NEWBORN ASSESSMENT

ASSESSMENT
I. General Measurements a. Age b. Weight c. Length d. Apgar Score Head Measurement a. Shape

NORMAL FINDINGS
Term- start of 38th wk. end of 42nd week 6.5-6.75 lbs. 18-20.5 inches / 45-52.3cm. 7-10 Round symmetrical; may have molding overriding sutures; slight asymmetry. 33-35cm 2cm>chest circumference Sutures- palpable Slight pulsation Soft 3-4cm long 2-3cm wide Diamond shape 1-2cm Triangular Black iris, white sclera Random, jerky, uneven. Focus momentarily. Follows to midline Pupils equal in size, round and reactive to light. May turn toward soft light. Without or occasionally Focuses and follows by 15min of age.; reactive to light Size ang movement symmetric. Blink reflez. Edema from prophylaxis. Eyes on a parallel plane. Startle reflex to loud noise. Attends to sound. By 15min. of age may move

POSSIBLE MAJOR DEVIATIONS AND COMPLICATIONS

Preterm=before end of 37th week Post term= after end of 42nd week <6lbs, >9lbs <7

II.

b. Size in relation to body

c. Fontanels size, shape, consistency 1. Anterior

Microcephaly <32cm Hydrocephaly >4cm from chest Cephalohematoma Full bulging, large, depressed Closed sutures

2. Posterior III. Eyes a. Color b. Movement

c. Reaction to Light d. Tears e. Evidence of sight f. Eyelids

Jaundiced sclera Gross nystagmus Constant Strabismus Dolls eye Pupils unequal, restricted, dilated, fixed Discharge Does not respond to light, focus of follow Does not respond to light, focus, or follow

IV.

Ears a. Reaction to noise

Absence of reaction.

b. Position

V.

c.Patency Nose a. Mucus b. Patency c. Reflexes 1. Sucking 2. Swallow 3. Gag Mouth

eyes in direction of sound. Responds to crooning by relaxation Line drawn through inner and outer canthi of eye comes to top notch of ear (where it connects with scalp.)symmetrical. Evidence of hearing. Reaction to noise. Midline Clear Infants obligatory nose breathers. Sneezing is common Dependent on state of wakefulness and hunger.

Low placement

Copius drainage Cyanosis at rest. Flaring or nares.

VI.

Symmetrical Presence of gag and swallowing reflex Hard and Soft palate intact Epsteins Pearls Short, thick, surrounded by skin folds Head held midline. Free movement from side to side. Full flexion and extension. Cannot move head past shoulder.

Mouth drawls to one side Clefts Webbing Rigid Restricted movement Head held at angle. Without head control. <30 cm Lack of breast tissue Bulging of chest Retractions Bowel sounds in chest Tachypnea >60/min Bradypnea <25/min Labored breathing Grunting, rales, rhonchi, wheeze (with or without stethoscope)

VII.

Neck a. Length b. Mobility

VIII.

Chest a. Size b. Breast tissue c. Characteristic shape

1-2cm < head circumference 30-33cm 3-10mm breast nodule Nipple prominent Almost circular Barrel shaped.

IX.

Respirations a. Rate b. Rhythm c. Breath sounds

30-60/min Shallow Irregular when infant is awake No sounds heard without stethoscope

d. Muscular activity involved

Bronchial. Loud, clear Simultaneous rise and fall of chest and abdomen. Diaphragmatic and abdominal breathing. 120-160/min 180 with crying 100/min if asleep May be irregular for brief periods especially after crying Femoral pulses palpable, equal, strong. Sluggish peripheral circulation. Arms equal in length. Arms longer than legs. Spontaneous Full range of motion Generally flexed. Fist often clenched with thumb under finger.

Apnea >15sec. Subcostal and substernal retractions. Flaring of nares. Chin tug.

X.

Pulse a. Rate

Persistent tachycardia - >170 Bradycardia - <120 Persistent irregular rhythm. Weak or absent.

b. Rhythm c. Peripheral Circulation XI. Arms and Hands a. Length b. Movements

Anelia phocomelia Limited movements. Asymmetry of movements. Tonicity Asymmetric contour. Poor tone/floppy +scarf sign. Absence of or additional. Short Polydactyl Syndactyl Rigid flexion. Persistent fists Abdominal distended scaphoid Sounds in chest.

c. Muscle tone

d. Fingers 1. Number 2. Webbing e. Position XII. Abdomen a. Contour b. Musculature Umbilical Cord a. Number of vessels at birth b. Appearance Genitourinary a. Female 1. Labia a.size

Correct Without webbing Fists often clenched with thumb under finger. Rounded, protruding Not fully developed. Bowel sounds audible 1-2 hours after birth 2 arteries 1 vein Clear gelatin, odorless, drying

XIII.

Bleeding or oozing; drainage or redness Ambiguous genitals

XIV.

