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8/2/2019 Newborn Assessment 2.16
1/16
1Rev 8/11
Name: Date Grade ______________
NEWBORN ASSESSMENT
**Complete this page on your assigned baby during your nursery or postpartum rotation. Turn in the completed
newborn assessment, Ballard score, and growth chart to your clinical instructor.**
Infant's last name____Sawyer____________________________ Sex ____M____
Birthdate __________02/09/12_____________________________ Time _09:01 am_
Maternal Blood Type (MBT) ____A+_______ ABS __________ Infant Blood Type (if available) __N/A___
Maternal GBS status ______Negative__________________________ Treatment received: No
Maternal HIV status __Negative_________ If positive, received treatment during pregnancy: Yes No
GTPAL ___2-1-0-1-1_________________________ EDD (if known) ____02/01/2012___________
Prenatal care: No Date of first visit ______N/A__________ # of visits ___0___
Complications/Risk factors during pregnancy ______No Complications/No Prenatal Care______
_____________________________________________________________________________________
Length of Labor (time of delivery time of onset) 18 hours (TOD: 09:01 am TOO: 2:58 am on 02/08/12
Type of Delivery: SVD Assisted delivery: ______No____________________
Complications during delivery_________________None________________________
Blood glucose level ____________________ CRP level (if applicable) __________________________
Vitamin K (Phytonadione) time ___09:15 am__ Erythromycin eye ointment time____09:18 am____
Other medications given/ordered _________None_____________
_____________________________________________________________________________________
Time of 1st
bath___10:00 am___ Time of 1st
urine_____10:17 am______ Time of 1st
stool ___09:46 am__
Method of feeding: Formula Type of Formula___Gerber New Start_________________
Time of 1st feeding _____10:40 am____________ Average amount of feeding _____1 ounce______
8/2/2019 Newborn Assessment 2.16
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NEWBORN ASSESSMENT
**Complete textbook description BEFOREcoming to nursery and/or postpartum clinical and bring it with you.
Complete the your baby column during either of these clinical days and turn in to clinical instructor.**
MEASUREMENTS TEXTBOOK DESCRIPTION YOUR BABY
Birth weight (lbs, oz, kg, or g) 2500 4000 g
(3400-female/3500-male)
Safe amount of weight loss
(ounces AND grams)
10 % loss (34-35 g)
(0.035 ounces in a gram and
1.19-1.23 ounces)
**Do the math!!**
Length (cm or in) 45-55 cm
Measure top of head to heel
Head circumference (cm or in) 32-36.8 cm
Measure a greatest diameter
occipito-frontal circumference
Chest circumference (cm or in) < or = 30 cm (average 30-33 cm
Measure @ nipple line
VITALSIGNS TEXTBOOK YOUR BABY (MOST RECENT)
Temperature
y What is the preferredmethod of measurement?
y What is a normal newborntemperature?
y When should it stabilize?
Axillary
37 degrees C (36.5 37.2)
8-10 hours old
Apical pulse
y How long should HR becounted in newborn?
y What is the normal HR in anewborn?
1 full minute
100-160 beats/min
Listen 4th
intercostal space
Respiratory Rate
y How long should RR becounted in a newborn?
y What is the normal RR in anewborn?
1 full minute
30-60 breaths/min
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Neonatal Pain
y List 2 pain scales used forassessment of neonatal pain.
y List 3 nonpharmacologicalmethods of pain
management.
y List 3 pharmacological agentsused for neonatal pain.
NIPS Neonatal Infant Pain Scale
PIPP Premature Infant Pain
Profile
CRIES Crying, Req increased 02,
increased V/S, expression and
sleeplessness
1)containment swaddling
2)Non-nutritive sucking pacifier
3)Skin to skin contac
4)Distraction-Visual, oral,
auditory
1)Non-opiod Tylenol (mild
moderate
2)Opiod MS04 & Fentanyl &
Toradol
3)Epidural Nerve Block
4)Sweeteze
**Use NIPS scale to rate your
babys pain with assessment.**
COMMON LABS TEXTBOOK YOUR BABY
Bilirubin (serum, TcB)
y What is the normal level?y When will the level peak?
5-6 mg/dl to 12 mg/dl
60-70 hours from birth
Glucose (one touch, accucheck)
y When is it checked?y What level is hypoglycemic?y What interventions are
initiated for low levels?
