Clinical Application for Child Health Nursing NUR 327 Newborn Assessment Lecture 1-B +Lecture 2

15/01/ Definitions Lab 3

Definitions Health a state of complete physical, mental and social wellbeing and not merely absence of disease. (WHO) 28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment3

Definitions Mortality :Rate of occurrence death. Morbidity: a specific illness in the population 28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment4

Mortality of infancy: -Low birth weight <2500mg (Lower birth weight = Higher mortality) -Short or long gestational. 28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment5

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment6 Essential Newborn Care Interventions Clean the baby’s nose & mouth Suctioning the baby’s nose & mouth The baby’s breathing Tying the umbilical cord Thermal protection Prevent and manage newborn hypo/hyperthermia Early and exclusive breastfeeding Started within 1 hour after childbirth

15/01/ APGAR SCORE Lab 3

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment8 APGAR EXPANSION A for Appearance (Color) P for Pulse Rate (Heart rate) G for Grimace (Reflex irritability) A for Activity (Muscle tone) R for Respiration

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment9 The time for judging the five objective signs were sixty seconds after the complete birth of the baby APGAR Score

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment10 Apgar Scoring system Meaning of an Apgar score APGAR Score

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment11 The newborn with special needs Weight-related gestational conditions 1- Small for gestational age infant (SGA) 2-Large for gestational age infant (LGA) Age-related gestational condition 1-Premature infant 2-Postmature infant

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment12 1- Small for gestational age infant (SGA) Characteristics: Thin & wasted infant Little s/c fat The head looks really big

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment13 1- Small for gestational age infant (SGA) The following conditions occur more frequently in SGA Asphyxia Hypoglycemia Hypothermia Congenital anomalies

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment14 2-Large for gestational age infant (LGA) The following conditions occur more frequently in LGA Hypoglycemia Hypocalcemia Hyperbilirubinemia Respiratory distress syndrome Congenital anomalies

15/01/ Vital Signs Lab 3

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment16 Vital Signs Temperature Heart rate Respiration Blood pressure Oxygen Saturation

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment17 Temperature - range 36.5 to 37 C axillary -range 35.6 to 37.5 C Rectally Common variations -Crying may elevate temperature -Stabilizes in 8 to 10 hours after delivery

15/01/ Temperature Position for taking axillary temperature.

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment19

Ear (Tympanic) Temperature Can also be affected by: Impacted ear wax & ear infections Should NOT be used if child had ear surgery

Ear (Tympanic) Temperature What Patients Think About Ear Temperatures Parents like them! Fast, easy, clean, and safe Children react better! Faster measurement  No holding or restraining  No positioning

15/01/ Temperature Oral temperature for children over 5 to 6 years. Rectal temperatures are contraindicated if the child has had anal surgery, diarrhea, or rectal irritation.

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment23 Heart rate - range 120 to 180 beats per minute Common variations -Heart rate range to 120 when sleeping to 180 when crying -Color pink with acrocyanosis -Heart rate may be irregular with crying Signs of potential distress or deviations from expected findings -All murmurs should be followed-up and referred for medical evaluation -Deviation from range -Faint sound

15/01/ Pulse Apical pulse for infants and toddlers under 2 years Count for 1 full minute Will be increased with: crying, anxiety, fever, and pain

15/01/ Pulse rates Neonate: 100 – year: 100 – years: years

Pulse - Brachial Used for infants and small children Place fingertips of first 2 or middle 3 fingers over the brachial pulse area Inside of the elbow Lightly press your fingertips on the pulse area

15/01/ Heart Sounds

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment28 Respiration - range 30 to 60 breaths per minute Common variations Bilateral bronchial breath sounds Signs of potential distress or deviations from expected findings -Asymmetrical chest movements -Apnea >15 seconds -Diminished breath sounds -Nasal flaring -Tachypnea

15/01/ Respiratory Count for one full minute May want to do before you wake the infant up Rate will be elevated with crying / fever Newborn: 30 – 60 Toddler: School-age: Adolescent:

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment30 Blood pressure –systolic: 60 to 80 mmHg -diastolic: 40 to 50 mmHg Factors to consider -Appropriate cuff size important for accurate reading -Average newborn: 75/42 mmHg in both upper and lower extremities

Oxygen Saturation Oxygen Saturation provide important information about cardio- pulmonary dysfunction and is considered by many to be a fifth vital sign.

