




NEWBORN ASSESSMENT
 AND

 ESSENTIAL NEWBORN CARE


 NEW BORN
ASSESSMENT
 Purpose Of Assessment Of
Newborn (Indications)


 For any gross anomalies as well

as evidence of shock or birth
trauma


Give parents a chance to ask

any question about their baby
 Detect congenital anomalies, which
may not be obvious at birth eg.
Cataract, cleft palate, heart
mummer, undescended testis.

Categorize the baby in the birth
weight gestational age groups

Identify any problems anticipated as a
result of maternal disease or familial
disorders e.g.: congenital infection,
maternal diabetes mellitus



SCIENTIFIC PRINICPLES
 Provision should be made to
prevent neonatal heat loss during
physical assessment.

A rapid overall assessment of the
baby will be done at the time of
birth, with a more detailed
assessment completed on later.

 Where possible , the parents
should be present during the
Sign Score = 0 Score = 1 Score = 2

Heart rate Absent Below 100 per Above 100 per

minute minute
Respiratory Absent Weak, irregular, Good crying
eXAMAINTION AT BIRTH / INITIAL
effort or gasping

Muscle ASSESSMENT
tone Flaccid apgar
- Some flexion of score
Well flexed, or
arms and legs Actively moving
the extremities

Reflex No response Grimace or weak Good Cry, coughs

stimulation cry or sneezes

Color Blue all over, or Body pink, Pink all over

pale extremities blue
7-10 -no difficulty in adjustment to
life
4-6 -moderate difficulty
3 or below - severe distress
HEAD TO FOOT ASSESSMENT OF NEW
BORN


 Anthropometric Measurements
 Birth weight : 2.5 – 3.5 kg
 Length : 50cm
 Head circumference :- 33-35cm
 Chest circumference : - 30-33cm



 VITAL SIGNS
• Temperature: 36.50 - 370 C
• Pulse : 110 -160 beats/minute (apical)
• Respiration: 35-60 breaths/minute
• B.P -46/20 for 800g neonate &
• 70/30 – for 300g infant


 POSTURE
•universal flexion

 SKIN ( EXAMINE UNDER NATURAL LIGHT)
 Colour
§ Red (plethora)
Blue (cyanosis)
 Hands and feet only
 Lips and mucous membranes


§ Pale (anemia)

§ Gray

§ Yellow (Jaundice) Do blanching test over
forehead, bridge of nose, sternum, palm and
soles.

 PIGMENTATION
 MILIA:
 Tiny sebaceous retention cyst,
whitish pin head sized

concretions seen usually on

forehead, nose, chin & cheeks.

 ERYTHEMA TOXICUM
Small areas of skin with yellowish white
papula in the center. Appearing 1-2 days
after birth and disappear several days
later.

 LANUGO : Slight, downy distribution
of fine hair over the body, most evident on
shoulders, back, extremities, forehead and

temples. It begins to appear on 16th week

and disappear after 32nd week.

•
VERNIX CASEOSA:

 Cheese like greasy, yellowish,

white substances, over folds of

the skin and between the labia.

•
• Tissue turgor:
• Desquamation:
• Telengiectatisnevi (strok
bites)
• Delivery marks

 HEAD
• Shape of the head
• Anterior and posterior fontanelle:
• Moulding
• Caput succedaneum
• Cephalhematoma
• Raised ICP

 Face
 Abnormal faces : Mongoloid
faces
 Cry: loud and lusty
 Asymmetric crying facies
 Eyes
 Hypertelorism
 Conjunctivitis
 Subconjunctival hemorrhage
 Ears: low set
• Nose: flaring, patency
• Mouth
 Cleft lip/ palate
 Excess frothing at mouth
 Epsteins’s pearl
 Pre- decidous teeth
 Short lingual frenulum
• Neck
 Palpate sternomastoid
 Short neck, webbed neck

• Chest

Symmetry of chest expansion
 Tachypnoea
 Sternal or intercostal retraction
 Grunting on expiration
 Feel for clavicle
 Witch’s milk
 Breast enlargement (2mm)

• Abdomen
 Shape
 Umbilical cord
 Hepatomegaly
 Spleenomegaly
• Genitalia & Anus
 Male babies
 Undescended testes
 Hypospadias
  Epispadias
 Hydrocele

• Femalebabies
 Grayish white mucoid vaginal discharge
 Pseudo menstruation
• Extremities
 Syndactyly, Polydactly
 TEV
 Digital and palmar crease
• Trunk and Spine
 Spina bifida
 Meningocele

ESSENTIAL NEWBORN
CARE
 PRINCIPLES OF CARE AT BIRTH
 After separation from mother baby
must
 Establish independent respiration
 Establish adult circulation
 Establish normal temperature
 Establish early nutrition
 Receive protection from infection &
injury
 Be diagnosed early for life threatening
conditions & malformations


CARE IMMEDIATELY AFTER
BIRTH
• When head is delivered suctioning of mouth &
nose respectively.
• After complete delivery clamp & cut the cord.
• Dry & cover with pre-warmed clothes.
• Place under a radiant warmer or mother’s
abdomen.
• Clamp cord 2-3cm beyond base.
• Quickly do the Apgar scoring & general
physical examination.

• Identify life threatening anomalies/ birth
injuries( single umbilical artery, single
palmar crease, facial asymmetry,
dextraposed heart, resuscitative problems
etc)
• Check location & patency of all orifices.
• Injection Vitamin K 0.5-1mg IM to be given.
• Apply identification tag.
• Initiate breast feeding
• Encourage initial mother child interaction.
• Transfer to nursery- inform in advance.

• Maintenance of body temperature
• Optimum nutrition: breast feeding
• Skin care
• Care of umbilical stump
• Care of eyes
• Weight record
• Detection of Danger Signs
• Supplements
• Vitamin K -1.0 mg IM at birth; vitamin
D at 3-4 months –rickets
•
 Immunization
Age Vaccine Optional

0-7 days BCG, OPV, Hepatitis B

6 weeks DPT, OPV, Hepatitis B Hib

10 weeks DPT, OPV, Hepatitis B Hib
14 weeks DPT, OPV, Hepatitis B Hib

9 months Measles
15-18 months MMR

18-24 months DPT, OPV booster Hib booster

4-5 years DPT, OPV

10 years TT

Page 23
REFERENCE :


 Kulkarni M . L . Manual of Neonatology . 1 st edition .

New Delhi : Jaypee Brothers ; 2000 .
 Arvind R . Applied Neonatology , New Delhi , Jaypee
Publications ; 2006 .
 Marlow D R , Redding B A . Text Book of Pediatric
Nursing . 1 st edition . Singapore : Hoarcocert
Brace & company Asia Pvt Ltd ; 2005
 Wong DL , Eatan M H . Essentials of Pediatrics
nursing , 7 th Edition , Missouri , Mosby
Publications , 2005
 Desai VJ , Avalokitha B . Achar ’ stext book of
Pediatrics , 3 rd edition , Madras , Orient Logmon
Limited ; 1991
 Parthasarathy A , Menon PSN , Nair MKC . IAP text
book of pediatrics . 2 nd edition . New Delhi :
Jaypee publishers ; 2000
 http :// www . lpch . org / DiseaseHealthInfo / HealthLibrar
y / hrnewborn / assess . html
 http :// health . howstuffworks . com / the - newborn - after -