Within 2-3 hours of birth
< 36 mg/dl
1)Feeding immediately
2)IV Dextrose
Newborn screeny When is it done?y List 3 disorders that can be
detected.
W
ithin 1-2 hours of birth
PKU, T4, Sickle Cell,
Galactosemia, Drug Serum
SKIN TEXTBOOK YOUR BABY
Color & temperature
Pink or acrocyanotic
T 36.5 37.0 C
Acrocyanosis
Hands and feet appear slightly
cyanotic. Intermittently over 7-
10
Mottling Condition that is marked bydiscolored areas. Looks like
lace.
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Harlequin sign
A benign transient color change
seen in neonates in which one
half of the body blanches while
the other gets redder clear
line of demarcation.
Erythema toxicum
I
nnocuous pink popularneonatal rash of unknown origin
with super imposed vesicles
appearing within 24-48 hours
spontaneously goes away.
Milia
Small white sebaceous glands
appearing as tiny white pinpoint
papules on the forehead, nose,
cheek and chin
Miliaria (see Tabers)
An inflamed popular or vesicular
rash that results in obstruction
of the flow of sweat from sweat
glands~ prickly head rash.
Patient returns to normal when
placed in a cooler environment.
Jaundice
y Definition, causes,treatments, & complications.
y Briefly differentiate betweenphysiologic & pathologic.
y List 2 possible causes ofpathologic jaundice.
y What is breastfeedingjaundice?
Yellow color of skin due to
increased level of bilirubin in
body tissues. Jaundice does not
usually appear until bilirubin
levels reach 5mg/dl. Any visible
jaundice within the 1st 24 hours
of life or persistence of jaundice
beyond 7-10 days requires
investigation.
Physiologic usually results from
destruction ofRBCs by the
immature liver at birth.
Pathologic
Hemolytic disease: hemolytic
anemia, sickle cell, auto immune
and mono
Breastfeeding P
hysiologic andresults initially from hemo
concentration due to
inadequate fluid intake. If bili
levels exceed 20 ml/dl, mother
should stop breast feeding for
24-36 hours or until levels drop.
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Mongolian Spots
Bluish, gray or dark non-
elevated pigmentation areas
usually found over the lower
back and buttocks and primarily
in non-white races
Stork bite marks
(Telangiectasia nevi)
A
vascular lesion formed bydilatation of a group of small
blood vessels. It may appear as
a birthmark.
Port wine stain
(Nevus flammeus)
A large reddish purple
discoloration of the face or neck
usually not elevated above the
skin. It is considered a
deformity due to size and color.
Tx with flash lamp laser.
Nevus vasculosus(Strawberry mark)
Superficial blood vessels are
enlarged. Usually congenital
and slightly elevated, red,
purple on face, neck, head and
arms.
Vernix caseosa
Protective gray white fatty
substance of cheesy consistency
covering of the fetal skin.
Lanugo
Fine downy hair covering the
fetus body. 1st seen at 13-16
weeks. At 20 weeks it covers
face and body. 28-30 weeks it is
at its greatest amount, but at 3rd
trimester it will disappear.HEAD AND NECK TEXTBOOK YOUR BABY
Size & position Head- 32to 36.8 cm. Measured
just above the eye brows
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Anterior fontanel
y Measurement & location.y When should it close?y What is the significance of
sunken/depressed? flat/soft?
full/bulging/tense?
The diamond shaped junction of
the coronal, frontal, sagittal
sutures.
It becomes ossified within 18
months.
Fontanels is an un-ossified
membrane or soft spot lying
between the cranial bones of
the fetus skull
1)Norm firm and turned
inward
2)Tense or bulging- fluid builds
up in brain or brain swells that
increases pressure in the brain
3)Sunken or depressed notenough fluid dehydrated or
malnutritioned.
Posterior fontanel
y Measurement & location.y When should it close?
The 3 cm x 2 cm triangular
fontanel at the junction of the
sagittal and lambdoid sutures is
ossified by 6-8 weeks after birth.
Suture lines
y Definition & function. The line union in an immovablearticulation, as those betweenthe skull bones. The skull bones
overlap at the suture lines which
permits adaptation to thevarious diameters of the
mothers pelvis. Babys head
assumes normal shape within 3
days of birth.
