NEWBORN
1. Initial assessment
– Apgar scoring system
1. Transitional assessment
2. Gestational age
3. Physical examination
1. APGAR SCORING SYSTEM
WHAT IS APGAR SCORE?
3) Muscle tone
o mature newborns - hold the extremities tightly
flexed
o resist any effort to extend their extremities
4) Reflex irritability
response to suction or gentle stimulation on
the soles of the feet.
infant with heavily sedated mother will
probably demonstrate a low score in this
category
WHAT IS APGAR SCORE? (CONT..)
5) Skin color
Appear cyanotic at the moment of
birth
Pink with or shortly after the first
breath.
WHAT IS APGAR SCORE? (CONT..)
A score from 4 to 7
needs gentle stimulation such as
rubbing the back.
may need clearing of the airway and
supplementary oxygen
possibility of respiratory depression
should also be considered
Scores of 3 or lower
needs active resuscitation
APGAR SCORING SYSTEM
SIGN 0 1 2
Heart rate Absent Below 100b/min 100b/min or
higher
Resp No spont. resp Slow/ weak cry Spontaneous/
strong cry
Muscle tone Limp Min. flexion Active/ flexed
body posture
Reflex irritability No response Grimace Strong cry/ active
2nd stage
Deep sleep & calm
Stimulation – elicits a minimal response
Heart & resp. rates - decreased
Temp. – decreased (avoid undressing & bathing)
Mucus production - decreased
Urine & stool - nil
2. TRANSITIONAL ASSESSMENT: PERIODS OF REACTIVITY (CONT…)
Purpose
1. Neonatal classification
term vs preterm
birth weight – growth chart
2. Mortality risk
3. Potential morbidity
3. GESTATIONAL AGE (CONT..)
Obstetric method
LMP
Pregnancy test
Ultrasonographic
Ballard score
i) Posture
- Evaluated for increasing flexor & hip adduction with
increasing gestational age
- Hypotonic – early gestation
- Slight flexion of feet & knees – 30/52
- Thighs & hips flexed, arm remain extended – 34/52
- Thighs, hips, & arm begin to flexed – 35/52
- Total flexion – 36 – 38/52
3. GESTATIONAL AGE (CONT..)
i) Ballard score - assessment of neurologic signs - posture (cont..)
3. GESTATIONAL AGE (CONT..)
v.Scarf sign
The arm is pulled across the chest & around the
neck
The score is determined by the position of the
elbow to the midline of the body
Resistant – increased gestational age
3. GESTATIONAL AGE (CONT..)
v) Ballard score - assessment of neurologic signs – scarf sign (cont..)
3. GESTATIONAL AGE (CONT..)
i) Skin
- Less transparent – increased gestational age
- Lost its transparency & underlying vessels no longer
visible – 36-37/52
- Subcutaneous tissue decreased, causing wrinkling &
desquamation – beyond 38/52
3. GESTATIONAL AGE (CONT..)
1. General condition
Purpose
To rule out:
Obvious congenital anomalies
Birth injuries
Cardiorespiratory distress
Assess for:
i) Size, contour & general well-being
ii) Posture
Healthy term – flexion of extremities
Breech – extension of legs & head
iii) Activity
Flexion & extension alternate between arms & legs
Hypotonia – decreased flexion (preterm or CNS)
Asymmetric movements – arms, legs or face – birth
injury e.g. brachial plexus palsy, bone #, congenital
anomaly
4. PHYSICAL EXAMINATION (CONT…)
iv) Skin
Dry, peeling, rashes, pustules, petechiae,
pigmentation
Skin lesions
v) State
Robust & vigorous cry – term
Sleep states – deep sleep, light sleep, quiet, active
4. PHYSICAL EXAMINATION (CONT..)
viii) Nutrition
Well-nourishedappearance
Thin & wasted – IUGR, postterm
4. PHYSICAL EXAMINATION (CONT..)
ix) Color
Mucous membrane
central cyanosis – low O2
Acrocyanosis – peripheral circulation, cold, shock
Pallor – poor perfusion
Pallor with bradycardia – anoxia, vasoconstriction in shock,
sepsis, RDS
Pallor with tachycardia – anemia
1st
stool within 24hrs
Rectovaginal or rectourethral fistula
iv) Genitalia
Male
Covered with foreskin
Urinary meatus at center
Scrotum size, rugae, testes
Ambiguous
Female
Covered by labia majora
Vaginal discharge – normal for first 48 hrs
Echymosis & edema of labia – breech deliveries
Patency of vaginal opening
Ambiguous
4. PHYSICAL EXAMINATION (CONT..)
2. Auscultation & palpation (cont..)
Body part examination
i) Head
Size, shape, symmetry & general appearance
2-3cm larger than chest
Microcephaly – delayed brain growth
Macrocephaly – accumulation CSF
Caput succedaneum, cephalhematoma
Fontanelles
Location, number & size
Bulging, full or tense – increased ICP, birth injury
Depressed – late sign of dehydration
Anterior – diamond shape, 4-6cm, closes @ 18mths
Posterior – triangular shape, closes @ 2mths
Scalp
Observe for lacerations or abrasions
Hair whorls – result of brain growth
Absence or number >2 – abnormal brain growth
4. PHYSICAL EXAMINATION (CONT..)
2. Auscultation & palpation (cont..)
Body part examination (cont..)
ii) Eyes
Subconjunctival hemorrhage – pressure on fetal head
during delivery
Pupil response to light & symmetry eye movement
Tears – produced until 2mths age
iii) Ears
Maturity, symmetry & size
Observe for unusual shape or position
Low-set ears – chromosomal abnormalities
Malformed or malpositioned – chromosomal or
congenital abnormalities
4. PHYSICAL EXAMINATION (CONT..)
iv) Nose
Shape & size
Patency of nostrils
v) Mouth
Symmetric & positioned in the midline
Cleft lip or palate
Mucous membrane mouth & tongue – pink
Natal teeth
Oral thrush – contact with vaginal moniliasis during delivery
Assess for
Root & gag reflex
Suck & swallow
Size of jaw – small – Pierre Robin syndrome
4. PHYSICAL EXAMINATION (CONT..)
vi) Face
Symmetry & location of the eyes, nose & mouth
Obs. for symmetry when crying – facial falsy
Facial characteristics e.g. wide-spaced eyes, flat & broad
nasal bridge, mouth size – congenital abnormalities
vii) Neck
Thyroid enlargement
Webbing or redundant skin – turner or down syndrome
Palpable mass, crepitus, tenderness, limited arm
movement - # clavicle
4. PHYSICAL EXAMINATION (CONT..)
ix) Skin
Soft, smooth & opaque
Warm to touch
Capillary refill – normal 2-3 seconds
Benign lesions e.g. mongolian spots, erythema toxicum, milia
4. PHYSICAL EXAMINATION (CONT..)
3. Nervous system
i) Hx & gestational age
Hx of family, genetic, birth trauma, prolonged labor,
maternal medication/drugs/alcohol
Gest. Age – preterm - underdeveloped nervous syst.