ASSESSMENT OF THE NEWBORN

Dr.Ekawati Lutfia Haksari, MPH, Sp.A(K)

Dr. Setya Wandita, M.Kes.,Sp.A(K)
Dr.Tunjung Wibowo,M.Kes., MPH., Sp.A

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

General Examination of The

Newborn
Should be done on a radiant
warmer with sufficient lighting
unless there are signs of
overheated.
Keep communicate with the
mother while examining the baby

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

General Examination of The

NewbornBefore the baby is undressed :
Examine :
a. Color
b. Respiratory rate
c. Posture
d. Movement
e. Reaction to stimuli
f. Obvious abnormality
Weigh the baby and record the weight (if he/she
has not been weighed yet).
Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

Skin
Color

At term appear paler than preterm.

Look for :
a. Jaundice (yellowish skin)

Jaundice (Depkes &

jaundice(Depkes &

IDAI, 2007)

Kramer grade of

IDAI, 2007)

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

Skin
Color

b. Cyanosis

Acrocyanosis dan Central Cyanosis (Perinasia,2006)

c. Pallor
d. Plethorhea, very red skin.

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

Pale

Icteric

Plethorea

Cyanotic

Respiratory
rate

Normal :
- 40 60 breaths per minute, no chest
indrawing,
no grunting on expiration.
- small baby might have mild chest indrawing.
- periodically stop breathing for a few
second.
- count respiratory rate during a full minute.

Mild chest indrawing (MMBBL,Depkes,IDAI,MNH-JPEIGO 2004)

Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

Respiratory
rate

Important signs :
a. Respiratory rate consistently more
than 60 or less
than 30.
b. Grunting on expiration
c. Chest indrawing
d. Apnea
No Breathing within 20 seconds or more, OR
Less than 20 seconds, With
Cyanosis OR
bradycardia
Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

Respiratory rate
Parameter

Respiratory
rate/minute

<60

60-80

>80

Cyanosis

none

Cyanosis
dissolves with
O2
supplementatio
n

Cyanosis is
persistent
even though
oxygen is
applied

Retraction

none

Mild
retraction

Severe
retraction

Breathing
sound

Good breathing
sound in both
lungs

Decrease
breathing
sound in both
lungs

No breathing
sound in both
lungs

Grunting
none
Can be heard
Downes Score of Clinical Respiratory Distress with
stethoscope
Score 3 = Mild
4-5 = Moderate
6 = severe

Can be heard
without
stethoscope.
Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

10

Posture and Movement

Posture of normal neonate

Posture of neonate with breech

presentation
(MMBBL,Depkes,IDAI,MNH-JPEIGO 2004)

Posture of small neonate

(MMBBL,Depkes,IDAI,MNH-JPEIGO 2004)

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

11

Posture and
Movement
Look for
1. Opisthotonus
2. Irregular, jerky movements of the
body, limbs, or
face (convulsion or spasm).
3. Jitteriness

Opisthotonus
(MMBBL,Depkes,IDAI,MNH-JPEIGO 2004)
Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

12

Reaction to stimulation (muscle tone

and level of alertness)
The normal newborn baby ranges from quiet
and alert and is consolable when upset.
The baby is arousable when quiet or
asleep.
Important sign !
Lethargy
Floppiness
Irritability
Drowsiness (sluggish)
Reduced activity
Unconciousness

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

13

14

15

Obvious abnormality
A.

SKIN
Considered normal as long as the
babys general condition is normal.
- Milia
- Erythema toxicum
- Exfoliation of the skin in the body,
back and
abdomen after the first day.

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

16

Obvious abnormality
Abnormality :
- Redness or swelling of the skin or
soft tissues
- Pustule or blister
- Cut or abrasion
- Bruise
- Thrush
- Birth mark or skin tag
- Loss of elasticity
Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

17

18

Obvious abnormality
B. UMBILICUS
Normal white-bluish on day 1. It then begins to
dry and shrink and falls off after 7 to 10 days.
Abnormal red, swollen, draining pus or foul
smelling. The skin surrounding the umbilicus is
red and hardened. There might be bleeding from
umbilicus.

Omphalitis (Depkes & IDAI, 2007)

Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

19

20

Obvious abnormality
C. HEAD AND FACE
Babys head may be moulded from a
vertex birth, this will resolve
spontaneously over a period of three to
four weeks.

