NEWBORN ASSESSMENT

PRESENTED BY-
MR. FRANK WILLIAM
M.SC.(N)PREVIOUS YEAR
• DEFINITION- Healthy new born baby is one
who is delivered between the gestational age
of 38-42 weeks with average birth weight
more than 2.5kg, who cry immediately and
establish independent rhythmic respiration,
quickly adapt to the changed environment as
evidenced by establishment of breast feeding.
PRE- REQUISITE-
• Detailed History Of Date Of Birth, Gestational
Age, Education/ Occupation & Economic Status,
• Age Of The Mother, Previous Obstetrical
History, Antenatal Check-ups,
• Family History, Natal History-obstructed Labour,
Cried Immediately After Birth,
• APGAR Score, Anthropometric Measurement At
Time Of Birth, Immunizations etc.
NURSING ASSESSMENT-
• Warm and comfortable room should be kept
ready before the examination begins.
• The temperature of the room should be 26-28
degree Celsius, by switching on the warmer
half hour before.
• 2 Pre-warm towel should be ready to receive
the baby.
EXAMINATION OF
THE NEW BORN
AT BIRTH

WITHIN 24
HOUR

AT
DISCAHRGE
1. AT BIRTH:
AIMS:
• Is to ensure and assess that lungs have
expanded
• Air passages not obstructed
• Make an early diagnosis of congenital
malformations and birth injuries
ASSESSMENT INCLUDE:
I. APGAR SCORING
  Category 0 Points 1 Point 2 Points

Heart Rate Absent <100 >100

Respiratory Effort Absent Slow, Irregular Good, crying

Muscle Tone Flaccid Some flexion of extremities Active motion

Reflex Irritability No Response Grimace Vigorous cry

Color Blue, pale Body pink, extremities blue Completely pink

KEY POINTS:
• Total Score-10
• 7 to 10- No Depression Newborn_cry.mp3
• 4 to 6- Mild Depression slow irregular cry2.mp3
• 0 to 3- Severe Depression
II.QUICK ASSESSMENT:
• Birth weight, head circumference and chest
circumference
• Orifice- their counting and their patency
• Presence of congenital deformities: single
umbilical artery, single palmar crease, cleft lip
& palate, closed anus, spina bifida,
meningomyelocele, hypospadias’s,
exomphalos, etc.
PROCEDURE FOR ASSESSMENT
AT BIRTH
 HEAD
SUTURES & FONTANELLS
FORCEP MARK ENCEPHALOCELE
CAPUTSUCCEDANEUM CEPHALOHEMATOMA
MICROCEPHALY MACROCEPHALY
 EYES
OPTHALMIA NEONATRUM
CORNEAL HAZZINESS
EAR
 NOSE
CONGENITAL SYPHILLIS
CHOANAL ATRESIA
 MOUTH
CLEFT LIP CLEFT PALATE
MICROGANATHIA RETROGANATHEA
 CHEST
SUPERNUMERARY NIPPLE
PECTUS EXCAVATUM PECTUS CARINATUM
 ABDOMEN

EXAMPHALOS GASTROSHCISIS
UMBLICAL HERNIA INGUINAL HERNIA
 GENITALIA

PSEUDOMENSTRUATION SMEGMA
NORMAL HYPOSPADIA EPISPADIA
BACK
 ANUS
IMPERFORATED ANUS
 EXTRIMITIES
SIMIAN CREASE PALNTAR CREASE
CLUB FOOT
AT BIRTH

WITHIN 24
HOUR

AT
DISCAHRGE
EXAMINATION WITH IN 24 HOURS/NEXT DAY

PURPOSE:
• Conduct detail examination of the child
• Record measurement’s
• Enquire feeding behavior
• Look for onset of jaundice
• Confirm baby has passed urine and meconium
• BALLARD SCORING-
-1 0 1 2 3 4 5
 NEW BORN ASSESSMENT
• ANTHROPOMETRIC
1. MEASUREMENTS

• VITAL SIGNS
2.

