 cm or 1
2. Hemorrhoids inch
3. Imperforate anus o 2nd clamp/forceps at 5cm or 2 inches
4. Cardiac problems from the baby
- Do not milk towards the baby, “swipe” only
towards the mother
2. Cardiac rate: 120-160bpm
Best site: apical (regular assessment)
Most accessible site: brachial pulse (CPR)
Two palpable pulses: brachial
3. Respiratory rate: 30-60bpm
Best site: abnormal area for 1 full minute
 - WHO currently advocates DRY CORD CARE and CS – 4-6hours post delivery
cleaning by water only Exclusive – for the 1st 6 months
Extended – up to 2 years and beyond
DRUGS
Breastfeeding position
Vitamin K
C – cradle position
- Time band: 90minutes – 6hours
- Vitamin K (phytonadione, aquamephyton) C – cross cradle position
- Purpose: to catalyze the synthesis of
F – football hold
prothrombin
- Dose: 0.5mg-1mg (IM) S – side lying position
- Site: vastus lateralis, rectus femoris, ventro
gluteal S – saddle position
- Minimum gauge: 25; 5/8inch Proper latching during breast feeding
- Avoid: Dorso Gluteal area
- Alternative dose: 2-4mg (PO) after first feeding C – chin touches breast

Crede’s prophylaxis O – open mouth widely

- Purpose: prevent neonatal blindness or L – lower lip turned outward

ophthalmia neonatorum (conjunctivitis) A – areola adequately covered
- Causes:
o Chlamydia Order of solid food introduction
o Neisseria gonorrhea
1. Rice cereals
- Medication:
2. Vegetables
- Erythromycin
3. Fruits
- Tetracycline
4. Egg yolk
- 2.5% povidone iodine
5. Meat and poultry
Site: lower conjunctival sac from inner to outer 6. Egg white
canthus 7. Fish/seafood
8. Table food/sugar
Elimination
Guidelines:

- Age/month: earliest: 4months

Ideal: 6months
- Interval: One food type every 4-7days
- Amount and method: as tolerated and on-
demand

Breastfeeding recommendations

- Give your baby colostrum

- Breastfeed at least 8x in 24hrs; for low
birthweight – feed at 2-3hrs
- At 6-9months, babies can be given thick
porridge and well mashed foods at 2-3meals
FEEDING - Feeding cues – fussing, sucking fingers, moving
lips
- Breastfeeding initiation
3 E’s of breast-feeding initiation
Early – NSD - ASAP