For those suffering from either acute or chronic cardio-pulmonary disorders, Oxygen Saturation can help quantify the degree of impairment. Oxygen Saturation

15/01/ Growth Measurements Lab 3

15/01/ Weight 2. Height / length 3. Head circumferences 4. Chest circumferences Physical growth parameter:

15/01/ Weight

15/01/ Needs to be recorded on a growth chart Newborn may lose up to 10% of birth weight in 3-4 days. Too much or too little weight gain needs to be further investigated. Double birth weigh by 5-6 months Triple birth weight by 1 year Nutritional counseling The normal birth weight is g. Weight

15/01/ Weight Weight-for-age percentiles, boys 0 to 24 months, WHO growth standards

15/01/143738

15/01/ Infants head is against end point and legs fully extended. Height / length Measurement

15/01/ Length-for-age percentiles, boys birth to 24 months, WHO growth standards Height / length Measurement Length range - 48 to 53 cm

15/01/143741

15/01/ Child is measured while standing in stocking or bare feet with the heels back and shoulders touching the wall. Height / length Measurement

15/01/ Stature-for-age percentiles, boys, 2 to 20 years, CDC growth charts: United States Height / length Measurement

15/01/143744

15/01/ Head Circumference - 33 to 35 cm Head circumference is measured by wrapping the paper tape over the eyebrows and the around the occipital prominence.

15/01/ Head circumference-for-age percentiles, boys 0 to 24 months, WHO growth standards Head Circumference

15/01/143747

15/01/ Head circumference is measured in children from birth to 3 years of age because this is the period of rapid brain growth. Head circumference also should be measured in older children with abnormal growth because it may be helpful in determining the etiology. Head Circumference

15/01/ Head, chest, and abdominal circumference.

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment50. Chest circumference to 33 cm Head should be 2 to 3 cm larger than the chest Head and chest circumference may be equal for the first 24 to 48 hours of life

15/01/ Physical Assessment Lab 3

General appearance General appearance and behavior of new born. Flexion position Head flexed, chin resting on the upper chest, arm flexed with hand clenched and the feet dorsiflexed. Tiers easily with feeding or activity. Fever Sleep pattern 28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment52

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment53 Skin Expected findings Skin reddish in color, smooth and puffy at birth At hours of age, skin flaky, dry and pink in color Edema around eyes, feet, and genitals Turgor good with quick recoil Nipples present and in expected locations Cord with one vein and two arteries

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment54 Vernix caseosa The white, cheesy substance covering the newborn's body. Often present only in the skin folds.

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment55 Lanugo Fine downy body hair usually distributed over shoulders, sacral area, and back of newborns. Usually disappears before birth or shortly after birth

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment56 Common variations Acrocyanosis - result of sluggish peripheral circulation

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment57 Mongolian Spots: Patch of purple-black or blue-black color distributed over coccygeal and sacral regions of infants of African-American or Asian descent. Not malignant. Resolves in time.

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment58 Mottling: Generalized red and white discoloration of skin of chilled infants with fair complexion

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment59 Jaundice Physiologic Jaundice: Hyperbilirubinemia not associated with hemolytic disease or other pathology in the newborn. Jaundice that appears in full term newborns 24 hours after birth and peaks at 72 hours. It may caused by the inability of the infant’s immature liver to modify bilirubin

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment60 Milia: Tiny white papules (plugged sebaceous glands) located over nose, cheek, and chin.

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment61 Petechiae: Pinpoint, flat hemorrhages often visualized on head, face, and chest. Associated with rapid onset of pressure followed by immediate release of pressure during birthing process. Bruises/ Ecchymoses: Larger than petechia, hemorrhagic areas associated with rapid delivery or breech birth.

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment62 Signs of potential distress or deviations from normal findings Pathologic Jaundice: Jaundice occurs before the baby is 24 hours of age It may caused by metabolic disorders

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment63 Head Expected findings Anterior fontanel diamond shaped cm Posterior fontanel triangular cm Fontanels soft, firm and flat Sutures palpable with small separation between each

Head Expected findings Check fontanels: Anterior: 12 to 18 months Posterior: closes by 2-3 months head control usually establish by 6 month 28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment64

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment65

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment66 Common variations Caput succedaneum: Swelling of the soft tissue of the scalp caused by pressure of the fetal head on a cervix that is not fully dilated. Swelling crosses suture line and decreases rapidly in a few days after birth.

