Newborn Assessment

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 Equipment
What’s in Your setting?
 Tape measure
 Stethoscope
 Otoscope
 Opthalmoscope
 Phonendoscope
 Thermometer
 Measurement of
blood pressure
 Pulse oximeter
 Tongue depressor
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 Apgar score is a method to quickly summarize the health of newborn children.The Apgar
score was introduced In 1952 by an anesthesilogist Dr. Virginia Apgar, Apgar is a quick test
performed on a baby at 1 and 5 minutes after birth.
The five criteria of the Apgar score:

Score of 0 Score of 1 Score of 2

Skin color blue or pale all over blue at extremities body and extremities
body pink -(acrocyanosis) pink
Pulse rate Absent < 100 ≥100
beats per minute beats per minute

Respiratory effort Absent Weak,irregular, strong, robust cry

gasping
Muscle tone None some flexion Activity
Reflex No respose to stimulation grimace on suction or cry on stimulation
( irritability grimace) aggressive stimulation

If a baby score is 6 or < 6 It mean that

a baby need some special immediate care to help !

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Inspection

• First step of
physical
examination

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Main features of routine
examination of the newborn

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 Assessment

 Posture of Newborn, skin

 Head , Eyes,Ears,Nose, Mouth
 The Masculoskeletal system
 Screening investigations

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 skin, Head & Neck, Eyes, Ears, Nose, Face,
Mouth & Throat

• Skin: Red color of skin , acrocyanosis, jaundice

Mongolian spots, vernix caseosa, Lanugo hair, rash.
• Head: Symmetry of skull and face
• Neck: Structure, movement, trachea, thyroid, vessels
and lymph nodes
• Eyes: Vision, placement, external and internal
fundoscopic exam
• Ears: Hearing, external, ear canal and otoscopic exam
of tympanic membrane
• Nose: Structure, exudate, sinuses
• Mouth: Structures of mouth, teeth and pharynx 8
Posture of newborn

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Posture of Newborn

Premature Newborn 10
Skin:
General description:
At birth;
color: bright red,
texture: soft and has good elasticity.
edema is seen around eye, face, and
scrotum or labia.
Cyanosis of hands & feet (acrocyanosis) 11
General description of the skin

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Acrocyanosis

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 Vernix Caseosa:

1. Soft yellowish cream layer that may thickly cover

the skin of the newborn, or it may be found only

in the body creases and between the labia.

The debate on an issue wash it off or to keep it.

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Vernix Caseosa

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 Lanugo hair:

Distribution

- The more premature baby is, the heavier the

presence of lanugo is.

- It disappears during the first weeks of life

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Lanugo hair

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 Mongolian spots:

Black coloration on the lower back, buttocks,

anterior trunk & around the wrist or ankle.

They are not bruise marks or a sign of mental

retardation, they usually disappear during preschool

years without any treatment.

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Mongolian spots

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Mongolian spots

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 Desquamation:

- Peeling of the skin over the areas of bony

prominence that occurs within 2-4 weeks of life

because of pressure and erosion of sheets.

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Desquamation

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What is a fontanelle?

• A fontanelle
• (or fontanel) is, an
anatomical featur of
the infant human
skull comprising any
of the soft
membranous
gaps (sutures)
between the cranial
bones that make up
the calvaria of a fetus
or an infant.
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 Fontanelle

6 fontanel: The sequence

of fontanelle closure
is a follows:
The posterior fontanel –
is trianngle-shaped,
measures about 0,5—1,0cm .
Generally closes 2 to 3 moths after
birth.
The sphenoidel fontanel –
is the next to close around 6 -
month after birth.
The mastoid fontanel –
closes next from 6 to 18
months after birth.
The Anterior fontanel –
it is lozenge-shaped and
measures about 2,5-4cm.
Generally the last to close
18 to 24 moths . 24
 Appearance of healthy babies fontanell look as pulsating, lozenge-shaped,
slightly buligng or sunken .
We generally assess two fontanell:
(Anterior and Posterior )
There is a special formula in which we calculate size of fontanell:
Longitudinal + transversal diameter / 2.
Size of posterior fontanell not exceeding 0,5-0,7cm.
It generally closes during first or second month of life.
The Anterior fontanelle measures 2,2-3,5 სმ.
The anterior fonatanelle generally close 6-18 months , although in some
cases ,
2019 - 2020 It can be close 3-6 months , or later on 18-24 month. 25
 Fontanelle is felt when newborn have rest condition !

