The Newborn Assessment And The Normal Newborn Prepared by Kellie Caswell, RN, BSN K.C. 2003

Apgar Scoring Evaluate the physical condition of the newborn at birth. Done at 1 minute and 5 minutes The score ranges from 0 to 10. 8 – 10 indicates good condition 4 – 7 indicates the need for stimulation A score less than 4 indicates resuscitation K.C. 2003

When are these assessments done? Immediately after birth in the delivery room. If the infant is stable it can remain with the parents for bonding or initiation of breastfeeding. During the first four hours after birth. This is routine admission procedure Prior to discharge the pediatrician will do a complete exam on the newborn. K.C. 2003

Estimation of Gestational Age Physical Characteristics Done within the first four hours Look at the resting posture Look at the skin Is there Lanugo? Look at sole creases Palpate breast tissue Ear form and cartilage distribution Genitals ( are the testes descended? Do the labia cover the clitoris?) K.C. 2003

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Neuromuscular assessment Fetus develops caudocephalic or from bottom to top. Square window Recoil Popliteal angle Scarf sign Heel to ear extension Ankle dorsiflexion Head lag Ventral suspension Major reflexes K.C. 2003

Neuromuscular maturity- Square window sign K.C. 2003

Neuromuscular maturity- Scarf sign K.C. 2003

SGA, AGA, LGA SGA- Small for gestational age ( growth is below the 10th percentile) AGA- Appropriate for gestational age LGA- Large for gestational age ( growth above the 90th percentile) K.C. 2003

Physical assessment General appearance- head is larger than the body. Flexed posture. Weight and measurements- length, head and chest circumference Temperature K.C. 2003

Skin characteristics Acrocyanosis- Bluish discoloration of the hands and feet. Mottling- lacy pattern of dilated blood vessels under the skin Harlequin sign- deep color develops on one side while the other side remains normal Jaundice- Yellow color of the skin and sclera of the eyes Erythema toxicum- newborn rash “ Look like flea bites” Milia- “ pimples” K.C. 2003

Skin characteristics ( continued) Skin turgor Vernix caseosa Forceps marks Birthmarks A. Telangiectatic nevi - stork bites B. Mongolian spots C. Nevus flammeus- port wine stains D. Nevus vasculosus - strawberry marks K.C. 2003

Head Molding may be present “ cone head” Fontanelles “ soft spots” Cephalhematoma- collection of blood resulting from ruptured blood vessels between the surface of the cranial bone and the periosteal membrane. Caput succedaneum-collection of fluid, swelling of the scalp K.C. 2003

Face Look for symmetry Eyes A. Eye color is usually established at approximately 3 months. B. Erythromycin ointment is instilled as a prophylactic medication. It is used to treat gonorrhea if the newborn has been exposed. C. Subconjunctival hemorrhages D. Transient strabismus E. Doll’s eyes F. Red reflex K.C. 2003

Face ( continued) Nose- look for flaring Mouth- look for cleft lip and palate. Ears- In the normal newborn the top of the ear should be parallel to the outer and inner canthus of the eye. K.C. 2003

Assessment( continued) Neck Chest- can frequently see the xiphoid process A. “ Witches milk” whitish secretion from breasts as a result of mothers hormones. B. Extra nipples or supernumerary nipples Cry- lusty and strong Respirations- 30-60 breaths per minute A. Look for signs of respiratory distress B. Breath sounds C. Brief periods of apnea may occur K.C. 2003

Assessment ( continued) Heart rate- 120-160 bpm. When sleeping it can go as low as 100 and when crying as high as 180. Count an apical pulse for one full minute each time you check the pulse. Assess rhythm May have murmur that is transient due to PDA but needs to be reported and monitored Blood pressure is usually taken in all four extremities. K.C. 2003

Umbilical Cord Initially white and gelatinous with two arteries and one vein. Shriveled and blackened by second or third day. Falls off within the first 10 days. K.C. 2003

Genitals Females – nurse examines the labia majora, minora and clitoris. A vaginal or hymenal tag can be present and will disappear in a few weeks. May often have whitish or blood tinged discharge. Males- Look at urinary meatus and the size and symmetry. The scrotum should be palpated to see if the testes have descended. K.C. 2003

Assessment( continued) Anus- Checked for patency Extremities- Look for abnormalities ( extra digits, webbed digits, how they move,etc. ) Erb- Duchenne paralysis ( Erb’s palsy) Club foot K.C. 2003

Assessment ( continued) Back A. Straight and flat B. Examine the base of the spine for a nevus pilosus “ Hairy nevus” C. Pilonidal dimple at the base of spine K.C. 2003

Assessment of Neurologic Status Note the newborns state of alertness, resting posture, cry, quality of muscle tone and motor activity. CNS of newborn is immature so tremors or jitteriness is common but needs to be differentiated from a convulsion or other central nervous system disorder. Look for common reflexes ( Tonic-neck, grasping, moro, rooting and sucking reflex) K.C. 2003