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Normal Newborn
Assessment
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A nurse has completed the assessment ofnewborn who weighs 3,000 g and is 48 cmlong, with a head circumference of 33 cm.His Apgar scores were 8 at one minute and 9at five minutes. Other assessment data
include skin smooth and pink; lanugo present; sole creases covering the entire sole;; well-curved pinna soft with ready recoil; andtestes descended. Reflexs intact; posturefully flexed. The parents express concerns
over his small size.
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Newborn
The great majority of newborn infant have hadanormal intrauterine existance. Infant in normaldelivery are in good condition at birth but have
some veriation in size and shapeand appearancewithin normal, depend on genetic and ethnicfactor.
All newborn should examined at birth to observe
the general condition and to rule out majoranomalies, then the further examination isusually carried out on the third day when thebaby is completely stabilized
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Permit rapid assessment of the need forresucitation .
The test is generally done at one and fiveminutes after birth, and may be repeated
later if the score is remains low. Scores below 3 are generally represent sever
distress and baby need resuscitation , scores
of 4 to 6 fairly low and baby need closeobservation, and over 7 generally normal
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The five criteria of the Apgar score
210Sign
>100beats/min
Slow,
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Vital Signs
Temperature - range 36.5 to 37axillary
Common variations
Crying may elevate temperature Stabilizes in 8 to 10 hours after
delivery
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Heart rate - range 120 to 160 beats
per minuteCommon variations
Heart rate range to 100 when
sleeping to 180 when cryingColor pink with acrocyanosisHeart rate may be irregular with
crying
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Respiration - range 30 to 60 breathsper minute
quite, Effortless diaphragmatic abdominalmore than chest
Common variations Bilateral bronchial breath sounds
Moist breath sounds may be presentshortly after birth
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Blood pressure - not done
routinelyFactors to consider
Varies with change in activity level
Appropriate cuff size important foraccurate reading
Average newborn (1 to 3 days)oscillometry pressure value 65-95/ 30-60 in both upper and lower extremities
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General Measurements
Head circumference33 to 35.5 cm
Measured at top ofeyebrow to widest part of
occiputExpected findings Head should be 2 to 3 cm
larger than the chest
Chest Circumference30.5to 33 cm Measured at nipple line
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Head and chest circumference maybe equal for the first 24 to 48 hours
of life, why??
Common
variationsMolding of headmay result in alower headcircumferencemeasurement
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Weightrange - 2500 - 4000
gms Lengthrange - 46 to 57 cm
(pilletry)
Measured on supine, Crown-to-heel
head at midline, full
extension of the knees
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General Appearance
Complete flexion alert behavior full range of motion, spontaneous
movementCOMON VARIATION Legs extended with frank breech Drowsiness irritability indicates
(neurological problems)
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Skin
Expected findings
Skin reddish in color,
smooth and puffy atbirth
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Edema around eyes, feet, and genitals
Vernix caseosaa cheesy white material, covers the body
Lanugo
a fine hair, over the entire body Turgor good with quick recoil
Nipples present and in expected locations
without any accessory nipples.Cord with one vein and two arteries*Cord clamp tight and cord dryingwithout any sign of infection
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Common variations
Acrocyanosis - resultof sluggishperipheral
circulation
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Mongolian spots ininfants of African-
American descent
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Mottling
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Physiologic jaundice
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Miliaenlarged sebaceous glands found on nose, chin, cheeks,and forehead; regress in several days to a week or two.
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Erythema toxicum
(newborn rash)pink
to red papular rashappearing on trunkand diaper areas;regresses within 48
hours.
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HeadExpected findings Anterior fontanel diamond shaped ,2-3cm
width, 3- 4cm length.
Posterior fontanel triangular about 1 cmlength.
Fontanels soft, firm and flatSutures palpable with small separation
between each
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Common variations
Caput succedaneum
A newbornsscalp often isswollen from
edema andbruising overtheoccipitoparietalregion
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Molding of fontanels and suture
spacesinfants cranialbones mayoverlap at thesutures to acertain degree,
as a results frompassage of thehead through thebirth canal anddisappears
within 2 days. Itis not seen inbabies born bycesarean section.
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Signs of potential distress or
deviations from normal findings
Fontanels that are bulging or depressedHydrocephalus
CephalhematomaC collection of blood betweenthe periosteum of skull boneand bone it self , its caused by
rupture of preosteal capillarydue to the pressure of bitrh
Usually appears 24 hours afterbirth
Resolved within 2-3 months .
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Eyes
Expected findingsGray or blue eye colorNo tearsFixation at times - with ability to follow
objects to midlineRed reflexBlink reflexDistinct eyebrows
Cornea bright and shinyPupils equal and reactive to light
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Uncoordinated movements
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"Doll's eyes"beyond 10
days of agethis Reflex absent
Subconjunctivalhemorrhage
Deviation of normalAccumulation of lacrimal
fluids with secondaryinfection is common
Result from incompletedrainage of nasocramialducts
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Nose
Expected findings
Nostrils patent bilaterallyObligate nose breathersNo nasal discharge
Have a sneeze reflex with or withoutstimulation.
