Neonatal Examination and Assessment 1)History 2)Examination: In Delivery Room: a)Color: - Cyanosis - Pallor - Acrocyanosis - Differential Cyanosis b)Meconium- stained c)Jaundice d)Respiration: - R.R, RD e)C.V.S : HR, peripheral pulse & Murmurs f)Abdomen g)Genitalia h)Congenital anomalies i)APGAR scoring (A = Appearance, P = Pulse, G = Grimace, A = Activity, R = Respiration )

Examination in the nursery: (Detailed) a)Monitoring of vital signs should be done every 30 min after birth for 2 hr. or until stabilization. 1- Temp. 2- R.R 3- HR + Peripheral pulses. 4- BP b)Anthropometric Measurement: wt, Ht, Hc c)Skin: - Plethora - Jaundice - Hemangioma - Mongolian Spots - Milia - Hemorrhage - Mottling - Edema

4) Skull : - Overlapping Sutures - AF - Opened post Fontanel - Craniotabes - Caput Succedenum - Cephalhematoma 5)Face6) Eye 7) Ears8) Mouth 9) Nose10) Neck 11) Chest12) Abdomen 13) Genitalia14) Anus and rectum 15) Extremities16) Back 17) Neurological examination: Primitive Reflexes a) Moro b) Rooting Suckling c) Palmar Grasp reflex d) Stepping

Assessment of Newborn Gestational Age -Physical and neurological examination (Dubowitz scoring system and New Ballard Score) 1)Neuromuscular Maturity: a) Posture b) Square Window c) Arm recoil d) Popliteal angel e) Scarf sign f) Heel to Ear 2) Physical Maturity: a) Skin b) Lanugo hair c) Plantar surface d) Breast e) Eye/Ear f) Genitalia

New Ballard Score

Physical Maturity

Resuscitation of Newborn (ABC) 1)Preparation 2)Radiant heater 3)Suction of airway 4)Dry the infant 5)Gentle tactile stimulation 6)Apgar evaluation: 1)One minute Apgar score : Intrapartum asphyxia 2)After 1 minute : adequacy resuscitation Sequence of Resuscitation: 1)No asphyxia : (Apgar 8-10) - > 90% of NB - Dry, Warm - Suction 2)Mild asphyxia : (Apgar 5-7) - Stimulation - O 2

3)Moderate asphyxia: (Apgar 3-4) - HR < 100/M despite O 2 - PPV + 100% O 2 - Bag + Mask (15-30 sec) 4)Severe asphyxia (Apgar 0-2) - need immediate vigorous resuscitation - O 2 + PPV - If no response ( HR < 60/M after sec) A)Intubation B)Circulation: - After sec of ventilation - Cardiac Massage C)Medications: if no response (HR < 60/M) a) Sod. Bicarbonate + Glucose b) Epinephrine c) Volume expansion d) Dopamine or Dobutamine e) Narcosis (Naloxone Hydrochloride) Duration : 15 – 20 Min

Objectives: 1-to know steps of examination of the neonate at birth immediately(rapid) and during 24 hours(detailed) in ward. 2-to define APGAR score as tool to asses birth asphyxia. 3-to know how to asses gestational age. 4- to determine steps of resuscitation in neonate. 5- to know methods of nutrition of newborn(breastfeed, bottle feed) 6- to determine advantages and contraindications of breastfeed. 7- to know problems associated with breastfeeding. 8- to define weaning, and steps of introduction of foods.