K.C. 2003

The Newborn AssessmentAnd

The Normal Newborn

Prepared by Kellie Caswell, RN, BSN

K.C. 2003

Apgar Scoring

• Evaluate the physical condition of the newborn at birth.

• Done at 1 minute and 5 minutes

• The score ranges from 0 to 10.

• 8 – 10 indicates good condition

• 4 – 7 indicates the need for stimulation

• A score less than 4 indicates resuscitation

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When are these assessments done?

• Immediately after birth in the delivery room. If the infant is stable it can remain with the parents for bonding or initiation of breastfeeding.

• During the first four hours after birth. This is routine admission procedure

• Prior to discharge the pediatrician will do a complete exam on the newborn.

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Estimation of Gestational AgePhysical Characteristics

• Done within the first four hours

• Look at the resting posture

• Look at the skin• Is there Lanugo?• Look at sole creases• Palpate breast tissue• Ear form and cartilage

distribution• Genitals ( are the testes

descended? Do the labia cover the clitoris?)

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Neuromuscular assessment

• Fetus develops caudocephalic or from bottom to top.

• Square window• Recoil• Popliteal angle• Scarf sign• Heel to ear extension• Ankle dorsiflexion• Head lag• Ventral suspension• Major reflexes

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Neuromuscular maturity- Square window sign

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Neuromuscular maturity- Scarf sign

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SGA, AGA, LGA

• SGA- Small for gestational age ( growth is below the 10th percentile)

• AGA- Appropriate for gestational age

• LGA- Large for gestational age ( growth above the 90th percentile)

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Physical assessment

• General appearance- head is larger than the body. Flexed posture.

• Weight and measurements- length, head and chest circumference

• Temperature

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Skin characteristics• Acrocyanosis- Bluish

discoloration of the hands and feet.

• Mottling- lacy pattern of dilated blood vessels under the skin

• Harlequin sign- deep color develops on one side while the other side remains normal

• Jaundice- Yellow color of the skin and sclera of the eyes

• Erythema toxicum- newborn rash “ Look like flea bites”

• Milia- “ pimples”

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Skin characteristics ( continued)

• Skin turgor• Vernix caseosa• Forceps marks • Birthmarks A. Telangiectatic nevi -

stork bites B. Mongolian spots C. Nevus flammeus- port

wine stains D. Nevus vasculosus -

strawberry marks

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Head

• Molding may be present “ cone head”

• Fontanelles “ soft spots”• Cephalhematoma-

collection of blood resulting from ruptured blood vessels between the surface of the cranial bone and the periosteal membrane.

• Caput succedaneum-collection of fluid, swelling of the scalp

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Face

• Look for symmetry• Eyes A. Eye color is usually established at

approximately 3 months. B. Erythromycin ointment is instilled as a

prophylactic medication. It is used to treat gonorrhea if the newborn has been exposed.

C. Subconjunctival hemorrhages D. Transient strabismus E. Doll’s eyes F. Red reflex

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Face ( continued)

• Nose- look for flaring• Mouth- look for cleft

lip and palate. • Ears- In the normal

newborn the top of the ear should be parallel to the outer and inner canthus of the eye.

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Assessment( continued)

• Neck• Chest- can frequently see the xiphoid process A. “ Witches milk” whitish secretion from breasts

as a result of mothers hormones. B. Extra nipples or supernumerary nipples• Cry- lusty and strong• Respirations- 30-60 breaths per minute A. Look for signs of respiratory distress B. Breath sounds C. Brief periods of apnea may occur

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Assessment ( continued)

• Heart rate- 120-160 bpm. When sleeping it can go as low as 100 and when crying as high as 180. Count an apical pulse for one full minute each time you check the pulse.

• Assess rhythm• May have murmur that is transient due to PDA

but needs to be reported and monitored• Blood pressure is usually taken in all four

extremities.

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Umbilical CordInitially white and gelatinous with two arteries and one vein.

Shriveled and blackened by second or third day.

Falls off within the first 10 days.

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Genitals

• Females – nurse examines the labia majora, minora and clitoris. A vaginal or hymenal tag can be present and will disappear in a few weeks.

• May often have whitish or blood tinged discharge.

• Males- Look at urinary meatus and the size and symmetry. The scrotum should be palpated to see if the testes have descended.

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Assessment( continued)

Anus- Checked for patency

Extremities- Look for abnormalities ( extra digits, webbed digits, how they move,etc. )

Erb- Duchenne paralysis ( Erb’s palsy)

Club foot

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Assessment ( continued)

• Back

A. Straight and flat

B. Examine the base of the spine for a nevus pilosus “ Hairy nevus”

C. Pilonidal dimple at the base of spine

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Assessment of Neurologic Status

• Note the newborns state of alertness, resting posture, cry, quality of muscle tone and motor activity.

• CNS of newborn is immature so tremors or jitteriness is common but needs to be differentiated from a convulsion or other central nervous system disorder.

• Look for common reflexes ( Tonic-neck, grasping, moro, rooting and sucking reflex)