Normal newborn - .2014-10-13  Normal newborn. objectives Quickly ... Newborn examination indications

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  • Normal newborn

  • objectives

    Quickly identify any danger signs

    Assess the normal adaptations of a

    newborn after birth

    Identify conditions requiring special care or

    follow-up observation.

    Identify any birth defect or birth trauma;

    Monitor growth

    Counsel the mother

  • TERMS:

    Neonatal Period:

    Birth --> 28 days of life

    Term Infant:

    38 - 42 weeks of gestation

    Transition Period: Phases of instability

    during the first 6-8 hours after birth

    (?????)

  • Gestational Age & Birth Weights

    Gestational Age: Pre-term: < 37 weeks

    Term: 37-41 6/7 weeks

    Post-term: 42 or more weeks

    Term Infant (weight classification) LGA: >4000 g

    AGA: 2500-3999 g

    SGA:

  • Gestational

    Age

    Classification

    Pre-term, term, and

    post term infants

    must all be plotted to

    determine if they are

    SGA, AGA, and LGA

    with regards to

    weight, length, and

    head circumference.

    LGA

    AGA

    SGA

    X X X

  • danger signs for newborn

    not feeding well

    Fast breathing, difficult breathing with severe

    chest in drawing ,grunting ,cyanosis

    Convulsions

    hypothermia, fever

    Reduced movement, and jaundice appearing

    anywhere on the first day or palmer or sole

    jaundice at any age

  • Newborn examination indications

    Immediately after birth

    Before discharge from maternity unit

    Whenever there is any concern about the

    infant's progress

  • Examination precaution

    Hand washing,hand washing ,hand

    washing

    Thermal environment

    Light and noise

    Brief examination time

  • General examination

    Attention : at initial ex

    Congenital anomalies

    Infant has successful transition from fetal

    life to air breathing

    Gestational age ,delivery medication

    Any sign of infection or metabolic disease

  • APGAR Score

    Score 0 1 2

    Heart Rate Absent 100bpm

    Respiratory effort Absent, irregular Slow, crying Good

    Muscle tone(activity) Limp Some flexion of

    extremities

    Active motion

    Reflex irritability (nose

    suction)

    No response Grimace Cough or sneeze

    Color Blue, pale Acrocyanosis Completely pink

    Newborn first exam

  • Postnatal assessment of gestational

    age

    New Ballard Score

    Accuracy within 1-2 weeks

    2 parts Neurologic characteristic

    Physical characteristic

    Part of general examination

  • General(Growth parameters)

    Weight (Naked) N:( 2.5-4 kg) full term

    ,loss of weight is expected by 5-10% in the

    first few days

    Length(straight) N:(48-53cm ) full term

    Head circumference(3 measurements)

    N:(33-38 cm) full term

  • Vital Sign

    Heart RateHR 120-160

    Respiratory Rate

    RR 40-60 periodic rather than regular

    Temperature skin: 36-36.5 C

    rectal :36.5-37.5 C

    Blood Pressure

  • General

    Well, Distress or not?

    skin

    Pink is normal

    Acro cyanosis is normal

    Cyanosis

    -- pallor

    Jaundice

    Common variants skin rash

    Erythema toxicum, mongolian spot

    Vigorous cry is assuring

    Weak cry

    sepsis, asphyxia, metabolic, narcotic use

    High pitch cry

    CNS causes, kernicterus

  • 16

    s

  • Erythema Toxicum Erythematous

    macules and firm 1-3

    mm yellow or white

    papules

    Etiology obscure

    Papule contain

    eosinophils and are

    sterile

    Appear in the first 3-

    4 days of life

    Range: Birth to 14

    days

    Benign and self

    limited

  • Mongolian Spots

    Slate-gray to blue-

    black lesions

    Usually over

    lumbosacral area and

    buttocks

    Accumulation of

    melanocytes within

    the dermis

    Generally fade by age

    1year

  • Head and Face

    Shape of the head

    Fontanels?

    Sutures?

    Eyes?

    Nose?

    Mouth,lips,palate?

    Ears?

    Neck?

  • 20

    Eye

  • Head Forceps and vacuum

    marks

    Caput succedaneum

    Boggy edema in presenting part of head

    Cross suture lines

    Disappear in few days

    Cephalhematoma

    Subperiosteal

    Weeks to resolve

    Dose not cross sutures

  • Newborn Scalp Hematomata

    http://upload.wikimedia.org/wikipedia/commons/0/0a/Scalp_hematomas.jpghttp://upload.wikimedia.org/wikipedia/commons/0/0a/Scalp_hematomas.jpg

  • Chest

    Distress signs(,Tachypnea,Nasal flaring,asymetric chest

    rise,supra-sternal, intercostal, sub costal retraction

    Grunting ).

    Deformities(Pectus excavatum, carinatum)

    Auscultate

    Air entry, symmetry

    crepitation

    Breast hypertrophy

    Milk production

    No redness

  • Heart

    HR 120-160 beats/min

    Color, perfusion, Central cyanosis

    Murmur

  • Abdomen

    Inspection Scaphoid

    Distention

    Abdominal wall defect (gastroschisis)

    Palpation; baby sucking and use warm hands Liver 2.5 cm

    Spleen may palpable

    Umbilical vessels 2 artery, one vein

    Hernias ; umbilical and inguinal

  • The umbilicus: Which one is

    normal? Normal vs. Abnormal

  • Genitalia

    Penile size

    Hypospadias, epispadias

    Testes 2% crypoorchid

    Hydrocele

    Female: Prominent clitoris and majora

    Vaginal skin tag

    Vaginal discharge /blood

    Labial fusion

    Anus : Patency and location

  • Hip and Extremities

    Erbs palsy: extended arm and internal rotation with limited

    movement

    Humorus fracture ,clavicle fracture

    Digital abnormality

    Syndactaly, brachdactaly, polydactaly

    Single palmar crease

    Hip dislocation

    Feet deformities

    Back and spine

    abnormal curvature

    Sinus tract, tuft of hair

  • Hip Exam

  • Neonatal reflexes

    Also known as developmental, primary,

    or primitive reflexes.

    They consist of autonomic behaviors

    that do not require higher level brain

    functioning. They can provide

    information about lower motor neurons

    and muscle tone.

    They are often protective and disappear

    as higher level motor functions emerge.

  • Newborn Reflexes

    Moro reflexwww.nlm.nih.gov

    Stepping reflexwww.imi.org.uk

  • Newborn Reflexes

    Palmar and plantar graspwww.winfssi.com

    Rooting reflexwww.winfssi.com

  • Moro

    Onset: 28-32 weeks GA

    Well-established: 37 weeks GA

    Disappearance: 4-6 months

    How to elicit and what is the response?

    An absent or inadequate Moro response on

    one side : hemiplegia, brachial plexus palsy,

    or a fractured clavicle

    Persistence beyond 6 months of age is :

    indicate severe neurological defects

  • Please contact me with any questions or

    concerns.

    studentmail2015@gmail.com