This slide contain detail description of basic terminologies, neonatal (head to toe examination) assessment, neonatal reflexes, minor physiological handicaps of newborn

1. NEWBORN
ASSESSMENT/EXAMINATION
AMRITA A.S
ASSISTANT PROFESSOR

2. NEWBORN EXAMINATION
• DEFINITION: it is systematic examination
(physical and neurological) of newborn.
• OBJECTIVES
1. To provide an assessment of infant’s state
of development of wellbeing.
2. To detect any deviation from normal.
3. To assess the progress of the child.

3. INDICATIONS
• First examination: a detailed one in labor
room within 2 hours of birth.
• Second examination; Before discharge.
• Third examination: After 6-8 weeks of
neonatal life.

4. TERMONOLOGIES
• Small for gestational age (SGA)is less
than 10% for weight at the time of birth
• Large for gestational age (LGA) is more
than 90% for weight at the time of birth
• Appropriate for gestational age( AGA)
is the birth weight between 10-90%

5. • FULL TERM: 37 to 42 weeks or 259 to
294 days.
• PRE-TERM: after 28 weeks and before 37
weeks.
• POST- TERM: after 42 weeks.

6. ARTICLES REQUIRED
TPR Tray
A tray containing:
1. Hand washing articles
2. Apron
3. Stethoscope
4. Inch tape
5. Torch
6. Bowl containing cotton wisp
7. Weighing machine
8. Bowl with extra cotton
9. Mackintosh
10. Kidney tray
11. Paper bag

7. INITIAL ASSESSMENT OF
NEWBORN
1. IDENTIFICATION
Check and identify the sex of the
infant and verify the records with the
correct name, sex and registration
number.
2. GESTATIONAL AGE
FULL TERM/ PRE-TERM/ POST-
TERM

9. VITAL SIGNS
Check the vital signs in the following
order:
a) RESPIRATION: normal value of
respiration is 40-60 breaths/min.
b) HEART RATE: normal value of heart
rate is 120-140 beats/min.
c) TEMPERATURE: normal value of
temperature is 36.5-37.5 degree
Celsius.

10. PHYSICAL EXAMINATION
LENGTH: Crown to heel
length with infant
supine/ upside down/
with the knees slightly
pressed down to
obtain maximum leg
extension. (47-50 cm)
HEAD CIRCUMFERENCE: It
is measured with a tape
measure drawn across
the center of the forehead
and the most prominent
portion of the posterior
head. ( 33-35 cm )

11. CHEST
CIRCUMFERENCE: It
is measured at the
level of nipples and is
about 2 cm less than
head circumference.
30-33 cm
WEIGHT: Average birth
weight 2.5 -3.5 kg

12. . POSTURE AND MOVEMENTS:
# Supine position with partial flexion of arms, legs
and hand commonly turned a little to one side.
Hip joints are partially abducted.
# Movement is most evident in face and limbs.
Unusual movement or lack of movements and
asymmetry should be noted and reported.

14. 2.SKIN
a) Colour:
# Most term newborns have a ruddy complexion
because of the increased concentration of red blood cells
in the blood vessels and a decrease in the amount of
subcutaneous fat. This ruddiness fades slightly over the
1st month.
.

15. # Peripheral cyanosis appear due to
immature peripheral circulation. This is a
normal phenomenon in the first 24 to 48
hour after birth.
# Central cyanosis indicates decreased
oxygenation. It may be the result of
temporary respiratory obstruction or an
underlying disease
Cyanosis:

17. b) VERNIX CASEOSA: It is a white,
cream cheese-like substance that
serves as a lubricant, is secreted by
the fetal sebaceous glands and which
disappear within a few days.

18. c) LANUGO: is the fine, downy hair that covers a
newborn’s shoulder, back and upper arms. It
may be found also on the forehead and ears.
# Pre-term newborns has more lanugo then
post-term.

19. DESQUAMTION: Peeling of the skin takes
place few days after birth and most
marked on the hands and feet.

20. e) MILIA: Newborn sebaceous glands are
immature, therefore pinpoint white papule
can be found on the cheek or across the
bridge of the nose of newborn. It disappear
by 2 to 4 weeks.

21. f) Erythema toxicum: It begin as a
papule, increasing in severity to
become erythema by the 2nd day
and then disappearing by the 3rd
day.

