NEWBORN

ASSESSMENT
ALICIA A. STONE RN,MS,FNP
ASSISTANT PROFESSOR OF
NURSING
MOLLOY COLLEGE
Everyone is
kneaded out of
the same
dough
but not baked
in the same
oven. ~Yiddish
Proverb
 Nursing Objectives

 To promote physical well-being.

 Nursing care
 Physical assessment
 Nutrition

 To promote and establish a functioning

family.
 Support

 Education
 Fetus to Newborn:
Respiratory Changes
 Initiation of respirations
 Chemical
surfactant reduces surface tension 34-36wks
decrease in oxygen concentration
 Thermal
sudden chilling of moist infant
 Mechanical
compression of fetal chest during delivery
normal handling
Apgar Scoring
 Neurologic Adaptation:
Thermoregulation

 The maintenance of body temperature is a major

task for the NB infant (normal temperature is 97.7-
98.6)
 1) their skin is thin and blood vessels are close to the
surface
 2) they have little SQ fat to serve as a barrier to
heat loss
 3) they have 3x the surface to body mass as an
adult
 4) Preterm infants are especially susceptible to heat
loss because their tone is poor and they have even
less fat and thinner skin than full term babies.
Methods of Heat Loss
 1) Evaporation-occurs when wet surfaces are
exposed to air.
 2) Conduction- occurs when the NB comes in
direct contact with objects that are cooler than
their skin.
 3) Convection- occurs when heat is transferred
to air that surrounds the NB.
 4) Radiation- occurs when there is a transfer of
heat to cooler objects that are not in direct
contact with the infant.
Convection

Radiation

Evaporation

Conduction
 Nonshivering thermogenesis
The distribution of brown adipose tissue (brown fat)
 Effects of Cold Stress
 1) Metabolic Rate: leads to  use of glucose and
 production of Surfactant. This can lead to
hypoglycemia and respiratory distress.
 2) Non-Shivering Thermogenesis-metabolism of
Brown fat. This leads to increased production of
free fatty acids, which leads to metabolic
acidosis and jaundice.
 3) Vasoconstriction: leads to pale, mottled skin
and shut down of pulmonary vessels, which leads
to fetal circulation patterns.
Bonding

 Kennell and Klaus

 En face
 Encourage
Breastfeeding
 Skin to skin
 Periods of Reactivity

 First Period (30-60 minutes)

 Vital
signs, Color, Eyes wide open.
 Encourage attachment (Bonding)
 Apgar Scoring, radiant warmer
 Medications
 Sleep Phase (1 – 4 hours)
 Second Period (4 – 12 hours)
 Intensesensitivity to internal and
external stimuli.
 Void and meconium
 Watch mucus, apnea, emesis
 Nursing Assessments

 Vital signs
 Measurements
 Gestational Age
 Medications
 Glucose levels
 Temperature
stabilization.
 What is a
successful
transition???
General Survey

Appearance
 Symmetry, any
obvious deformities,
size, smell, muscle
tone, sex, posture
Behavior
 Crying, lethargic,
responsive, reflexes,
jittery
 Measurements
 Normal Weight
 2500-4000gms
 5 ½lbs. – 8lbs, 13 oz.
 (AGA-appropriate for gestational
age)
 Below normal (SGA- small for
gestational age)- <10%
 Above normal (LGA-large for
gestational age)- >90%
 Normal Length- 18-22” or 48-52 cm.
 Head circumference- 13-14” or 32-36 cm.
(measure right above eyebrows)
 Chest circumference- 12-13” or 30-34cm
(measure at nipple line)
Vital Signs

 Temperature- first is usually

taken axillary, but may be
taken rectally to assure anal
patency (36.5-37.5C or 97.5-
99.5F)
 Pulse- 110-160 bpm, unless
sleeping (100) or crying
(180)
 Respirations- 30-60 with
periodic breathing
 B/P- only if suspected heart
problem or premature infant
Gestational Age
Assessment
Physical Characteristics of
Gestational Age
Medications in the Delivery
Room
 Vitamin K (Aquamephyton)

 Erythromycin Ointment
 FONTANELLES

 Bulge – IICP
 Depressed –
dehydration
 Molding

 Overriding
sutures.
 Resolve quickly
 Caput Succedaneum

 Soft tissue edema

from birth
trauma.
 Crosses suture
lines.
 Cephalohematoma

 Bleeding
between the
cranial bone and
the periosteum in
periosteal space.
 Does not cross
suture lines
 What will happen
when it starts to
resolve?
 SKIN