MoldingMolding of head may result in a lower head circumference measurement refers to the process by which the neonates head is shaped during labor as it passes through the birth canal. The head may become elongated due to the overlapping of the cranial bones at the suture lines. 28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment67 Common variations

CEPHALHEMATOMA Sub periosteal extravasation of blood due rupture of vessels. Swelling increases in size on second and third day after delivery. Often associated with delivery by forceps. Swelling does not cross suture line and may take several weeks after birth. Jaundice may occur as blood cells are broken down as the swelling resolves. 28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment68

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment70 Eyes Expected findings Slate gray or blue eye color No tears Fixation at times - with ability to follow objects to midline Distinct eyebrows Cornea bright and shiny Pupils equal and reactive to light

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment71 Common variations Edematous eyelids

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment72 Uncoordinated movements

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment73 Signs of potential distress or deviations from expected findings Discharges Conjunctivitis

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment74. Doll's Eyes Reflex: When the head is moved slowly to the right or left, the eyes do not follow nor adjust immediately to the position of the head.

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment75. Reflexes absent Subconjunctival hemorrhage

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment76 Ears Expected findings Pinna top on horizontal line with outer canthus of eye Loud noise elicits Startle Reflex Flexible pinna with cartilage present

. pulled down and back to straighten ear canal in children under 3 years Ear Exam

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment78 Common variations Skin tags on or around ears

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment79 Signs of potential distress or deviations from expected findings -Ear placement low -Clefts present -Malformations

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment80 Nose Expected findings -Nostrils patent bilaterally -Obligate nose breathers -No nasal discharge Common variations -Sneezes to clear nostrils -Bridge appears absent -Thin white nasal mucus discharge

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment81 Signs of potential distress or deviations from expected findings -Other discharge -Malformation -Nasal flaring beyond first few moments after birth

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment82 Mouth and Throat Expected findings Mucosa moist. Shortly after birth may visualize sucking calluses on central portions of lips.

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment83. Palate high arched

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment84. Uvula midline Minimal or absent salivation Tongue moves freely and does not protrude Sucking reflex Gag reflex

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment85 Common variations Epstein's pearls on ridges of gums

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment86 Signs of potential distress or deviations from expected findings -Cleft lip or cleft palate -Lip movement asymmetrical -Reflexes absent or incomplete -Protruding tongue -Diminished tongue movement -Candida Albicans

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment87 Neck Expected findings -Short and thick -Turns easily side to side -Clavicles intact -Some head control

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment88 Signs of potential distress or deviations from expected findings -Torticollis -stiff neck drawing head to one side -Resistance to flexion -Large fat pad on back of neck -Movement with palpation of clavicle

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment89 Chest Expected findings -Evident xiphoid process -Equal anteroposterior and lateral diameter -Bilateral synchronous chest movement -Symmetrical nipples

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment90 Common variations -Enlarged breasts -Accessory nipples

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment91 Signs of potential distress or deviations from expected findings -Asymmetrical chest movements -Sternum depressed -Marked retractions -Absent breast tissue -Flattened chest -Supernumerary nipples- -Nipples widely spaced -Bowel sounds auscultated

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment92 Abdomen Expected findings Dome-shaped abdomen Abdominal respirations Soft to palpation Well formed umbilical cord Three vessels in cord Cord dry at base Liver palpable cm below right costal margin Bilaterally equal femoral pulses Bowel sounds auscultated within two hours of birth Voiding within 24 hours of birth Meconium within hours of birth

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment93 Common variations Small umbilical hernia

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment94 Signs of potential distress or deviations from expected findings -Bowel sounds absent -Abdominal distention -Palpable masses -Base of cord with redness or drainage -Cord with two vessels

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment95 Female Genitalia Expected findings -Edematous labia and clitoris -Labia majora are larger and surrounding labia minora -Vernix between labia Common variations Pseudomenstruation Increased pigmentation Ecchymosis and edema after breech birth

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment96 Signs of potential distress or deviations from expected findings Labia fused Fecal discharge from vaginal opening Ambiguous genitalia Widely separated labia