**Use these terms to document:
palpable, separated,
overlapping, widely spaced,
&/or closed.**
Molding Shaping of the fetal head to
adapt itself to the dimensions of
the birth canal during descent
through the pelvis.
Forcep marks Forcep injury produces linear
marks across both sides of the
face in the shape of the bladesof the forceps. Forceps help
extract head from birth canal.
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Cephalhematoma
y Definition & location.y Most common causesy Cross or does not cross
suture lines?
y Complications or specialmonitoring needed if noted
A mass composed of clotted
blood located between the
periosteum and the skull of the
newborn. It is confined
between suture lines and is
usually unilateral. A rupture
occurs of the periosteal bridging
veins due to pressure and
friction during L & D. The blood
reabsorbs gradually over a few
weeks. Swelling is limited by
the margin of the cranial bone
(usually parietal).
Caput Succedaneum
y Definition & location.y Causey Cross or does not cross
suture lines?
Diffuse edema of the fetal scalp
that crosses the suture lines.
Head compression against the
cervix impedes venous return
forcing serum into interstitialtissue. The swelling reabsorbs
within 1-3 days. Swelling of the
tissue over the presenting part
of the fetal head is caused by
pressure during labor.
EYES TEXTBOOK YOUR BABY
Placement Eyes and space between eyes
each 1/3 the distance from
outer to outer canthus.
Epicanthal folds E.F. are characteristic in some
races. However, EF can presentwith Downs syndrome.
Vision
y PERRLA?y What is the visual acuity of a
full-term newborn?
y What are the newbornsvisual preferences (color,
black & white, distance,
patterns)?
Pupils equal in size, round and
reactive to light.
Visual acuity 50 cm from
objects. Clearest 17-20 cm.
Prefer soft red light, darkened
room.
5 days of age and < they preferblack and white patterns.
NOSE TEXTBOOK YOUR BABY
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Placement Observe shape, placement,
patency and configuration
midline, nose breather, flat or
deviated.
Sneezing & nasal mucusnormal
or abnormal?
Sneezing is normal and is used
to clear nasal mucous with someor no drainage.
Choanal Atresia
y Definitiony How is it diagnosed?
Cyanosis at rest and return of
pink color with crying due to
copious drainage and blockage
of bone.
EARS TEXTBOOK YOUR BABY
Placement Line drawn through inner and
outer canthus of eyes which
reaches to the top notch of ears.
Hearing Screenwhen is it
done?
Screened by hospital discharge
to home after birth.
MOUTH TEXTBOOK YOUR BABY
Cleft lip or palate
y Brief definition.y Discuss how a newborn is
assessed for both.
Midline fissure or opening in the
lips or palate resulting from
failure of the primary palate to
fuse.
Perform visual assessment.
Facial nerve paralysis
y Define and list S/S.y Most common cause
Facial nerve injury (facial
paralysis caused by pressure on
facial nerve; often by forceps.
Absence of movement inaffected sided. Noticeable
when baby cries.
Epstein's pearls Small whitish areas found on
gum margins and juncture of the
hard and soft palate.
Thrush (Moniliasis)
y Cause & treatmenty What if breastfeeding?
Fungal infection of the mouth or
throat by the formation of white
patches on a red, moist inflamed
mucous membrane. Caused by
candida (yeast). Tx: oral
antifungal cream.S
ometimesinfant cannot breast feed.
CHEST TEXTBOOK YOUR BABY
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Nipples
y Define breast engorgementof newborns.
y DefineWitchs milk.
Engorgement is the swelling of
the breast tissue in both sexes
by the hyper-estrogen of
pregnancy. Witchs milk is the
thin discharge from the nipples.
Respiratory patterny Symmetric?y Define periodic breathing &
apnea. Are these findings
normal or abnormal?
y What are S/S of respiratorydistress?
Breaths are shallow andirregular from 30-60
breaths/min.
Periodic breathing includes
pauses in respirations lasting 60)
Breath sounds
y What is normally heard?y What may be heard at birth,
especially with C-section
delivery, and why?
Breath sounds are loud and
clear
Infant can present with crackles
and/or adventious sounds
because the secretions are being
squeezed out of the lungs as in avaginal birth.
Heart murmurs
y Normal or abnormal?y Do murmurs require follow-
up?
