The Newborn

Leifer, G. (2011) Introduction to maternity and pediatric nursing Leifer, G. (2011) Introduction to maternity and pediatric nursing. (6th edition. Philadelphia: Saunders. Ministry of Health Tamariki Ora Health Book

The aims of the assessment of the newborn are to: -ensure adaptation to the environment outside the uterus -to identify any abnormalities early so intervention may begin

At birth, the following is completed: -the time of birth is recorded -Apgar score completed -cord clamp -identification labels (if appropriate) -baby dried -baby’s weight is recorded (2.5-3.4 kg) -a full top to toe and systems assessment Rationale / reason….why these assessments are performed…………

Assessment of the newborn is on going. A “head to toe assessment” follows a logical format -allows the observation of general appearance, normal neonatal characteristics, vital signs and reflexes

A combination of both assessments is very thorough Systems approach An assessment which focuses on body systems ensures the newborn has adapted to the new extra uterine environment. A combination of both assessments is very thorough

-head circumference 34-35 cms Head to toe assessment General appearance: colour, activity…. prioritise Head -head circumference 34-35 cms -size and shape, symmetry -fontanelles ( anterior, posterior) soft and flat -cephal hematoma -caput succedaneum -molding

Face -symmetry, colour, (pink, jaundiced) -eyes clear -nose clear (infants nose breathers)

-mouth (sucking reflex) -milia

Chest -chest is symmetrical, (32-33cm) skin, colour -respiratory and cardiac assessments are done -heart rate 120-140 beats, (apical heart rate) -respirations 30-60 breaths per minute, -temperature 36.5 – 37.2 C.

Abdomen -soft, cylindrical, skin colour -umbilical cord (check) -Moro reflex

Extremities (arms and legs) -symmetrical, full range of motion -colour of hands and feet -palmer (grasp) reflex -babinski reflex -hips (assess for hip dysplasia) -skin, colour

Back -spine straight, flat and intact -mongolian spots -anus patent, passed meconium, stools

Genitals -assess for normal appearance -? passing urine -? passing meconium, stools.

Reflexes -assess an intact neurological system Moro reflex (startle) Grasp reflex -

Babinski reflex

Care of the cord. -assess any ooze or bleeding, redness…. -there is debate as to whether the cord should be left alone or cleaned with an alcohol base solution -the clamp is usually removed after 48+ hours

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Weight -normal variation 2.5-3.5 kilograms -when weighing babies important aspects include: -warmth of the area -consistency of the scales (scales vary) -clothing eg. singlet or not -documentation -involvement of the family

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Physiological weight loss Weight loss which is normal and expected in the newborn following birth. -usually approximately 10% of the initial weight after birth. -regained by 10 days to 2 weeks

Length -crown to heel -average 50cm (47-53 cm) Head circumference -normal 33-35 cm -taken from above the ears and eyes in the occipito-frontal plain. This may change due to molding (moulding) of the newborns head following birth

Head circumference

The measurements of weight, length and head circumference are plotted together on a standardised growth chart. All 3 measurements should be within the same percentile The first measurements = baseline

Newborn characteristics -milia -lanugo -vernix caseosa -mongolian spots -physiological jaundice -caput succedaneum -cephalhematoma -molding

Assessment of skin -milia: white spots, typically on the nose, sometimes the forehead. -cause retention of secretions in sebacous glands. -disappear usually by 2 weeks.

milia http://newborns.stanford.edu/images/milia1.jpg

Mongolian blue spots irregular dark pigmentation back and sacral area

Vernix caseosa http://www.netterimages.com/images/vtn/000/000/003/3708-150x150.jpg

http://www. ehealthconnection. com/adam/doc/graphics/images/en/9696 http://www.ehealthconnection.com/adam/doc/graphics/images/en/9696.jpg molding

http://img87.imageshack.us/img87/1858/cephalhematoma.jpg Cephalhematoma -subcutaneous swelling containing blood found on the head of an infant several days after birth. -usually disappears within a few weeks to 2 months.

http://www.netterimages.com/images/vtn/000/000/003/3708-150x150.jpg Caput succedaneum -swelling or edema occurring in or under the fetal scalp during labour.

Physiological jaundice Physiological jaundice. -a harmless condition in the new born caused by the normal reduction of red blood cells following birth. -occurring 48 hours after birth, peaking at day 5 and then disappearing by the 10th day -the newborn has a “yellowish” appearance to its skin colour. -the newborn may be sleepy and lethargic, but feeding must be regular -lying the baby in the sunshine helps.

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Examination of the hips (-refer to the picture in the book of readings) Abduction maybe limited in congenital dislocation of the hips. One hand stabilises the pelvis. With the other hand, the flexed thigh is gently pushed posteriorly and then abducted. During abduction a displaced hip relocates with a “clunk” “Hip click test”

Newborn screening for several inborn errors of metabolism is done through a small blood test usually after 48 hours of feeding. The Guthrie test uses a small amount of blood (obtained through a heel prick) to saturate a piece of filter paper.

The metabolic conditions tested for include: PKU (phenylketonuria), Cystic Fibrosis, Galactosaemia, hypothyroidism, Maple syrup Urine Disease (MSUD), Biotinidase deficiency and congenital hyperplasia (CAH)

Priority assessments / on going and for the days and weeks following birth : -general appearance -respirations and heart rate -colour, skin, cord, eyes -temperature -passing urine -passing meconium / stools -presence of sucking and swallowing / -feeding patterns -top to toe and systems assessment know the rationale reason why?

At each ongoing assessment of the newborn / baby the child health nurse (plunket nurse) will assess -general appearance, skin, colour, cord, eyes, -feeding patterns, -patterns of elimination urine, bowel actions -sleeping patterns -general wellbeing, patterns of crying -hearing and vision -developmental milestones

-work with the mother and family to assist in providing a safe and stimulating environment for the baby, infant. -provide education regarding the introduction of solid foods, immunisations, dental health , vision and hearing assessments, availability of support services in the area…..type of car seat,