4. 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.
5. 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.
6. 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 .
8. Infant:-
Name…………………………
Birth weight…………………
gestational age……………
sex…………………………..
date and time of birth…..
race…………………………..
9. Name
Age.
Gravida , Para + .
blood group & Rh .
Race.
Education level.
labor, delivery.
Type of contraception used.
10. Location of prenatal care and number of
visits.
Medications - drug, dose, route, length of
therapy, indication, when used during
pregnancy.
11. 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 .
12. 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?
13. ◦ 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?
14. ◦ 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.
15. The initial assessment using the Apgar
scoring system.
Transitional assessment during the
periods of reactivity.
Assessment of gestational age, and
Systematic physical examination
16. 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
17. Sign Score = 0 Score =1 Score=2
Heart Rate Absent Below 100 per minute Above 100 per minute
Respiratory Absent Weak irregular (gasping) Good crying
Effort
Muscle Flaccid Some flexion arms & Well flexed or active
Tone legs movement of extremities
Reflex No response Grimace or weak cry Good cry
(Irritability
Color Blue all over Body pink hands and Ping all over
or pale feet blue
18. 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.
19. 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.
20. 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 .
21. 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.
22. Temperature:
Axillary: 36.5 C- 37 C.
Heart Rate:
Apical 102-140 beats/ min.
Respiratory:
30-60 breaths/ min.
Blood Pressure:
65/41 mmHg.
23. 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.
24. 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 .
25. 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.
26. 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.
27. 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.
28. 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.
29. 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
30. 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.
31. 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.
32. 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.
33. ◦ 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.
34. ◦ 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.
35. 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.
36. 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.
.
37. Urethral opening is at tip of glans pens.
Testes palpable in each scrotum.
Scrotum usually large edematous, pendulous
and covered with rugae and pigmented
38. 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:
39. 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.
40. 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.
.
41. 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
42. 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.
43. 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.
44. ◦ 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.
45. 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.
46. •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.
47. Observation of the baby behaviour
provides information about his general
wellbeing .
1/Feeding.
2/excretion
3sleeping and waking.
48. 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.
49. 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.
50. A newborn baby usually sleeps for most of the
time between feeds but should be alert and
responsive when awake .
51. Each day the baby should be examined by a
midwives to evaluate his progress and identify
problems as they arise.