Heart murmurs Normal during
1st few days of life
Murmurs require f/u if there is a
murmur + poor feeding, apnea,
cyanosis or pallor.
ABDOMEN TEXTBOOK YOUR BABY
Bowel sounds
Sounds are present within
minutes after birth.
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Umbilical cord
y Appearance at birthy How many vessels?y When is a clamp used?y What care should be given to
stump & when?
y When should cord fall off?
Whitish, gray appearance
3 vessels 2 arteries/1 vein
A clamp is placed closer to the
newborn upon delivery so cord
can be cut.
Cord clamp is removed once
stump starts drying and no
longer bleeding. Use sterile
water initially then plain water
to clean cord. Then use triple
due once and continuous
cleansing with water until cord
falls off in 10-14 days.
GENITOURINARY TEXTBOOK YOUR BABY
Voiding
y Pattern (times/day)y Time of first void
Babies void 2-6 times/day for 1-
2 days; 6-10 x day by 5th
or 6th
day.
Within first 24 hours.
What is the significance/cause of
rust-stained urine or brick
dust?
Normal uric acid crystal findings
Pseudomenstruation
y Definition & causey Normal or abnormal?
Blood tinged discharge caused
by pregnancy hormones which is
normal in female newborns.
Where is the normal placementof the urinary meatus for male
infants?
Should be at a tip of penile shaft
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Circumcision
y Definition & methodsy When is it done, by whom,
and where?
y Pre- & post-procedure care
Involves removal of the prepuce
(foreskin) of the glans
Usually performed at hospital
before discharge but never
immediately after birth. If
Jewish then 8th
day after birth.
Feeding with held 2 hours
before to avoid vomiting.
Positioned on a plastic
restraining board, penis cleaned
with soap and water. A yellow
clamp is applied, prepuce
excised and a plastic bell fitted.
Baby is monitored for bleeding q
30 minutes 1st hour and q hour
for 4-6 hours.TRUNK AND EXTREMITIES TEXTBOOK YOUR BABY
ROM, symmetry, & muscle tone
Check, inspect, palpate for full
ROM of all body parts. Note
symmetry of motion and muscle
tone.
Simian line/crease (definition &
most common chromosomal
abnormality seen with)
The crease on the palms appear
to fuse. Downs, Rubella,
Turners, Klinefelter.
SyndactylyWebbing of fingers or fusion of
one or more fingers or toes.
PolydactylyHaving more than the normal #
of fingers or toes.
Erbs Palsy (Erb-Duchenne
Paralysis)
Paralysis of the muscles of
the upper arm due to injury
of the a5th and 6th
cervical
roots of the brachial plexus.
Hand muscles are not
affected.
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Developmental dysplasia of the
hip (DDH)
y What maneuver is used tocheck for DDH?
y What assessment findingsmay be seen with DDH?
Head of femur on legs are flexed
and abducted, placement in
acetabulus If normal femur is
intact.
Asymmetry of gluteal and thigh
folds with shortening of thigh
upon rotation you hear a click
Limited hip abduction with
flexion
Apparent shortening of femur is
indicated by level of knee
flexion.
Ortolani test with femoral head
moving in/out of acetabulus.
ANUS/STOOLS TEXTBOOK YOUR BABY
Placement of anus
y Where should the analopening be?
y What is an imperforateanus?
The outlet of the rectum lays in
the fold between the buttock
Imperforate anus is closed (no
opening)
Stool
y Pattern (times/day)y Time of first stooly Define meconium,
transitional, & milk stools.
Include when each should be
passed.
Pattern and times vary
Passage of 1st 24 48 hours
although it may be delayed upto 7 days in LBW babies.
Meconium babies 1st stool
filled with bacteria is greenish
black, viscous and contains
blood.
Transitional 3rd
day it is
greenish brown to yellowish
brown, thin and less sticky. Can
contain milk curds.
Milk stool 4th day breastfed
stool is yellow, pasty and sour
smelling. Formula fed pale
yellow firmer and stinky.
NEWBORN REFLEXES TEXTBOOK YOUR BABY
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Rooting reflex Touch babys cheek and baby
turns head toward stimulus and
opens mouth.
Suck/Swallow reflex Touch infant cheek, baby opens
mouth, takes hold and sucks and
swallow which is usuallycoordinated.