• HEAD TO TOE ASSESSMENT

3.
 ANTHROPOMETRIC MEASUREMENTS

BODY WEIGHT HEAD

CIRCUMFERENCE

CROWN TO
CHEST HEAD TO HEEL RUMP LENGTH
CIRCUMFERENCE LENGTH OR SITTING
HEIGHT
 VITAL SIGNS

AXILLARY
TEMPERATURE RESPIRATION

BLOOD CAPILLARY
HEART RATE PRESSURE REFILL TIME
 HEAD TO TOE ASSESSMENT
• The behavior of the newborn demonstrates
neurological status.
• In general the neonate appears drowsy, calm,
quiet and sleepy most of the day and night time.
Note the sign of irritability and degree of alertness.
• Assess the level of satisfaction after feeding,
comfortable with rocking and cuddling, is
awakened by loud noise, disturbed by any stimuli.
• After assessing the neonate for appearance and
behavior continue with head to toe examination as
given below:
Head-
• Contour of the head.
• Check for forceps mark, encephalocele etc.
• Caput succedaneum (edema of soft scalp
tissue )
• Uncomplicated CEPHALOHEMATOMA may be
kept under observation.
• Assess for MICROCEPHALY.
• Assess for MACROCEPHALY.
• Palpate the skull for sutures and fontanels,
noting size, shape, molding or any abnormal
closure.

• The anterior fontanel[2-3cm] are diamond

shaped and posterior[0.5-1cm] is triangular.
Face
• Observe the face whether triangular (normal)
• round being swollen or asymmetrical
(prolonged labour or hemolytic disease)
• eye brows and eyelashes present (normal
baby) or not (low birth weight).
Eyes
• Eyes appear edematous for the first two days
after delivery. Infant keeps eyes tightly closed.
• Tears may be present at birth. Any purulent
discharge is a sign of infection (OPTHALMIA
NEONATORUM).
• Cornea is examined for any HAZINESS. The
response of pupil to light is normally by
getting constricted.
• Nystagmus or strabismus is normally seen at
birth.
• Assess the colour of sclera that appears
whitish bluish and clear.

• Note the colour of iris which is dependent on

race and familial background.
Ears
• The top of Pinna lies in the horizontal plane to
the outer canthus of the eye .

• The Pinna is seen flat against the side of the

head because of the pressure in utero.
• The auditory canal is usually filled with Vernix
Caseosa and amniotic fluid.

• The auditory ability of the neonate can be

assessed by eliciting startle reflex. Absence of
startle reflex in response to solid noise may
indicate loss of hearing and should be
reported.
Nose

• The nose appears flat and bruised after birth.

• The important observations of nose (watery,

mucoid nasal discharge is normal) includes
patency of air passage, presence of mucus,
bloody discharge.
• Non-patent canals (bilateral CHOANAL
ATRESIA) warns for use of oral airway and
feeding with tube.
• Presence of thick, bloody discharge from nose
is suggestive of congenital SYPHILIS.
• Milia may be present (These are distended
sebaceous glands seen as white small papules
on cheeks, chin and nose).
 Mouth and Throat
• The anomalies are commonly seen around
orifices. Any gross anomaly would be evident
like CLEFT LIP and PALATE.
• Rarely teeth may be present.
• Displacement of tongue- GLOSSOPTOSIS.
• Abnormal smallness of the jaw
(MICROGNATHIA), underdevelopment of the
maxilla and/or mandible (RETROGNATHIA)
causing respiratory difficulty and attacks of
cyanosis coupled with in coordinated.
• Presence of white adherent patches on
tongue, palate and buccal surfaces means
presence of candidiasis (ORAL THRUSH)
• Excessive salivation, drooling, inability to pass
nasogastric tube, respiratory distress and
choking with cyanosis are suggestive of
ESOPHAGEAL ATRESIA with
TRACHEOESOPHAGEAL FISTULA.
Chest
• The ribs may be prominent. The normal
respiratory movements are easy, spontaneous
and periodic.(see-saw)
• The breast is examined for size, shape.
• In a few cases SUPERNUMERARY NIPPLES may
be seen in the chest or axilla.
Some normal variations is the chest shape
include:
• PECTUS EXCAVATUM (funnel chest)-
• PECTUS CARINATUM (pigeon chest)-
Lungs
• Auscultation of breath sounds bilaterally is
symmetric.
• Presence of crackles soon after birth indicate
areas of ATLECTASIS.

lung_sounds_-_crackles.mp3
• Presence of peristaltic sounds, diminished air
entry on the left side with displacement of
heart sounds to the right suggest midiasternal
shift commonly caused by CONGENITAL
DIAPHRAGMATIC HERNIA (CDH).
Heart
• Neonates with cardiac abnormalities may not
exhibit any variations in heart sounds in the
first few days till ductus is open.
However, before discharge of the
baby palpation of femoral pulses and
assessment of cardiomegaly should be done.
• Presence of transient cyanosis on crying,
breastfeeding, straining should warn on
further assessment.