Usually edematous Covers labia minora

Labia majora widely separated

b.appearance 2. Vaginal discharge a.color b.type b. Male 1. Testes in scrotum 2. Urethral meatus at end of penis c. Voidings 1. Color 2. Amount 3. Frequency 4. Specific gravity Rectum a. Patency b. Stools 1. Number 2. Color 3. Consistency 4. Frequency Hips a. Symmetry b. Femur heads Back a. Appearance b. Turns head from side to side in prone position

May have pigment. Symmetric in size

Minora prominent. Absence of vaginal orifice Fecal discharge

Smegma under labia. May be blood tinged Mucoid/white Palpable each side Large. Rugge. Cremasteric Correct position Prepuce covers glans. Not easily retractable. Clear, light yellow Well saturated diapers By 24 hrs after delivery. At least 3-4 times/day 1.008-1.010 Good sphincter tone of anus. Good wink reflex. Meconium by 24 hrs. after birth Depends on age of infant and type of feeding she is receiving. Ambiguous genitals Undescended Scrotum smooth. Not at tip of penis Adherent prepuce.

XV.

Failure to pass meconium Abdominal distention Diarrhea curdy, green, large water ring, forceful.

XVI.

Gluteal folds even Intact No protrusions Straight, easily flexed Yes Can raise head momentarily

Congenital hip dysplasia.

XVII.

Limitation of movement. Pigmented nevus with tuft of hair located at base of spine. Spina bifida.

XVIII. Legs and Feet a. Appearance

May appear to have bowed legs

b. Warmth c. Length d. Movement e. Alignment f. Muscle tone g. Toes 1. Number 2. Webbing h. Position XIX. Skin a. Color

Equal Legs of equal length. Shorter than arms Full ROM Foot in straight line. May appear to turn in but easily rotated externally. General flexion Feet flat. Well lined over 2/3 of surface Correct Without webbing General flexion. Most often see legs drawn up against abdomen Generally pink. Acrocyanosis. May see some mottling. Smooth, soft. Flexible. May have dry peeling hands and feet. Without edema. Teleangiectases Mongolian spots Transient hyperpigmentation of areolas, genitals. Distended sebaceous glands particularly on nose and cheeks Over shoulder, pinniias, forehead, back White, cheesy, odorless substance in creases and folds Petechiae over presenting part. Ecchymosis from forceps Amount varies. Silky, growth pattern toward face and neck. Present, extended beyond fingertips Of hands and feet at about day 3. 97.6-98.6F axillary Shivering mechanism undeveloped. Brown fat. From evaporation, conduction, convection, radiation.

Different temperatures Unequal. Hypermobility Lack of leg movement Club foot.

Absent or excessive digits. Syndactyl Rigid of floppy posture

b. Textures c. Birthmarks

Jaundice Cyanosis Pallor or dark red. Thinner or thicker texture. Fish scale skin. Hemangiomas

d. Characteristics 1. Milia 2. Lanugo 3. Vernix Caseosa 4. Ecchymosis 5. Hair 6. Nails 7. Peeling Temperature a. Normal b. Temperature regulatory mechanism c. Heat Loss

Absent or excessive Absent or excessive; yellow, green or foul odor. Over other areas. Fine, woolly, coarse, brittle, unusual growth pattern. Absence Generalized cracking and/ or peeling. Hypothermia/Hyperthermia Temperature not stabilized by 10hrs after birth. Swings of >2F from one reading to the next.

XX.

XXI.

Reflexes a. Local 1. Blink

2. Pupillary 3. Dolls eyes 4. Rooting 5. Sucking/ swallowing 6. Gag 7. Yawn 8. Grasp 9. Babinski

Response to light stimulus. Tap on forehead, bridge of nose, maxilla when eyes open-blink first 4-5times. Response to light is equal. Round. Pupil constricts When head is turned, eye movement lags behind. Turns head in direction of stimulus; opens mouth Follows rooting. Takes hold, sucks and obtains fluids. Safety reflex. Do not try to elicit. Spontaneous Finger curl around examiners finger. Toes turn downward. Hyperextension of all toes with dorsiflexion of big toe when one side of sole is stroked from heel across ball of foot to toe. Symmetric abduction and extension of arms. Finger may fan with forefinger and thumb forming a C. Arms then adduct in embracing motion and return to relaxed flexion. When head is turned to one side, extremities on same side extend and on opposite side flex. When held upright with one foot touching a flat surface, will stimulate walking. Will step alternately. While on abdomen, will make crawling movements with arms of legs.

Continued blinking with repeated taps.

Failure to respond. Response unequal.

Weak or absent. Weak or absent. Gagging, coughing, or vomiting with swallowing

Absent

b. Generalized 1. Moro (startle)

2. Tonic neck (fencing)

3. Dance/ walking

Asymmetry of stepping

4. Crawling c. Assess the newborn for: 1. Presence or absence of each reflex. 2. Strength of each reflex 3. Infants response to your

Absent.

XXII.

assessment. Cry a. Frequency b. Pitch

Individual 15-20min q 24 hrs to 2hrs q 24hrs. Lusty, strong, moderate pitch.

Unconsolable. High pitch. Weak or absent

XXIII. Personality and Behavior a. Response to handling b. Reactions to environment

Touch, massaging, warmth -soothing Low pitch voice- relaxation Responds with quietness and increased alertness and cuddling voice. Turns head and focuses when interested. Coordinates body movement to parents voice and body movement Variations in interest/ hunger. Usually feeds well within 24hrs. Wakeful periods about q 3-4 hours. Unconsolable.

c. Parent-infant interaction

No focus on person handling

d. Eating-Sleeping patterns

Lethargy

APGAR SCORING