Moulage (MMBBL, Depkes RI,

IDAI, MNH-JPEIGO 2004)

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

21

Caput Succedaneum

Extracranial injury
Cephalhematoma
Subgaleal hemorrhage with skull fracture

22

Hidocefalus

Myelomeningochele

Anencafali

Bibir sumbing

23

Paralisis N. Facialis

Strabismus

24

Microcephal

25

Obvious abnormality
Look for :
- Hidrocephalus
- Bulging of the anterior fontanelle
- Sunken fontanelle
- Swelling on scalp thet is not
restricted to the area over the
fontanelles.
- Face paralysis
- Unable to breastfeed without dribbling
milk.
Face Paralysis (MMBBL,
Depkes RI, IDAI, MNH-JPEIGO 2004)

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

26

Obvious abnormality
D. EYE
Notice !
- Pus draining from eye
- Red or swollen eyelids
- Subconjuctival bleeding

Suppurative eyes (Depkes &

IDAI 2007)

Skills
Skills Laboratory,
Laboratory, Faculty
Faculty of
of
Medicine Medicine
Universitas
Universitas
Gadjah
Gadjah
Mada
Mada

27

Obvious abnormality
E. Mouth and Nose
Mouth examination must carefully inspect
for ;
- Cleft lip
- Cleft palate
- Thrush
- Central cyanosis
- Profuse nasal discharge
- Dry tongue and mucous membrane
Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

28

Obvious abnormality
F. ABDOMEN AND BACK
Look for :
- Abdominal distension
- Gastroschisis
- Spina bifida

Abdominal Distension (MMBL, Depkes RI, MNH-JPEIGO 2004)

Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada 29

Obvious abnormality
G. LIMBS
Abnormalities :
- Abnormal position and movement of limbs
- Babys arms or legs move asymmetrically
- Baby cries when his/her leg, arm or
shoulder is
touched or moved.
- Club foot
- Extra finger (s) or toe (s)
Erb palsy (MMBL, Depkes RI,
MNH-JPEIGO 2004)
Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

30

Heart Rate
determined using a stethoscope
Normal heart rate : 100 -160 beats per
minute
It is not uncommon for the heart rate
to be more than 160 beats per minute
for short period of time during the
first few days of life, especially if
the baby is distressed.
NOTICE!
Heart rate consistently more than 160
or less than 100 beats for minute.
Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

31

Body temperature
Normal axilla temperature in neonate
ranges from 36.5 C to 37.5 C.

Birth Weight

Normal birth weight

: 2500 4000 g
Low birth weight
: <2500 g
Very low birth weight : <1500 g
Extremely low birth
: <1000 g
Large birth weight
: >4000 g
Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

32

Lubschenco Growth Chart

Large for gestational age

Appropriate for gestational age

Small for gestational age

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

33

Urine and
Stool

Normal condition :
- have 6-8 watery stools per day.
- Vaginal bleeding in female newborn
during the first week of life.
Notice!
Passes urine less than six times per
day after day 2
Diarrhoea
Has not passed meconium within 24
hours of birth.
Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

34

Breast Feeding
Baby has fed well at birth but is now
feeding poorly or has stopped feeding.
Baby has not fed well since birth
Baby is not gaining weight (proven or
suspected)
Mother has not been able to breastfeed
successfully
Baby is having difficulty feeding and is
small or a twin.
Baby is vomiting forcefully, regardless
of the method of feeding after every
feeding, or is vomiting bile or blood.

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

35

APGAR SCORE

To examine a neonates condition

Not for determining resuscitation of
neonates
Show prognosis of neonate

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

36

APGAR SCORE
0

Heart rate
per minute

absent

<100

>100

Respiratory
effort

absent

Slow,
irregular

Good, crying

Muscle tone

limp

Some flexion

Active
motion

Response to
stimulation

No response

grimace

Good
response

Color

Blue or pale

Pink body,
blue
extremities

Completely
pink

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

37

Primitive Reflex
How to examine..
1. Moro reflex
2. Palmar and plantar grasping reflex
3. Tonic neck reflex
4. Rooting and sucking reflex
5. Swallowing reflex
6. Babinski reflex
7. Automatic reflex

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

38

39

Estimating Gestational
Age
DUBOWITZ SCORE
A. Neurologic signs
B. External signs

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

40

Estimating Gestational
Age

Estimated gestational age :

(0.2642 x (total score)) + 24.595

Regression graph of Dubowitz score

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

41

Example
s
Skin

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

42

 Ear

(Depkes & IDAI, 2007)

(Depkes & IDAI 2007)

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

43

 Breast

(Depkes & IDAI, 2007)

(Depkes & IDAI,2007)

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

44

 Female Genital

(Depkes & IDAI,2007)

(Depkes & IDAI,2007)

Skills Laboratory, Faculty of
Medicine
Universitas Gadjah Mada

45

 Male Genital

(Depkes & IDAI, 2007)

(Depkes &IDAI,2007)

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

46

 Plantar Dermatoglify

(Depkes & IDAI, 2007)

Skills Laboratory, Faculty of

Medicine
Universitas Gadjah Mada

47

48

49

QUESTION ?

50

Thank You

51