• Absence of femoral pulse is indicative of co-

articulation of Aorta.
• Shift of heart to the right side DEXTRACARDIA
should be reported.
Abdomen
• The contour of the abdomen appears
Cylinderic with prominent visible veins.
• The abdomen is observed for its contour,
(shape) any masses, INGUINAL HERNIA and
UMBILICAL HERNIA.
• The umbilical cord appears bluish white and
moist after birth.
• The umbilical cord has two arteries and one
vein; presence of single artery should be
reported.
• It begins to dry, after first day, turns yellowish
brown, shrinks and becomes greenish black.
After 2-4 hours of birth the cord should be
inspected for any bleeding.
• Palpation of abdomen is done for liver, spleen
and kidneys.
• Herniation of abdominal contents through
abdominal wall –GASTROSCHISIS-
• EXOMPHALOS-
Genitalia
• Normally the labia Minora, Majora, Clitoris in
female and scrotum in male appears
edematous especially after breech delivery.
Female Genitalia
• The labia Majora covers the labia Minora
completely in full term babies.
• The Vernix Caseosa is present between labial folds.
• The urethral opening is located behind the clitoris.
• In the first week of life vaginal discharge is seen
(PSEUDOMENSTRUATION) that disappears by 2-4
weeks.
• Presence of any fecal discharge from vaginal Orfice
should be reported which may be due to
rectovaginal fistula.
Male Genitalia
• The urethral opening is located at the tip of
the penis, covered by prepuce.

• A white cheesy substance called smegma

normally is present around glans penis.

• Erection of penis (priapism) is a common

findings in the neonate. The urine is passed
within 24 hours of birth.
• The scrotum is large, pendulous with dark
pigmentation of the overlying skin. The testis
can be palpated bilaterally in the scrotal sac.

• In small newborn testis can be palpated within

the inguinal canal. The testis may descend as
the baby grows but continuous check should
be made for descent of the testis.
 Back and Anus
• The spine is seen as round in shape without
any curvatures seen in later life, e.g., cervical
thoracic, lumbar and sacral curves.
• Back is inspected for any herniation of its
contents, masses (MYELOMENINGOCELE)
dimple, soft area along the length of spine.
• Any asymmetry in the hip and folds require
assessment for developmental dysplasia of
hip.
• Anus is inspected for patency of anal orifice.
Passage of meconium within 48 hours of birth
is indication of patency. Failure of pass
meconium within 36 hours is indicative of
IMPERFORATE ANUS.
 Extremities
• Extremities are observed for number, range of
motion, symmetry muscle tone and reflexes.

• The palms of the hands show three Palmar

Creases and Sole Creases in full term newborn
usually cover entire sole.
• Presence of single Palmar Creases(SIMIAN
CREASE), i.e., fusion of two distal horizontal to
form one horizontal crease is abnormal and is
seen in Down's Syndrome.
• The sole of the feet have usual prominent fat
pads.

• A flexed extremity when extended if met with

resistance shows a sign of good muscle tone.

• Failure to move the limbs suggest spinal cord

lesion or injury.
• The difference in the count of digits —
supernumerary digit (POLYDACTYLY), fusion of
digits (SYNDACTYLY) partial fusion of toes may
be seen as a common variation.
• Slight blueness is evident due to
ACROCYANOSIS.
• Gross abnormality, e.g., close attachment of
hands or feet to the trunk (PHOCOMELIA),
absence of distal part of extremity
(HEMHNELIA) may be associated to maternal
history of intake of drugs.
• Hyperflexibility of joints, persistent cyanosis of
nail beds, yellow discoloration of nail beds
needs attention and further intervention.

