NEWBORN

ASSESSMENT
Introducti
on
 Definition
Head to toe physical examination of a
newborn to look for any abnormalities or
pathology.

Includes biochemical screening & certain

special screening.
 Purposes:
To understand the physical and mental
well being of the child.

To detect disease in early stage.

To determine the cause and effect of

the disease.

To teach child and parent.

To measure the health in future.

To determine the nature of treatment or

care needed for the child.
 Types of Health
assessment of newborn:
Initial Assessment
 Initial Assessment
Assessment immediately after birth. It
includes:
First cry,

Heart rate, respiratory rate, temperature,

gross congenital anomalies,

consciousness,

birth injury, meconium staining &

APGAR assessment.
Newborn first exam :
Apgar Score
Each item is given a score 0, 1, or 2
0-3 severe distress
4-6 moderate difficulty
7-10 no difficulty adjusting to life

Evaluation of all five categories are

made on 1 & 5 min after birth.
 Transitional
Assessment
First period of reactivity:

Begins at birth & lasts for first 30 minutes after

birth.

Assessment includes:
Temperature

Pulse

Respiratory rate

Heart rate
 Second period of
reactivity:
Begins when the newborn awake from the
deep sleep, it lasts about 2-8 hours.
The newborn is alert and responsive,
heart and respiratory rate are
increased, gastric and respiratory
secretions are increased, and passage
of meconium commonly occurs.
 Gestational Age
Assessment:
An accurate assessment of age is
important for 2 reasons
Age and growth patterns appropriate to
that age aid in identifying neonatal risks
Help in developing management plans

Gestational age can measure by

weight for gestational age chart.
Gestational Age:
SGA- small for gestational age-weight
below 10th percentile
AGA-weight between 10 and 90th
percentiles
LGA-weight above 90th percentile
 Less than 36 More than 39
Character 37-38 weeks
weeks weeks
Skin texture & Shiny, oily plethoric, Less shiny, Pink, scanty lanugo
opacity plenty of lanugo, peripheral & only large veins
edema with visible cyanosis, less are seen. Good
veins & venules on lanugo & veins are elasticity or turgor.
abdomen only found on
abdomen
Scalp hair Fine, Wooly, Fuzzy Fine, Wooly, Fuzzy Coarse, silky

Breast nodule 2 mm 4 mm 7 mm

Ear lobe No cartilage Moderate amount Stiff ear lobe, thick

of cartilage cartilage
 Less than 36 More than 39
Character 37-38 weeks
weeks weeks

Sole creases 1-2 transverse Multiple creases Entire sole covered

creases on anterior on anterior 2/3 of with creases
1/3 of sole sole

Male genitalia Testes partially - Testes fully

descended, descended,
scrotum small & scrotum normal
few rugae size, prominent
rugae

Female genitalia Labia majora Labia majora Labia majora

widely separated partially cover the completely cover
with prominent labia minora the labia minora &
labia minora & clitoris
clitoris
 Behavioural
Assessment
While babies may not speak their
first word for a year, they are born
ready to communicate with a rich
vocabulary of body movements,
cries and visual responses.
 The Neonatal Behavioral
Assessment Scale
(NBAS) was developed in 1973 by Dr. T. Berry
Brazelton and his colleagues. The scale
represents a guide that helps parents,
health care providers and researchers
understand the newborn's language. " The
scale is designed to reveal an infants
strengths and preferences, so that
parents may have a better
understanding of their newborns
capabilities.
It is based on 3 assumptions:
1.Newborn baby control their
movements.
2.They communicate in different
means.
3.They are social organisms.
The scale contains 28 behavioral and 18 reflex
items for parents and doctors to assess. It also
reviews a babys capabilities in several different
developmental areas: autonomic, motor,
state regulation, and social-interactive
systems. The result is not a score, but instead
an understanding of how infants integrate these
areas as they adapt to their new environment.

It includes habituation, orientation, motor

maturity, variation, self quieting ability &
social behaviour.
 Major components of
growth & development
 Physical
examination
Complete physical examination within 24
hours of birth.

It is best to examine when the infant is

quiet.

Ensure infant is naked : he/she can be in

diapers, but you have to open it.

