Initial Assessment of the Neonate

8/13/2019 Initial Assessment of the Neonate

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INITIAL ASSESSMENT OF THENEWBORN

Presented

ByBarbara D. Mlewah


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OBJECTIVES

1. To outline the techniques used inexamination of the newborn.

2. To outline the principles of newbornexamination.3. To describe the procedure of initial

assessment of the newborn.

4. To describe the characteristics of anormal newborn.


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TECHNIQUES USED

Observation/inspection (very importanttechnique)

Auscultation Palpation Percussion


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PRINCIPLES OF NEWBORNEXAMINATION

Necessary tools should be ready at hand;stethoscope, ophthalmoscope, tape measure,thermometer and watch

Create a conducive environment; clean, safe,flat surface, warm and out of draughts, well lit

Review records:

-antenatally; medical history that can be passed onto the baby, weight gain, obstetric complicationsduring pregnancy any STIs


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-labor; duration of first & second stages oflabor, time of rapture of membranes,

number of vaginal examination,medications received in labor, anyobstetric complications, mode of delivery,

fetal condition during labor, Apgar score Wash hands before touching the baby


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Calm the baby before beginning theexamination

Keep baby warm during the examination Handle the neonate gently Examination should be systematic

Complete the examination


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PROCEDURE FOR INITIALEXAMINATION

When examining the newborn start withinspection of the general condition, if

satisfactory continue with specific examinationas follows:

-check V/S starting with temperature

-temperature should be within the normal range

36 to 37.2 degrees Celsius, if not stop the wholeexamination- keep baby warm


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PROCEDUREArea examined Expected

characteristicof a termneonate

Abnormal

findings

Posture:

inspection

Head turned to 1

side, arms & legsflexed (supine orprone)

Extended limbs

or flog position-preterm, sick,nerve injury,fracture

Appearance No apparentinjury/abnormality

An apparentinjury orabnormality


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Well being:

inspection

Active, alert, normalmuscle tone

Lethargic & sick,twitches, fits &coma

color:

inspection

Face, chest, tongue & lipsare pink. Hand and feetmay be bluish

Cyanosis, pallor,jaundice, dark red,grey, meconeumstaining

Temperature(axilla)

36 to 37.2 degrees Celsius Less than 36 ormore than 37.2

Respirations: inspection&

auscultation

30-60 b/min (not crying)regular & quite, no chestin-drawings, no nasal

flaring, chest and abdomenmove with each breath

More than 60b/min,gasping, apnea withlow heart rate or

cyanosis, grunting,stridor, wheezes

Heart rate:auscultation

100-160b/min, shortperiods of change in heart

rate are normal (crying)

More than 160/lessthan 100

(persistent)


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Skin & scalp:

Inspect &palpate

Color: as above

State: soft & smooth,white bumps on the

face (milia), Vernixcaseosa and lanugo onthe face, slight bruises,birth marks, Mongolian

spots

Color as above

State: dry, peeling,very red, very thick

or thin. Little orexcessive vernix orlanugo, swelling

Measurements

Head circumference:33-37cm occipitalfrontal

Length: crown heel 48-54cm, average 51cm

Less than 33cm-microcephally, SGA,preterm.

More than 37cmLGA, hydrocephaly

Weight: after 1hour of birth

2500 to 3800gm.Newborns loose 5-10%

of bwt, but shouldth

Less than 2500-SGA,preterm more than

3800gm- LGA


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Head: shape

Inspect andpalpate

Elongated oruneven due tocaput and

moulding

Abnormal shape inanencephaly orhydrocephaly

Excessive caput &moulding, cephalo-hematoma due tovacuum extraction

Head: skull bones,sutures andfontanels

Inspect and

palpate

Bones: slightlymovable atsutures

Sutures: slightly

open or justoverriding

Fontanelles: open,soft and flat

Bones: very soft orhard & immobile

sutures: very wide,excessive

overriding, fusedFontanelles: verywide or not palpable


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Head: scalp &hair

inspect

Scalp: intact, slightswelling (caput)

Hair: good scalp

growth

Scalp: bruising andswellings, abrasionsand cuts

Hair: fine, downy forpreterm, low blackhair line (turnersyndrome)

Face: inspection Normal appearance Slight or grossanomalies, bruising,facial palsy

Eyes: inspection,

examine withlight orophthalmoscope

Normal size and

shape, correctplacement,symmetrical. Nodischarges & not

sticky 1.5cm- 2.5cm

Agenesis (one or

both), asymmetrical,eyelid edema,bruising, tears,discharge, ptosis


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Eyeballs: corneacorrect size, clear,bright and shiny. Nolesions or marks