Normal appearance fontanell is surrounded by

bones of skull and slightly pulsating.
The changed appearance fontanel
(very bulging or vice-versa sunken )
it may indicate the whole of disease such as ………

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•

• Fontanells –sunken

• A sunken (also called

“depressed”) fontanelle
indicates dehydration or
malnutrition
 Fever
 Dysbacteriosis
 Frequency of vomiting
Rehydration is important!

Fontanelle– bulging
It can occur due to:
 Intracranial pressure (ICP)
 Meningitis
 Encephalitis
 Cancer

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Caput succedaneum

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Caput succedaneum

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Caput succedaneum

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Cephalhematoma

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 Eyes:

-Usually edematous eye lids Gray in color.

True color is not determined until the age of 3-6 months.
-Pupil: React to light
- Absence of tears
- Blinking reflex is present in response to touch
- Can not follow an object (Rudimentary fixation on
objects). 33
Normal Eye

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“Down syndrome” - The eye and nose

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Eyelid Edema

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Dysconjugate Eye Movements

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Subconjunctival Hemorrhage

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Congenital Glaucoma

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Congenital Cataracts

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 Ears:

Position:

Startle Reflex:

Pinna flexible, cartilage present.

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Normal Ears

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Ear Tag

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 Nose:

Nasal Patency (stethoscope).

Nasal discharge – thin white mucous

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Normal Nose

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Dislocated Nasal Septum

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 Mouth & Throat:

- Intact, high arched palate.

- Sucking reflex – strong and coordinated
- Rooting reflex
- Gag reflex
- Minimal salivation

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Cleft Palate

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Cleft Lip

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Normal Tongue Ankyloglossia

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Ankyloglossia

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Gum:

May appear with a quite irregular edge.

Sometimes the back of gums contain whitish

deciduous teeth that are semi-formed, but not

erupted

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Irregular edges with Natal Teeth

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Natal Tooth

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 During postnatal period physiological improving is depens on process of
adaptation.frequently some process due to functional changes in various kind of
systems, this condition is called Disadaptation syndrome .
it ‘s important to differentiate this syndrome from abnormal condition.

Physiological weight loss

Skin Lungs

Mummification
Kidney GI processof
umblical

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 Physiological loss of weigh is noted – 40–80% in newborn
The common causes loss of fluid are by way of skin, lungs, kidney, GI,
mummification process of umbilical.
It is expected that newborns will lose some weight in the first 5-7 days of life.
A 5% weight loss is considered normal for a formula-fer newborn.
A 7-10% loss is considered normal for breastfed babies.
There are three grade to assess Newborn weight loss:

III grade - >10 %

II- grade - indicates

6–9% abnormal process
I grade– - 6%

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 Most babies should
regain
this lost weight
by days 10-14 of life

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Icterus Neonatorum

Physiological

Abnormal

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Jaundice

Abnormal

Cyanosis
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 Transitional jaundice in newborn
– The yellow color shows up first in the baby’s face and chest usually 1 to 5 days
after birth.

In neonates, jaundice tends to develop because of two factors -

The breakdown of fetal hemoglobin and the relatively immature metabolic
pathways of the liver, which are unable to conjugate and so excrete bilirubin
as quickly as an adult.
This causes an accumulation of bilirubin in the blood (Hyperbilirubinemia ), leading to the
symptoms of jaundice.
 Bilirubin production - is elevated because of increased breakdown of
fetal erythrocytes . This is the result of the shortened lifespan of fetal
erythrocytes .
 Immature of liver function – Hepatic excretory capacity is low both
because of low concentrations of the binding protein ligandin in the
hepatocytes and because of low activity of glucuronyl transferase.
 The enzyme responsible for binding bilirubin to glucuronic acid, thus making
bilirubin water-soluble.