Do not forget to wash hands prior to

examination.
 Anthropometric
Measurement
Weight: 2.5-3 kg

Length: 50-52 cm

Head circumference:32cm-
37cm

Chest circumference: 30-32

cm

Mid arm circumference: 9-

13 cm
 Vital signs
a) Temperature : Normal 36.5 0c to 37.50c.

b) Respirations : Normal rate is 40-60bpm

c) Blood pressure :Normal 45-60/25-

40mmhg.Correlates with gestational
age, post natal age, birth weight.

d) Pulse rate : Awake 120-160bpm, Asleep

70-80bpm

e) Heart rate: 140-160 bpm

 Skin
Colour Rashes Nevi
Plethora Macular
Milia
Cyanosis hemangioma
Blue on Erythema Caverneous
pink: or toxicum
hemangioma
Pink on
blue Acne Strawberry
Harlequin neonatru
hemangioma
coloration m
Port wine stain
Mottling
Mongolian spot
 Head
o Anterior and posterior fontanell
o Moulding
o Caput succedaneum
o Cephalohematoma
o Craniosynostosis
o Craniotabes
 Face

Eyes :eyes are examined for congenital

cataract, sub conjunctival hemorrhage,
conjunctivitis & Downs syndrome.

Ears : Unusual shape, low set ears,

periauricular skin tags (papillomas), hairy
ears.
 Face & neck
Nose : Verify patency (Flat nasal bridge , Deviated septum ,
Choanal atresia )

Mouth : Hard & soft palate for evidence of cleft palate Neonatal
tooth (predeciduos,true deciduos), Macroglossia & Oral thrush.

Neck : Note shape, range of motion, and any webbing; palpate

for masses
Brachial palsy
Erbs palsy
Fractured clavicle
 Chest
Observation : respiratory rate, chest
symmetrical, sternal/intercostal /subcostal
recession, nasal flaring, grunting, stridor

Breath sounds : Equality bilaterally,

presence of any additional sound.

Breast in newborn.
 Heart
Observation : heart rate, rhythm, quality
of heart sounds, active precordium

Position of heart : may be determined

by auscultation

Presence of murmur

Palpate the pulses (femoral) & define

whether its normal, weak or absent.

Signs of congestive heart failure : gallop,

tachycardia & abnormal pulses
 Abdomen
Observation : scaphoid abdomen,
omphalocele, gastroschisis

Palpation : Check for distension,

tenderness or masses. Palpate liver,
spleen, kidneys and groin and note any
masses

Auscultation : Listen for bowel sound

 Umbilicus
Should have 2 arteries 1 vein.

Inspect for discharge, redness or

edema around base of the cord.
Normal Umbilical Cord Umbilical Hernia
 Genitalia
Male Female
Palpate bilateral testicles Inspect for size
Examine for inguinal and location of
hernia the labia,
clitoris, meatus,
Look for hypospadias, and vaginal
epispadias, Phimosis opening
Observe colour of scrotum
Pseudomenses
Cryptotorchidism
Female Genitalia
Normal Abnormal Configuration
 Male Genitalia
Normal Undescended Testes
Ambiguous Genitalia
Anus & rectum
 Extremities

Syndactyly

Polydactyly

Oligodactyly

Congenital deformities of foot

 Back & Spine
Observe curvature and integrity

Spina bifida defect in closure of the neural tube

that is associated with malformations of the
vertebrae & spinal cord.

Meningocele & Meningomyelocele

 Hips
Congenital hip dislocation ( Ortolani &
Barlow Maneuvers)
Assymetry of the skin folds on the dorsal
surface
Shortening of the affected leg
 Nervous System
Neuromuscular system evaluation:

-Gestational maturity rating is measured after

the baby is born by the Ballard Scale, it
consists of six evaluation areas of
Neuromuscular maturity and seven items of
physical maturity.

-A score is assigned to each area. The more

neurologically mature the baby, the higher the
score.
Neuromuscular system evaluation,
includes:

Posture - how does the baby hold his/her arms

and legs
Square window - how far the baby's hands can
be flexed toward the wrist
Arm recoil - how far the baby's arms "spring
back" to a flexed position
Popliteal angle - how far the baby's knees extend
Scarf sign - how far the elbows can be moved
across the baby's chest
Heel to ear - how close the baby's feet can be
moved to the ears.
 Posture

Square Window
 Arm Recoil

 Popliteal Angle

Scarf Sign
 Heel to ear
0 if heel can easily be pulled to ear
 Reflexes
Glabellar reflex
Blinking reflex
Dolls eye reflex
Corneal reflex
Sneezing &
coughing reflex
Gagging reflex
 Plantar grasping
reflex
Babinski reflex
Traction reflex
Ventral suspension
reflex
 Subsequent
assessment
First day examination
Daily examination
Examination on
discharge
 First day
assessment
Vital signs
General behavior
Anthropometric assessment
Feeding behavior
Pattern of elimination
Head to toe assessment
 Daily assessment
Feeding behaviour
Vomiting
Passage of urine & stool
Sleep pattern
Hypothermia
Respiratory distress
 Jaundice
Umbilical sepsis
Oral thrush
conjunctivitis
Any other problems
On discharge
assessment
Detailed head to toe
assessment