CIC1.4Newborn Evaluation

7/25/2019 CIC1.4Newborn Evaluation

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N EW BO RN EVALUATIO N



The APGAR SCORING SYSTEM

Dr. Virginia Apgar

Special Consideration

1. 1st 1 minute → determines general conferral

condition of the baby2. Next 5 Minute → determines the capability of the

baby to adjust extrauterinely most important!

". Next 15 minutes → optional → depndent on the

5 minutes apgar score#. A heart rate belo$ 1%% signi&es asphyxiated

baby and a heart rate abo'e 1(% signi&esD)*+,-**



Factors that affect the APGAR score are:

1. Degree of physiologic maturity.

2. etal cardiorespiratory and

neurologic conditions.". Maternal perinatal theraphy such

use of analgesia during labor.



Rule!

1. +he best $ay to assess the heart rate is byauscultation $ith stethoscope for one full minute.

2. ,espiration is assessed by counting respiratorymo'ement and by listening to the infant cry.

". Muscle tone is assessed by obser'ing the resistanceof the ne$born to e/orts to extend the extremities.

#. ,e0ex irritability can be e'aluated by using suctioncatheter in the nostril or by tangential foot slap

5. olor of the ne$born at birth is often cyanotic $ithpinish coloring being attained after the &rst breath.



A ppearance Color upon birth is slightly cyanotic

After first cry baby will be pink

P ulse Rate Take apical pulse at the lower left nipple

G rimace Determines reflex irritability using

tangential foot slap and catheter insertion

A ctivity To determine the degree of muscle tone

R espiration

Ne$borns $ill cry $ithin "% seconds upon expulsionASPHYXIA NEONATORUM → failure to cry $ithin "% seconds becausemother recei'ed Demerol

NA,AN → antidote of Demerol



Score

Criteria 0 1 2

Heart Rate Absent < 1 ! 1

Respiratory

Effort

Absent "low RR# $eak %ood strong cry

Muscle Tone &laccid'xtremities "ome reflexes $ell &lexed

Reflex

Irritability

Cateter Tan!ential

"S

(o Response

(o Response

%rimace

%rimace

Cough or snee)e

Cry

Color *lue # +ale Acrocyanosis +ink



Score Interpretation

Normal3 41% good adjustment6'igorous7 N8 )N+-,V-N+)8N isre9uired

)ntermediate3#( moderatelydepressed infant7 ne$born conditionid guarded and may need air$ay

clearance and supplementaryoxygenation.

:o$3 %" se'erely depressed infant7

ne$born is serious danger and is in



Cario Pul onar"#Resuscitation

ardio pulmonary resuscitation or;, other name

ardio pulmonary cerebralresuscitation ;,!

<asic :ife *upport <:* !



Air$ay lear Air$ay!

5 minutes =no> 8xygen ?

irre'ersible brain damage1. *hae6 no respiration6 call for help

2. lat on head

". @ead tilt chin lift maneu'erexcept spinal cord injuryB o'erextension may occlude air$ay



<reathing 'entilating the lungs !

#. hec for breathlessness

5. )f breathless6 gi'eCadminister 2breaths ambu bag ? use one mas

infant ? mouth and nose

E 1 year old mouth to mouth6

pinch noseF 1 year ? mouth to nose

force ? di/erent bet$een baby G child

infant ? pu/





Sil$er an An Anerson

Scorin% S"ste +his test is used to e'aluate the

respiratory status or breathingperformance of premature infantsand of $ith respiratory distress.



Score

Criteria 0 1 2

Cest #o$e#ent "ynchroni)ed ,ag on

inspiration

"ee-saw

Intercoastal

retraction

(o retraction .ust visible /arked

%ipoi& Retraction (o retraction .ust visible /arked

'ares &ilatation (o dilatation /inimal /arked

Expiratory Grunt (one 0eard by stet

only

0eard by ear

*core interpretation3*core of 8 indicates no respiratory distressA score bet$een #( means moderately depressed

A score of 41% means se'erely depressed



ASSESSM EN T O F GESTATIO N AL AGE (Ballard andDubow itz

Score

Criteria (ess )* +ee,s )- . )/ ee,s ) +ee,s an& up

Sole creases Anterior transverse

only

ccasional 2#3 "ole cover with

crease

reast no&ule

3&#4

2 mm 4 mm 53 6 7 cm8 9 mm 5!7cm8

Scalp Hair &ine and fu))y &ine and fu))y Course and silky

Ear (obe +liable "ome Thick

Testes an&

Scroto#

:n lower canal;

covered testes with

rugae

"ome intermediate Testes pendulous;

scrotum full;

extensive rugae



Si!n" o# $r%t%r& Babi%"

<orn after 2% $ees6 after "4 $ees

frog leg or laxed positon

hypotonic muscle tone prone torespiratory problem

scarf sign ? elbo$ passes midline

s9uare $indo$ $rist ? H% degrees

angle of $rist heel to ear sign

abundant lanugo



Signs of Post term aies!

E #2 $ees

classic sign ? old manIs face

des9uamation ? peeling of neonatesin

long brittle &nger nails $ide G alert eyes

Documents

CIC1.4Newborn Evaluation