Sclera: white

Eyeballs: corneasmall (rubella),large (glaucoma),sub-conjunctivableeding

Sclera: blue

(brittle bones)yellow

Pupils: react evenly tolight

Conjunctival sacs:

pink

Pupils: irregular,cataracts,abnormal eyemovements

Conjunctival

sacs: pale


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Nose:inspection

Midline, flattish, broad, lowbridge, wide & patentnostrils. Air from nostrils

heard & felt duringbreathing

Squashed, no bridge(syphyillis) blocked,mucus ++ (choanal

atresia) purulent orbloody secretions,cleft

Lips:

inspection

Pink, normal size and

shape

Blue, bruised

Cleft lip

palate:inspection

Both soft and hard Clefts, high arch,congenital defects

Gums:

inspection

Pink, symmetrical, horse

shoe shape, smallretention cysts

Cyanosed,

asymmetrical due toclefts, jaundice,teeth, sweeling,bleeding


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Mucusmembranes:inspection

Pink, moist and shiny Cyanosed, yellow,pale

Saliva: inspection Normal: drooling Excessive bubbles

Ears: inspection Upper ear in linewith outer corner ofthe eye. Pinna

vertical, ears wellformed, symmetrical

Low set ears (downssyndrome)

Poorly formed

Neck: inspect &palpate

Short, thick with skinfolds. Head in

midline, no masses,some head control,side to sidemovement,

extension and flexion

Webbing, extended,goiter, no head

control, restrictedmovement, fracturedclavicle, swelling


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Chest: inspect Barrel, prominent end ofximphsternum,symmetrical movements

with respirations

Funnel or bulgingchest, rib recessionin respiratory

distressBreast:inspect andpalpate

Palpable breast nodules0.51 cm diameter

Enlarged and lactating

witches milk

Mastitis, smallnodules poorlydeveloped nipples

Mal-positionednipples

Theabdomen:

shape &movement

Inspect &auscultate

Rounded, bowel soundpresent 1hr after birth,

moves with respirations

Distended or hollow,no bowel sounds or

bowel sounds heardin the chest withproblems


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Umbilicus: inspect 2 arteries, 1vein,grayish white,drying around

base, no bleeding

1 artery, 1 vein,redness, soggy,smelly, bleeding,

hernia, meconeumstaining

Abdominal organs:palpate

Liver palpable 2cmbelow right costal

margin, softSpleen: tippalpable in thininfants

kidneys: lowerborder palpableback flank in thininfants only

Liver: enlarged, firm,tender

Spleen: enlarged,firm

Kidneys: enlarged,firm, malformation,

absent


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Female genitalia Clitoris & labiaoften edematous.Labia majora well

developed, vaginaorifice present,white discharge,mucoidal blood

tinged discharge(up to 7 days)hymenal tags seen

Clitoris enlarged,labia fusion,absence of vaginal

orifice orimperforatedhymen

Male genitalia Scrotum welldeveloped, testespalpable in a sac

Penis: urethralopening at centreof glans

Undescendedtestes, inguinalhernia

Penis: micro-penis


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Anus: inspection Correct positionand patent,meconeum passed

Imperforated anusor displacedanteriorly, no

stools, blood instools

Arms and hands:inspect and

palpate

Arms: full range ofmovement,

brachial pulsepalpable 80-150b/min in 1st24hours, equal andstrong

Hands wellformed, all digitspresent , palmercreases well

developed

Arms extendedwith no movement

(Erb-Duchenneparalysis)

Fractured clavicle


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Lower extremities:inspection,palpation- Ortolan or

Barlow test fordislocated hip

Hips & legs: semi-flexed, full rangeof motion

includingabduction, longbones normal size,femoral pulses

felt. Welldeveloped plantercreases

Legs extended(fractured),dislocated, abduction

limited, reducedfemoral pulses, extraabnormal digits,clubfoot or talipes

Back and spine:inspect

Spine: straight,easily flexed

limited movement,neural tube defect,spina bifida


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NEUROLOGICAL ASSESSMENT


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A. MORO REFLEX

1. Grasp thebaby's hands,

extend thearms andreleasesuddenly

-gives a startledresponse. Arms

fling out inembracingmovement, fingersfan out

symmetrically

-asymmetricalbody response

(fractured clavicle,injury to brachialplexus)

2. Lift the baby'shead off thelying surface

in the palm ofthe hand, thenallow head tofall back in thepalm about

2cm

-Legs may extend,eyes wide open

Slow return of

limbs to the flexedposition. Presentup to 8 months

-weak incompleteor absent- grossimmaturity


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B. GRASP REFLEX

1. Palmer: placethe tip of your

finger in thebaby's hand

Baby will firmlygrasp tip of the

finger

2. Plantar: placefinger at baseof baby's toes

Toes curldownward

Present from birthto 8 months


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C. WALKING REFLEX

Hold baby aroundupper thorax, under

arms, in a standingposition with the feeton a flat surface

-baby simulateswalking by lifting

and placing onefoot in front of theother

-asymmetry ofwalking

(neurologicalabnormality)


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D. ROOTING ANDSUCKLING REFLEX

Touch baby's

cheek, corner ofmouth or lip withnipple or finger.Must be done

before breastfeeds

-baby turns headtowards stimulusseeking nipple.Opens mouth,accepts nipple and

sucks strongly-Both present frombirth, rooting goesafter 6 months

-preterm infantswill not root

-weak suck-preterm, sedation


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E. SWALLOWINGREFLEX

Offer a breast -sucklingcoordinated withswallowingwithout gaggling,coughing or

vomiting

-weak suck atpreterm, sedation,jaundice, infection,breathingproblems, cerebral

injury, mentalretardation, cleftlip/palate


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THE END

Documents

Initial Assessment of the Neonate