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Physiological Jaundice

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Physiological Jaundice

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 firstly it should be noted:

 Haemolysis of red blood cells

 RH incompatibility
 Congenital membranopathy ( spherocytosis ) , Congenital enzyme deficiency
( deficit de Glucozo -6- fosfat dehidrogenaza)
 Cephalohematoma, haemorrhge, infection
 Congenital haemolitic anemia
 Jundice due to breastfeeding
 Hypothyreosis
 Comlications of perinatal period
 Sepsis
 Asphixia
 Intrauterine infection and so on …….
Bilirubin is potential Neirotoxin - Unconjugated bilirubin in serum is bound to albumin
. Undound ,unconjugated circulating bilirubin crosses the blood-brain barrier and
because it is lipid soluble, it penetrates neuronal and glial membranes , it can
cause brain damage called - Kernicterus
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 Physiologic Jaundice :

- Physiologic jaundice in healthy term newborns follows a typical patter n.

The average total serum bilirubin level usually peaks at 5 to 6 mg per dL (86
to 103 μ mol per L) on the third to fourth day of life and then declines over the
first week after birth
- The baby is active , temperature is normal, sucking reflex is good.
- Urine and stool color are unchanged.
- The liver and spleen aren’t swell.

Phathologic Jaundice:
- Jaundice is considered pathologic if it presents within the first
24 hours after birth, the total serum bilirubin level rises by more
than 5 mg per dL (86 mol per L) per day or is higher than 17 mg
per dL (290 mol per L);
-Common condition is satisfactory.
- Urine and stool color may be change
- Hepatosplenomegaly
2019 - 2020 65
 Cyanosis - is defined as a bluish discoloration , aspecially of the skin and mucous
memrances,due to excessive concentration of deoxyhemoglobin in the blood caused by
deoxygenation, Congenital Heart Disease, Asphyxia and so on ….
Cyanosis is divide into two main types: Central - (around the lips and tongue)
And Peripheral ( only the extremities or fingers).
Acrocyanosis - appear within first hour after birth, and refers to the peripheral
cyanosis around the mouth and the extremities (hand and feet)
It is caused by benign vasomotor changes that result in peripheral vasoconstriction,
which is ramained during 24–48 hour.

2019 - 2020 66
Erythema Toxicum

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Impetigo Neonatorum

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 „The Hormonal Crisis ‘’- most often occur in both sexes.
it belongs to:
 comedones neonatorum seu milia – visual it like a pin , they are
usually found around the nose and eyes and sometimes on the
genitalian, Milia is result hypersecretion of the eccrine sweat
gland.
 Milia disappear within the first few weeks of life.

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Neonatal Mastauxe – (Breast Enlargement of the Newborn)

 Breast enlargement occur in approximately 70% of newborn.

 it appear within first day after birth and litter by litter incease.
 skin color is unchanged or slightly hyperemic.
 The breast tissue will begin to shrink and become flat . This may
take days and weeks. A milky substance called “ witches milk”- may
leak from the nippy but will cease after a few days or weeks.

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 Desquamative
vulvovaginitis

Hormones from the mother

(maternal hormones)
that pass through the
placenta into the baby’s
blood during pregnancy.
These hormones can
affect the baby.

metroragia neonatorum - Pigmentation

uterine bleeding Around of the nipple
it will continue during 1-2 days. and
scrotum

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 Normal Male genitalia

• Urethral opening is at
tip of glans pens.
• Testes are palpable in
each scrotum.
• Scrotum is usually
pigmented, pendulous
& covered with rugae.

