assessment of normal newborn

بسم الله الرحمن الرحيم

Assessment of normal newborn

Seminar about:

Asia suliman mohamed

Postgraduate studentMch department

Presented by:

Each newborn baby is carefully checked at birth for signs of problems or complications. A complete physical assessment will be performed that includes every body system. Throughout the hospital stay, physicians, nurses, and other healthcare providers continually assess a baby for changes in health and for signs of problems or illness.

Introduction:

the neonatal period include the time from birth through the twenty eighth day of life .

Newborn infant usually are considered to be tiny and power less ,completely depended on others.

Normal newborn appearance is full term infant approximately 3,5 kg ,when fully extended measures 50cm from the crown of his head to his heels ,and has an occipitofrontal circumference of 34-35cm .his head comprises one-quarter of his size. He is plump and has a prominent abdomen . He lies in attitude of flexion .

History

Physical examination

Assessment include:

Infant:-Name…………………………Birth weight………………… gestational age…………… sex………………………….. date and time of birth…..race…………………………..

History :

  Name Age. Gravida     , Para                +       . blood group & Rh . Race. Education level.  labor, delivery.  Type of contraception used.

Maternal:

Location of prenatal care and number of visits.

Medications - drug, dose, route, length of therapy, indication, when used during pregnancy.

Pregnancy:

Labor spontaneous or induced? Complications of labor Fetal monitoring?  Fetal distress? Rupture of membranes: artificial or spontaneous, hours before delivery, character of fluid.

Medications - including analgesia and anesthesia: drug, dose, route, time prior to delivery .

Labor and Delivery:

Relationship of neonate's mother and father (married, divorced, cohabiting, live apart, no contact maintained, etc.)

Mother: amount of education, and is she employed

outside of the home?Father: age, amount of education, occupation Any illnesses or other problems in household

members? Any significant illnesses (physical, mental, growth

failure) in other members of father's or mother's family?  If so, what?

Is there any disorder(s) in particular that mother worries her child might develop?

Family:

◦Type of housing (trailer, apartment, etc.)

◦Number of bedrooms; running water, bath; electricity.

◦Is adequate heating or cooling a problem?  If yes, explain.

◦Do any of the children sleep in the same bed or same room as their parents?

◦Are there adults other than the parents sleeping or living in the house?

Environment:

◦Approximate level of income.  Are there a lot of debts?

◦Will the baby be an added financial stress?

Mother-Child Relationship:Mother's affect; attitude toward the child; knowledge of child care.

The initial assessment using the Apgar scoring system.

Transitional assessment during the periods of reactivity.

Assessment of gestational age, and

Systematic physical examination

Assessment:

The most frequently used method to assess the newborn’s immediate adjustment to extrauterine life is the Apgar scoring system. The score is based on observation of heart rate, respiratory effort, muscle tone, reflex irritability, and color

Initial Assessment: Apgar scoring

Sign Score = 0 Score =1 Score=2

Heart Rate

Absent Below 100 per minute

Above 100 per minute

Respiratory Effort

Absent Weak irregular (gasping)

Good crying

Muscle Tone

Flaccid Some flexion arms & legs

Well flexed or active movement of extremities

Reflex(Irritability

No response

Grimace or weak cry

Good cry

Color Blue all over or pale

Body pink hands and feet blue

Ping all over

First period of reactivity: During the first 30 minutes the newborn is very alert, cries vigorously, may suck a fist greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.

Transitional Assessment: Periods of Reactivity:

It lasts for about 2-4 hours. Heart and respiratory rates decrease, temperature continues to fall, mucus production decreases, and urine or stool is usually not passed. The newborn is in state of sleep and relative calm.

Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gag reflex is active, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.

Following this stage is a period of stabilization of physiologic systems .

Second period of reactivity:

General Measurements: Birth weight: 2500-4000 g. Head Circumference: 33-35 cm, about 2-3 cm larger than chest circumference.

Chest Circumference: 30.5- 33 cm. Head to heel length: 48-53cm.

Systematic physical examination:

Temperature:Axillary: 36.5°C- 37°C. Heart Rate:Apical 102-140 beats/ min. Respiratory:30-60 breaths/ min. Blood Pressure:65/41 mmHg.

Vital Signs:

Posture: Flexion of head and extremities while

rest on chest and abdomen. Skin: At birth, bright red, puffy smooth. Second to third day dark pink and dry. It is soft and has good elasticity or tissue

turgor due to hydrated subcutaneous tissue.

Edema is seen around eye, face, legs and scrotum or labia.

Cyanosis of hands and feet.

General Appearance:

It is a soft yellowish cream, which covers the neonates at birth to protect the skin from infection. It is formed of sebaceous gland mixed with old epithelial cells. It may thickly cover the baby or it my be found only in the body crease and between the labia. It dries off within

24-48 hours and fades spontaneously .

Vernix Caseosa:

It is a long soft growth of fine hair observed on the shoulders, back, extremities, forehead and temples of the neonate. The more premature baby is, the heavier the presence of lanugo is. It disappears during the first weeks of life.

Lanugos Hair:

Pealing of the skin occurs within

2-4 weeks of life. These are denoted areas where the delicate skin has been rubbed off the nose, knees and elbows, because of pressure and erosion of sheets. The skin of buttocks is particularly sensitive and should not be left wet and /or soiled.

Desquamation

These are small pinpoint white or yellow spots due to increased fat secretion. Common on the nose, forehead, cheeks, and chin of the newborn infants. They can be felt with the fingers they consist of accumulations of secretions from the sweat and sebaceous glands that have not yet begun to function normally. They will disappear within a few weeks (one to two weeks). They should not be expressed.