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment97 Male Genitalia Expected findings -Urinary meatus at tip of glans penis -Palpable testes in scrotum -Large, edematous, pendulous scrotum. -Stream adequate on voiding Common variations -Prepuce covering urinary meatus -Erections -Increased pigmentation -Edema and ecchymosis after breech delivery

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment98 Signs of potential distress or deviations from expected findings Non palpable testes Scrotum smooth Ambiguous genitalia

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment99 Back and Rectum Expected findings Intact spine without masses or openings Patent anal opening

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment100 Signs of potential distress or deviations from expected findings Limitation of movement Fusion of vertebrae Imperforate anus Anal fissures

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment101 Extremities Expected findings -Maintains posture of flexion -Equal and bilateral movement and tone -Full range of motion all joints -Ten fingers and ten toes -Legs appear bowed -Feet appear flat

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment102 Palmar creases present

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment103 Sole creases present

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment104 Signs of potential distress or deviations from expected findings -Asymmetrical movement of extremities -Polydactyly

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment105. Unequal leg length Asymmetrical skin creases posterior thigh

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment106. -Dislocation of hip -Persistent cyanosis of nail beds -Marked metatarsus varus

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment107 Neuromuscular System Expected findings -Maintains position of flexion -When prone, turns head side to side -Holds head and back in horizontal plane when held prone -Ability to hold head momentarily erect

28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment108 Signs of potential distress or deviations from expected findings -Quivering -Limp extremities or straightening of extremities -Clonic jerking -Paralysis

15/01/ Nutritional needs of the Neonate Lab 3

Feeding the Infant Good nutrition is essential for the growth and development that occurs during an infant’s first year of life. When developing infants are fed, the appropriate types and amounts of foods, their health is promoted. Early nutrition affects later development, and early feedings establish eating habits that influence nutrition throughout life. 10/28/

111 SFCC: Figure /28/2015

Why Is Breast Milk So Good for Babies? 10/28/

Why Is Breast Milk So Good for Babies? Breastfeeding is a natural extension of pregnancy – the mother’s body continues to nourish the infant. The American Dietetic Association (ADA) and American Association of Pediatrics recognize exclusive breastfeeding for 6 months, and breastfeeding with complementary foods for at least 12 months, as an optimal feeding pattern for infants.

Breast milk is more easily and completely digested than infant formula, so breastfed infants usually need to eat more frequently than formula-fed infants do. During the first few weeks, the newborn will need approximately 8 to 12 feedings a day, on demand. As the infant gets older, there are longer intervals between feedings. 10/28/

During the first two or three days of lactation, the breasts produce colostrum, a premilk substance containing antibodies and white cells from the mother’s blood. 10/28/ Immune Factors in Breast Milk

Breastfed infants may have: Less allergies Lower blood cholesterol Less ear and respiratory infections May protect against obesity in childhood and later years. May have a positive effect on later intelligence. 28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 م28/10/ :57 مNewborn Assessment116

Infant formulas are designed to resemble breast milk. Special formulas are available for premature infants, allergic infants, and others. 10/28/ Formula Feeding

10/28/ Complementary feeding practices Different reasons to start complementary food can be highlighted: Breast milk is not enough in quantity: this is the main reason for the huge majority of the mothers. Breast milk is not sufficient to cover the infant’s nutritional needs for growing. The mother has to go to work, so the child must be partially weaned.

119 Lactation Nutrient Needs Energy Intake Exercise intense may raise lactic acid concentration of breast milk and baby may not like the taste Vitamin and Minerals maintained in breast milk at expense of maternal stores if poor po intake; B6, B12, A, D; 10/28/2015

120 Water need plenty of fluids to prevent dehydration drink a glass of fluid at each meal Nutrient Supplements iron to replace stores often continue prenatal vitamins Particular Foods foods with strong or spicy flavors may alter flavor of breast milk. some infants may be sensitive to particular foods that mom eats 10/28/2015 Lactation Nutrient Needs

121 During Lactation Don’t: Don’t drink alcohol Don’t take medications unless OK by Medical Provider Don’t take illegal drugs Don’t smoke Don’t get into environmental contaminants Don’t have caffeine 10/28/2015

Consumer Corner: Formula’s Advertising Advantage 10/28/

The End