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2019 - 2020 73
Cryptorchidism

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Hydrocoeles

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Hydrocele

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Inguinal Hernias

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Female genitalia

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 Female genitalia Cont.
• Labia & Clitoris are
usually edematous.
• Urethral meatus is
located behind the
clitoris.
• Vernix caseosa is
present between
labia

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 Maternal hormonal withdrawal

• Female
genitalia,
normal with
vaginal
discharge

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Infantile menstruation

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 Neck:

Short, thick, usually surrounded by skin folds.

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Daun syndrome - neck

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Neck

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Back,Spinal

• Check back and spinal to exclude congenital

pathologi.
• Spina bifida – is incomplete closing of
the backbone (vertebrae) and membranes
around part of the baby's spinal cord.
• Meningocele- Spinal cord herniation
(hernial sac is contains membranes of
spinal cord)

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Spinal herniation

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Postoperative

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Extremities

• Assess of movement, size, symmetry.

• Check brachial plexus injury
• Check clavicle, upper and lower extremities
to excluding fractures, especially traumatic
deliver or brachial distortion.
• Check congenital hip dislocation.
( Barlow & Ortolani test)
Check curvature of the foot.
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Subluxation of the Hip

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Barlow & Ortolani test

Ortolani test Barlow test

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Assess hip conditions

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curvature of the foot

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Nevrological status

• Muscle tone assessment

• Check cranial nerves (for example: eyes and
tongue movement and so on…)
• Rifles Testing ( should be symmetrical)
• Rooting reflex
• Sucking reflex
• Grasp reflex
• Moro reflex
• Stepping reflex
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 The Central Nervous system:

Reflexes:
Successful use of reflex mechanism is a
strong evidence of normal functioning CNS.

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Moro Reflex

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Screening & Immunisation
 immunisation
Hepatitis B vaccine-
is given within 12 hour after
birth , against being
infected with the hepatitis
B virus.

 BCG vaccine
is given from birth to 2-5
days of life.

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Screening
In Red color is noted diseases
what are introduced in Georgia.
1 phenylketonuria (PKU)
2.congenital hypothyroidis
3.cystic fibrosis (CF)
4. Hearing screening
5. galactosemia
6. sickle cell disease
7. biotinidase deficiency
8. congenital adrenal hyperplasia
(CAH)
9. maple syrup urine disease (MSUD)
10. tyrosinemia
11. MCAD deficiency
12. severe combined
immunodeficiency (SCID)
13. Toxoplasmosis
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სკრინინგი სმენაზე
განსაკუთრებით რისკის
ჯგუფში მოიაზრება:

• დღენაკლები / დაბადებისას
განვითარებული სუნთქვის
უკმარარისობის ნიშნებით.
• ჰიპერბილირუბინემია
(გამოხატული სიყვითლე )
• ასიმეტრიული თავის და
სახის სტრუქტურა .
• ინფექციები როგორიცაა:
ციტომეგალოვირუსი,
სიფილისი, ჰერპესი,
ტოქსოპლაზმოზი.
• აბგარის შკალით შეფასებისას
დაბალი ქულა.

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 Alarming signs :
Newborn assessment of the folowing 3 characteristics:

Term gestation Crying or breathing Good muscle tone

 if the answer to all 3 of these questions is “Yes,”

the baby should be dried, places skin -to -skin with the mother
and coverd with dry linen to maintain temperature.
Observation of breathing , activity and color should be ongoing.
 If the answer to any of these assessment questions is “No”,
we begin to start first step of Neonatal Resuscitation!!!
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Thank for attention

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• https://www.health.qld.gov.au/__data/assets/pdf_file/0029/141689/
g-newexam.pdf
• http://www.uptodate.com/contents/assessment-of-the-newborn-
infant
• https://www.uptodate.com/contents/overview-of-cyanosis-in-the-
newborn
• https://en.wikipedia.org/wiki/Fontanelle
• https://www.slideshare.net/mohamadismail58/neonatal-
examination
• https://www.urmc.rochester.edu/encyclopedia/content.aspx?Conte
ntTypeID=90&ContentID=P02336

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Competition Assessmet:

 Newborn General examination

( from head to foot)
 Assessment of fontanelle
Physical assessment of hip
Examination Testes & Scrotum

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