Palmar & plantar grasp reflexes
y Definition & how to elicit.y When should they
disappear?
Palmar place finger in palm of
infants hand and its fingers will
wrap around your finger.
Palmar lessens by 3-4 months.
Plantar place finger at base of
toes and babys toe will curl
downward. Plantar lessens by 8
months.
Tonic neck or fencing reflex
With infant falling asleep or
sleeping turn head quickly to
left side and opposite arm
extends and leg flexes. (Same
on opposite rt side.)
Moro/Startle reflex
y Definition & how to elicit.y When should it disappear?
Hold infants head in semi sitting
and allow head and trunk to fall
backwards - 6 months it should
disappear
Place infant on flat surface and
strike surface and/or sharp hard
clap 6 months it disappearsunless there is a neurological
problem.
Dance or step reflex
Hold baby vertically, placing the
foot on flat surface and it will
stimulate movement like
walking.
Babinski reflex
y Definition & how to elicit.y When should it disappear?
+ sign - Dorsiflexion of great toe
when sole is stimulated by
upward stroking of foot sole.
Absence requires neurologicevaluation. Disappears after 1
year.
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When is the transition period? What occurs during
the transition period?
Period from birth to 4-6 hours later in which the
infant passes through a period of reactivity sleep
and a 2nd period of reactivity.
Transition period Period between intrauterine
and extrauterine existence.
1st phase lasts up to 30 minutes after birth (1st
period of reactivity) HR increases rapidly to 160-
180 bpm but gradually falls after 30 minutes to a
baseline rate of 100-120 b[m. RR is irregular and
between 60-80 breaths/min. Fine crackles,
audible grunting, nasal flaring and retractions of
the chest but will cease within 1st
day of birth. The
infant is alert, has spontaneous startles, tremors,
crying and movement of the head from side to
side. Bowel sounds audible and meconium may be
passed.
Sleep or decrease in motor activity Period of
unresponsiveness lasts 6-200 minutes.
2nd phase reactivity occurs again between 4 and
8 hours and lasts 10 minutes to several hours.
Brief periods of tachycardia and tachypnea,
increase muscle tone, skin color and mucous
production. Most babies pass the meconium
during this phase.
What is unique to the newborn in relation tothermoregulation? What temp is hypothermic?
What temp is considered a fever?
Control of temperature: a balance between heatloss and heat production. Newborns attempt to
stabilize their core body temperature within a
narrow range. Hypothermia - < 36.5 C
Hyperthermia- > 37.0 C
What is cold stress? Briefly explain how it can be
prevented.
Excessive heat loss that results in increased RR and
non-shivering thermogenesis to maintain body
core temperature. Mother/baby skin to skin
contact.
Explain the reasoning for vitamin K injection and
Erythromycin eye ointment administration for
newborns.W
here& when is the IM injectiongiven?
K injection helps prevent clotting problems
Measure to prevent gonorrhea and Chlamydia eyeinfections
K is given IM soon after birth to prevent
hemorrhage
NUTRITION QUESTIONS YOURANSWERS
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What is the average stomach capacity in mL of a
full-term newborn?
5-7 ml (size of fist)
When should PO feedings be started in the healthy
full-term newborn?
As soon as possible after birth for full term PO
feedings
How often should a full-term healthy newborn bebreastfed? What if formula-fed?
Breast fed 8-12 x qd every 2-3 hoursFormula fed 8-12 x qd every 2-3 hours
What is the average amount consumed in
mL/feeding for a full-term healthy newborn?
90-150 ml by end of 2nd week at every feeding.
What is the average time it takes for the healthy
newborn to breastfeed effectively? bottle-feed?
Breast fed avg. time 5 to 10 minutes per breast
Bottle fed avg. time 20-40 minutes
How many kcal/kg/day does a healthy full-term
newborn need?
120 Kcal/kg/day
W
hat is the average amount of kcal/oz inbreastmilk and standard formula? Breast milk 20 kcal/ozFormula 24 Kcal/oz
Using your babys current weight, calculate how
many kcal/d he/she needs.
Based on your babys formula or breastmilk,
calculate how many ounces per feeding your baby
needs.
EXPERIENCEEVALUATION YOUR COMMENTS
Describe any significant findings or needs of the
infant you cared for in the nursery.
What did you learn from your nursery experience?
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