Professional Documents
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Newborn Pa
Newborn Pa
Newborn Pa
Assessment
Of The Newborn
APGAR SCORING SYSTEM
❂ Developed in 1950s ❂ A = Appearance (skin
❂ Cardiopulmonary color)
status ❂ P = Pulse (heart rate)
❂ Dr. Virginia Apgar ❂ G = Grimace (reflex
❂ 1 minute after birth irritability)
❂ 5 minutes after birth ❂ A = Activity (muscle
❂ 5 parameters tone)
❂ R= Respiration
• (respiratory effort)
Criteria for Apgar Scoring
Category 0 Points 1 Point 2 Points
Heart Rate Absent Under 100 Over 100
❂ Neuromuscular Maturity
• Posture & extremities / muscle tone:
• Posture - hypotonic w/ arms & legs extended
to arms & legs flexed w/ recoil
• Square Window (wrist) - greater than 90* to 0*
• Arm Recoil - none to full recoil w/ angle < 90*
• Knee Joint Angle (popliteal) - from 180* to less
than 90*
ESTIMATION OF GESTATIONAL AGE
NBS - continued
❂ 5 Common
• Tachypnea
• Cyanosis
• Nasal Flaring - Silverman score
• Expiratory Grunting - Silverman score
• Retractions - Partially Silverman score
RESPIRATORY DISTRESS -continued
❂ Tachypnea = RR > 60
• Over 50 should increase suspicion
• Full minute assessment
❂ Cyanosis = bluish discoloration
• Local vs. General
• Central
– Involves mucous membranes
– Indicates excessive unsaturated hemoglobin
RESPIRATORY DISTRESS -continued
• Central Cyanosis - continued
– In excess of 5 g / dl
– Presence usually indicative of PO2 < 40 mmHg
– Slight drop in PO2 yields dangerous sharp decline
in hemoglobin saturation, O2 carrying capacity
– Anemic baby may have no cyanosis w/ extreme
hypoxemia
• Acrocyanosis - hands & feet
– common in newborns
RESPIRATORY DISTRESS -continued
❂ Retractions = inward movement of chest wall
• Intercostal = between ribs
• Supraclavicular = above clavicles
• Subcostal = below rib margins
• Suprasternal = top margins of sternum
• Xiphoid = bottom margins at xiphoid process
RESPIRATORY DISTRESS -continued
❂ Apnea
= periods of no respiration for at least 20
seconds
❂ Or periods of absence of respiration
accompanied by bradycardia (HR < 100)
Chest Auscultation
❂ Rales ❂ Rhonchi
• “crackles” • changes in pitch
• short, interupted • narrowing of airways
sounds – secretions
• usually during – swelling
inspiration – foreign matter
– smooth muscle spasm
• associated with
– HMD • “Course” = low pitch
– Pulmonary Edema • “Wheeze” = high pitch
– Pneumonia
Head, Face, & Neck Exam
❂ Assessment of Congenital Anomalies
❂ Head
• Shape & Size
– Compression during birth - self correcting
• Occipital Frontal Circumference (OFC)
• Ears
– Shape, Size, Position, Presnce of ear canals
Head, Face, & Neck Exam - cont.
❂ Face
• Eyes
– Size -Shape -Position
• Nose
– Size -Shape -Patency of Nasal Pasages
• Mouth
– Lips -Hard/Soft Palate -Size of tongue & jawbone
Head, Face, & Neck Exam - cont.
❂ Neck
❂ Inspected for;
• Range of motion
• Goiter
• Presence of cysts
ABDOMEN, SKIN, EXTREMETIES
❂ Abdomen
• Protrusion of abdominal contents
• Appearance & position of umbilicus
❂ Skin
• Pigmentation, Rashes, Bruising, Unusual
• Jaundice
ABDOMEN, SKIN, EXTREMETIES
❂ Extremeties - fingers & toes
• Position
• Size
• Number
❂ Hands & Feet
• Color
❂ Pulses
• Brachial & Femoral