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Assessment of normal newborn
Assessment of normal
      newborn
Asia suliman mohamed

Postgraduate student
   Mch department
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.
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
Infant:-
 Name…………………………
 Birth weight…………………
 gestational age……………
 sex…………………………..
 date and time of birth…..
 race…………………………..
  Name
 Age.
 Gravida     , Para        +   .
 blood group & Rh .
 Race.
 Education level.
 labor, delivery.
 Type of contraception used.
 Location   of prenatal care and number of
  visits.
 Medications - drug, dose, route, length of
  therapy, indication, when used during
  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 .
 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?
◦ 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?
◦ 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
   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
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
   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.
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 .
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.
 Temperature:
Axillary: 36.5 C- 37 C.
 Heart Rate:
Apical 102-140 beats/ min.
 Respiratory:
30-60 breaths/ min.
 Blood Pressure:
65/41 mmHg.
 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.
 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 .
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.
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.
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.
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.
 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
 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.
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.
   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.
◦ 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.
   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.
.
 Urethral opening is at tip of glans pens.
 Testes palpable in each scrotum.
 Scrotum usually large edematous, pendulous
  and covered with rugae and pigmented
   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:
 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.
   .
 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.

◦ 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:
•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/excretion
3sleeping and waking.
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.
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.
A newborn baby usually sleeps for most of the
 time between feeds but should be alert and
 responsive when awake .
Each day the baby should be examined by a
 midwives to evaluate his progress and identify
 problems as they arise.
Thanks for every body

                   asia

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Assessment of normal newborn

  • 3. Asia suliman mohamed Postgraduate student Mch department
  • 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.
  • 52. Thanks for every body asia