• Throughout the examination the movement of

extremities should be observed, decreased or
absent movement should be recorded.
• CERTAIN FEATURES OF NEW BORN
• Milia: These are distended sebaceous glands
seen as white small papules on cheeks, chin
and nose.
• Miliaria or Sudamina: These are distended
sweet glands seen as small vesicles on face.
• Erythema Toxicum: The pink, papular rashes
with vesicles superimposed are seen on
thorax, back, buttocks, and abdomen. These
rashes appear in 24-48 hrs after birth and get
resolved after several days.
• Harlequin Colour Change: These appear as
clear demarcated change in colour as infant
lies on side. Lower half of the body becomes
pink and upper half is pale.
• Mongolian Spots: These are deep blue
pigmented irregular patches seen on gluteal
and sacral region.
• Telangiectatic Nevi: These are flat, deep pink
localized areas seen in back of neck.
 However, appearance of certain major
abnormalities that require reporting and attention
include.:
 Progressive Jaundice In First 24 Hours Due To
Blood Incompatibilities
 Generalized Cyanosis
 Pallor Colour
 Rashes
 Pustules
 Blisters
 Cracked or peeling skin
 NEUROLOGIC SYSTEM/NEUROLOGICAL ASSESSMENT
 Neurological assessment is the most critical part of the
newborn.

 Most of the reflexes are examined while doing the head-to-

toe assessment. Some general reflexes are assessed at the
end as they disturb the infant and interfere with the
examination.

 The neurological reflexes can be divided into:

 (i) Localized
 (ii) General or mass reflexes.
 REFLEXES

LOCALIZED GENERAL / MASS

-BLINKING REFLEX
-MORO REFLEX
-PUPILLARY REFLEX
-STARTLE REFLEX
-DOLL’S EYE REFLEX
-PEREZ
-SNEEZING REFLEX
-TRUNK INCURVATION
-GLABELLAR REFLEX (GALLANT) REFLEX
-SUCKING REFLEX -DANCE OR STEP REFLEX
-ROOTING REFLEX -CRAWL REFLEX
-GAG REFLEX -TONIC NECK REFLEX
-COUGH REFLEX
-EXTRUSION REFLEX
-GRASP REFLEX
-BABINSKI REFLEX
-ANKLE COLNUS REFLEX
 LOCALIZED
Eyes
BLINKING OR CORNEAL REFLEX
 PUPILLARY REFLEX

• It is constriction of pupil in response to bright

light and dilation upon removal of light. It
persists throughout life.
DOLL'S EYE
 Nose
SNEEZING REFLEX

• It is spontaneous response of nasal passages

to any irritation or obstruction. It persists
throughout life.
GLABELLAR REFLEX
ROOTING REFLEX/ SUCKING REFLEX
 GAG REFLEX

• Stimulation of posterior pharynax by food,

tube (while doing suction, passing nasogastric
tube) causes infant to gag. It persists
throughout life.
 YAWN REFLEX

• Attempt to inspire air in spontaneous

response to decreased oxygen. It persists
throughout life.
 COUGH REFLEX

• Response by coughing to any irritation of

mucous membrane of larynx or
tracheobronchial tree by substances or foreign
body. It persists throughout life. It is absent
during first day of life.
EXTRUSION REFLEX
 Extremities
GRASP REFLEX
BABINSKI REFLEX
ANKLE COLNUS REFLEX
GENERAL OR MASS REFLEXES
MORO REFLEX
STARTLE REFLEX
 PEREZ REFLEX

• Response of the infant by crying, urination and

defecation when infant is put in prone position
and a thumb is pressed along spine from
sacrum to neck. It disappears by 4-6 months.
TRUNK INCURVATION (GALLANT) REFLEX
DANCE OR STEP REFLEX
CRAWL REFLEX
TONIC NECK
 EXAMINATION AT THE TIME OF DISCHARGE
• At the time of discharge nurse should conduct detail
examination to detect any missed abnormalities and to
make sure initial feeding difficulties have gone.
• The severity of the jaundice should be assessed.
• Careful auscultation of the heart is very essential because
previously detected functional murmur may no longer
audible and new murmur may appear.
• The mother should be advised about feeding, vitamin
and iron supplements, general cleanliness, immunizations
and given an appointment for visit to well-baby clinic.
 
THANK YOU