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Mouth and Throat
Expected findings
Mucosa moist.Shortly after birth
may visualizesucking calluses oncentral portions oflips.
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Palate high arched . Uvula midline
. Minimal or absent
.salivation
. Tongue moves freelyand does not protrude
. bilateral cheeks. Sucking reflex
. Rooting reflex
. Gag reflex
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Signs of potential
deviations fromexpected findings
Cleft lip or cleftpalate
Lip movementasymmetricalReflexes absent orincompleteProtruding tongueCandida Albicans
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Precocious teeth
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NeckExpected findings
Short and thickTurns easily side to sideuncoordinated movement: head lag which
disappear at 3-4 month Clavicles intact
Tonic neck reflex present
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ChestExpected findings Evident xiphoid process
Equal anteroposterior and lateraldiameterBilateral synchronous chestmovementSymmetrical nipples
Breath without effort orevident cyanosis
Common variations "Witch's milk"
Enlarged breasts
Accessory nipples
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Abdomen
Expected findingsDome-shaped abdomenAbdominal respirationsSoft to palpationWell formed umbilical cordThree vessels in cord(1 vain & 2 arteries )Cord dry at baseLiver palpable 2 - 3 cm below right costal marginBilaterally equal Brachial, femoral pulses
Bowel sounds auscultated within two hours of birthVoiding within 24 hours of birthMeconium within 24 - 48 hours of birth
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Female Genitalia
Expected findings Edematous labia
and clitorisLabia majora are
larger andsurrounding labiaminora
Vernix betweenlabia
urination within 24hrs
Male Genitalia
Expected findings Urinary meatus at
tip of glans penisPalpable testes in
scrotumscrotum is large,edematous.
urination within 24
hrs
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Back and Rectum
Expected findings
Intact spine without masses or openings Patent anal opening
Anal reflex" present
Passage of meconium within 48 hrs
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Extremities
Expected findings Maintains posture of
flexionEqual and bilateral
movement and toneFull range of motionall jointsTen fingers and tentoes
Negative hip clickGrasp reflex present
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Dislocation of hip
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Dislocated of hip is also called dysplasia of the hip (DDH) True dislocation is rare at birth with notable exception of
the baby. Unstable hip is more common in female except following
breech presentation where the risk is equal in both The method of examination is called Barlow's method The click that you feel it when doing the exam is called
ORTOLANI out in This tow test are just performed in neonatal period, after
age of six weeks these are unpredictable because ofincrease muscle tone
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Central Nervous System
Posture and tone: flexion
Movement: ranging from tremulous
movements of one or all limbs to jitterymovements
Reflexes:
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Neuromuscular System
Expected findings Maintains position of flexion
Able to turn head side to side whenprone
Able to hold head in horizontal linewith back when held prone
Head lag while sitting, with ability to
hold head momentarily erect
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Reflexs Moro Reflex: Sudden change in equilibrium
causes sudden extension and abduction ofextremities and fanning of fingers ,with indexfinger and thumb forming c shape, followed byflexion and adduction of extremities; legs mayweakly flex; infant may cry; disappears after
age 3-4months . Palmer grasp: touching palm of hand near
base of digits cause flexion of hands, lessensafter age 3 months.
planter grasp: touching feet near base of
digits cause flexion to toes, lessens by8months age
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Palmer grasp reflex
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Babniski reflex: stroking outer sole offoot upward from heel and across ballof foot causes toes to hyperextend andhallux to dorsiflex disappears after age1 year
Rooting reflex: touching the cheekalong side of mouth causes infant toturn head toward that side and beginto suck ;disappear at age 3-4 months,may persist for up to 12 months.
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Babinski's Sign ina healthy newborn Moro Reflex
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Sucking reflex: infant begins suckingmovement of circumpolar area in
response to stimulation ; persiststhoughout infancy , even withoutstimulation ,such as during sleep.
Tonic neck reflex: when infant headis turn to one side, arm and leg extendon that side, and opposite arm and legflex , disappears by age 3-4 months
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Tonic neck reflex
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Swimming reflex :If you were to put a
baby under six months of age in water, they
would move their arms and legs whileholding their breath. This is why somefamilies believe in swim training for very littlebabies. It is not recommended for you to testthis reflex at home for obvious safetyreasons.
Dolls eye reflex :as a head of infant movedslowly to right or left, eyes lag behind anddo not immediately adjust to new position of
head; disappears as fixation developed ifpersists , indicate neurological damage.
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Dance or step reflex: if infant is held sothat the sole of foot touch a hard surface there
is flexion and extension of the leg stimulatingwalking. disappear after age 3-4week.
Startle reflex: sudden loud noise causes
abduction of the arms with flexion of elbow,hand remain clenched ;disappears by age of 4months
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References
Hockenberry, M. J. & Wilson, D. (2004).Wong's Nursing Care of Infants and
Children( 7th ed.). St. Luis, Massouri:Mosby, Inc.
Sandra M. Nettina(1997).
Lippincott Manual of Nursing Practice