 Reddish in color,
smooth, puffy.
 Edema
 Turgor
 Cord
 Nails
Acrocyanosis

Mottling

Jaundice
 PHYSIOLOGIC JAUNDICE

 Hyperbilirubinemia
not associated with
hemolytic disease or
other pathology in
the newborn.
Jaundice that
appears in full term
newborns 24 hours
after birth and peaks
at 72 hours. Bilirubin
may reach 6 to 10
mg/dl and resolve in
5 to 7 days.
Vernix

Milia
Rashes/Marks
- Erythema Toxicum (Newborn Rash)
- Forcep marks
- Mongolian spots
- Birthmarks:
 Port wine stain
 Stork bite/Nevi
 Strawberry mark
 Café au lait
- Petechiae
 Erythema Toxicum

Mongolian spot

Forcep mark
 Port wine stain

Stork bite/ Nevi

Strawberry hemangioma
 Eyes
Check color, red reflex.

Subconjunctival Hemorrhage
From birth trauma

Chemical Conjunctivitis from a

reaction to eye prophylaxis.
 Ears

 Pinna top on
horizontal line
with outer
canthus of eye
 Loud noise elicits
Startle Reflex
 Flexible pinna
with cartilage
present
 Nose
 EXPECTED FINDINGS
 Nostrils patent bilaterally
Obligate nose breathers
No nasal discharge
 COMMON VARIATIONS
 Sneezes to clear nostrils
Bridge appears absent
Thin white nasal mucus discharge
 Signs of potential distress or deviations
from expected findings
 Malformation
Nasal flaring beyond first few moments after
birth
 MOUTH AND THROAT

 Mucosa moist
 Palate high arched
 Well developed fat
pads bilateral cheeks
 Sucking, rooting, gag,
and extrusion reflex.
 Epstein’s pearls, thrush,
supernumerary teeth,
cleft palate
Cleft lip and palate
 CHEST

 Expected findings
 Evident xiphoid process
Equal anteroposterior and
lateral diameter
Bilateral synchronous chest
movement
Symmetrical nipples
 Common variations
 "Witch's milk"
Enlarged breasts
Accessory nipples
 Apical Pulse, check for
retractions, grunting
 ABDOMEN

 Expected Findings
 Dome-shaped abdomen
Abdominal respirations
Soft to palpation
Well formed umbilical cord
Three vessels in cord
Cord dry at base
Liver palpable 2 - 3 cms below right
costal margin
Bilaterally equal femoral pulses
Bowel sounds auscultated within two
hours of birth
Voiding within 24 hours of birth
Meconium within 24 - 48 hours of birth
 GENITALIA

 FEMALE
 Edematous labia and clitoris
Labia majora are larger and
surrounding labia minora
Vernix between labia
 MALE
 Urinary meatus at tip of glans penis
Palpable testes in scrotum
Large, edematous, pendulous
scrotum, with rugae
Smegma beneath prepuce
Stream adequate on voiding
 EXTREMITIES

 Maintains posture of
flexion
Equal and bilateral
movement and tone
Full range of motion
all joints
Ten fingers and ten
toes
Legs appear
bowed
Feet appear flat
 Palmar and sole
creases evident
 POLYDACTYLY

 Count the fingers

and toes. Open
the hand and
look!
 HIP DISLOCATION

 Ortolani’s
manuver
 Unequal leg
length
 Asymmetrical skin
creases posterior
thigh
 CLUB FOOT

 Talipes
Equinovarus
 When the foot
turns inward and
downward
 Check for normal
positioning and
whether it
corrects easily.
 May be
positional.
NEUROMUSCULAR SYSTEM
 Expected findings
 Maintains position of flexion
When prone, turns head side to side
Holds head and back in horizontal plane
when held prone
Ability to hold head momentarily erect
 Moro reflex
 Signs of potential distress or deviations
from expected findings
 Hypotonia
Quivering
Limp extremities or straightening of extremities
Clonic jerking
Paralysis
 BEHAVIORAL

 Observe how the baby quiets to

soothing, cuddling, or wrapping
 Sleep-wake cycles.
 Brazelton Behavioral Assessment
Scale.
 Watch for excessive crying,
fretfulness, and inability to quiet self
(Drug Withdrawal)
 ADDITIONAL CARE

 Suctioning
 Positioning
 Wrapping
 Holding
 Circumcision
Care
 Newborn Testing
 PKU,T4
 Hearing
 PARENT EDUCATION

 Axillary temp
 Bathing
 Care of nails
 Diapering
 Feeding
 Health care
provider visits
 When to call for
immediate
attention.