Milia

The fontanels are soft spots. Consist of openings at the point of union of the skill bones.

The anterior fontanel; is diamond in shape and located at the

junction of two parietal and frontal bones. It is 2-3 cm in width and 3-4 cm in length. It closes between 12-18 months of age.

The posterior fontanel; is triangular and located between the

occipital and parietal bones. It closes by the 2nd month of age.

Fontanels should be flat, soft, and firm. It bulge when the baby cries or if there is increased intracranial pressure.

Head:

Lids: Usually edematous. Color: Gary, dark blue, brown. True eyes color is not determined until the age of 3-6 months.

Pupil: React to light. Absence of tears. Blinking reflex in response to light or touch.

Rudimentary fixation on objects

Eyes:

Position: Top of pinna on horizontal line with outer canthus of eye.

Startle reflex elicited by a loud sudden noise.

Pinna flexible, cartilage present. 

Nose: Nasal patency. Nasal discharge – thin white mucous.

Ears:

 Intact, high-arched palate. Uvula in midline. Sucking reflex- strong and coordination. Rooting reflex. Gag reflex. Minimal salivation.  

Neck: Short, thick, usually surrounded by skin

folds. Tonic neck reflex present.

Mouth and throat:

 Gastrointestinal System:◦Mouth should be examined for abnormalities such as cleft lip and cleft palate.

◦Esptein pearls are brittle, white, shine spots near the center of the hard palate they mark the fusion of the 2 hollows of the palate. It will disappear in time.

System Assessment of the neonates:

◦Gum: May appear with a quite irregular

edge teeth are semi-formed but not erupted.

◦Cheeks: Have a chubby appearance due to

development of fatty sucking pads that help to create negative pressure inside mouth and facilitate sucking.

Stomach and intestine: The capacity of infant’s stomach varies after birth from 30-60 cc and increase rapidly.

◦Abdomen: Cylindrical in shape.Liver: Palpable 2-3 cm below costal margin.Spleen:

Tip palpable at end of first week of age. Umbilical cord:

Bluish white at birth with two arteries and one vein. It is formed of gelatinous connective tissue called Wharton’s jelly.

Heart: Apex- fourth to fifth intercostal space,

lateral to left sternal border. Respiratory System:

◦Slight sternal retraction evident during inspiration.

◦Xiphesteranl process evident.◦Respiratory chiefly abdominal.◦Cough reflex absent at birth, present by

1-2 days.

Soon after the head is delivered babies are nose breathers, they don’t breath through an open mouth.

Circulatory System:

Normally, the newborn has urine in his bladder and voids at birth or some hours later.

Female genitalia: Labia and clitoris usually edematous. Urethral meatus behind clitoris. Vernix caseosa between labia..

Urinary System:

Urethral opening is at tip of glans pens.

Testes palpable in each scrotum. Scrotum usually large edematous, pendulous and covered with rugae and pigmented

Male genitalia:

There are maternal hormones that have crossed through the placenta to

the baby. After birth these are withdrawn and cause some normal

phenomenal such as:

Endocrine system:

Swollen breasts: This appears on 3rd day in both males and females. It lasts for 2-3 weeks and gradually disappears without treatment. Sometimes there is also breast secretion called “Witch’s milk”.

Infantile menstruation: a few spots of blood for 1-2 days can be seen in the diaper.

Reflexes: Certain reflexes are absolutely essential to the infant life- as protective reflexes:◦Blinking reflex- it is aroused when the

infant is subjected to light.◦Coughing and sneezing- to clear the

respiratory tract. Gagging- to prevent choking. .

The Nervous System:

Feeding reflexes:◦The rooting reflex-cause the infant to turn his head towards anything, which touched his check, and in his way to reach for food.

◦Sucking reflex provide such movements when anything touches the lips

Swallowing reflex: - It follows sucking reflex.The gagging reflex: - Comes into play when he has taken more into his mouth than he can successfully swallow, can also cough if a little of the fluid is swallowed the wrong way and enters the trachea.

The grasp reflex: An infant will grasp any object put into

his hands, holds on briefly and then drop it.

Moro reflex (startle reflex): This is aroused by a sudden loud noise

or less of support. The tonic neck reflex: It is a postural reflex in which the

infant when lying on his back turns his head to one side and extends the leg on the side to which the head turned.

Other reflexes:

◦Extremities usually maintain some degree of flexion.

◦Extension of an extremity followed by pervious position of flexion.

◦Head lag while sitting, but momentary ability to hold the head erect.

o Able to turn head in horizontal line with back when held prone.

Ten fingers and toes. Full range of motion. Nail beds pink, with transient cyanosis

immediately after birth. Creases on anterior two thirds of sole. Symmetry of extremities. Equal bilateral brachial pulse.

Extremities

•Extremities: •Ten fingers and toes.

•Full range of motion.

•Nail beds pink, with transient cyanosis immediately after birth.

•Creases on anterior two thirds of sole.•Symmetry of extremities.

•Equal bilateral brachial pulse.

Observation of the baby behaviour provides information about his general wellbeing .

1/Feeding.2/excretion3\sleeping and waking.

Observation of behaviour :

During feeds the midwife should observe the baby,s egerness or reluctance to feed ,the

co –ordination of his sucking and swallowing reflex .she should note the frequency with which he demand feeds.sucking is interspersed with rest periods.

feeding

Observation of the phases of the stools and of any vomiting helps to identify abnormalities of the gastro-intestinal tract ,in born errors of metabolism and infection.

Excretion

A newborn baby usually sleeps for most of the time between feeds but should be alert and responsive when awake .

Sleeping and waking

Each day the baby should be examined by a midwives to evaluate his progress and identify problems as they arise.

Daily examination:

Thanks for every body

asia