22. Forceps mark: If forceps were used for birth, there may be
circular or linear contusion matching the rim of the blade of
the forceps on the infant’s cheek. This marks disappear in 1
to 2 days along with he edema that accompanies it.

23. • Skin turgor: If a fold of skin is grasped
between the thumb and fingers, it should
feel elastic. When it is released it should
fall back to form a smooth surface. If
severe dehydration is present, the skin will
not smooth out again and will remain in an
elevated ridge.

24. i) Mongolian spots:
• Slate-gray to blue-
black lesions Usually
over lumbo sacral
area and buttocks
Accumulation of
melanocytes within
the dermis. Generally
fade by age 7 years

25. 3. HEAD
a) A newborn’s head appears
disproportionately large because it is
one fourth of the total length.
b) Fontanelles: The anterior fontanelle
will be felt as a soft spot. The
posterior fontanelle is so small that it
cannot be palpated readily.

28. • Sutures: Suture lines should never appear
widely separated in newborns. Separation
denotes increased intracranial pressure
from either abnormal brain formation,
abnormal accumulation of CSF in the
cranium (hydrocephalus), or an
accumulation of blood from a birth injury .
Fused suture lines also are abnormal and
need to be confirmed with X-ray and
further evaluation.

29. CAPUT SUCCEDANEUM
Swelling or edema of
the presenting
portion of scalp.
Goes away few days

30. Caput Succedaneum

31. CEPHALHEMATOMA
Bleeding between the skull and periosteum of newborn
baby . Secondary to suture of blood vessel crossing the
periosteum. It does not crosses the suture line. Disappears
by weeks and months

32. 4. EYES: Newborn’s usually crt
tearlessely because of the lacrimal
ducts are not fully mature until about
3 months of age.
# Eyes should appear clear without any
redness or purulent discharge.
# we should observe for subconjuctival
hemorrhage, opthalmia neonatorum
etc.

33. EARS: The level of the top part of the external ear
should be on a line drawn from the inner
canthus to the outer canthus of the eye and back
across the side of head.
# Ear Cartilage: Pinna firm, cartilage felt along with
the edge.
# Ear Recoil: Instant recoil.

34. 6.MOUTH:
# Mouth should be observed for cleft lip,
cleft palate and tongue tie. The palate of
newborn should be intact. Occasionally,
one or two small round, glistening, well-
circumscribed cysts (EPSTEIN
PEARLS) are present on the palate, a
result of the extra load of calcium that
was deposited in utero.

36. Sometimes in some newborns one or two
natal teeth may have erupted.
NECK: The neck of newborn is short, often
chubby and creased with skin fold. Head
should rotate freely on it.

37. 8. CHEST: It looks small because the infant’s
head is large in proportion.
# Possible breast engorgement with possible
secretion of thin’ watery fluid popularly
termed witch’s milk..
# Absence of retraction.

38. 9. ABDOMEN:
# Bowel sounds present
within an hour after
birth.
# Edge of the liver
usually palpable at 1 to
2 cm below the right
costal margin.
Edge of the spleen
usually palpable at 1 to
2 cm below the left
costal margin.

39. UMBLICAL CORD
• It has 2 arteries and 1
veins
• At birth cord appears
bluish white and moist
• After clamping , it begin
dry and appears a dull
yellowish brown and
sheds after 6-10 days

40. If presence of 1 artery then
it is associated with
V- Vertebral
A- anorectal
C- cardiac
TE- tracheoesophageal
R- renal
L- limbic
ABNORMALITIES

41. 10.BACK:The spine of newborn typically
appears flat in the lumbar and sacral areas.
The base of the spine should be free of any
pinpoint openings, dimpling, or sinus tracts
in the skin, which would suggest a dermal
sinus or SPINA BIFIDA or occulta, Lumbar
hair tuft & haemangioma

42. 11. ANOGENITAL AREA
# The anus of newborn must be inspected
to be certain that is present, patent, and
not covered by a membrane (imperforate
anus). Male Genitalia: Scrotum is
pendulous and both the testes are present
in the scrotum. Males with one or both
undescended testicles (cryptorchidism)
needs further evaluation.

43. # Female Genitalia: in female newborns
labia majora fully covers labia minora.
Some newborns have a mucous vaginal
secretion, which is sometimes blood
tinged, called pseudomenstruation. This
discharge disappears as soon as the
infant’s system has cleared the hormones.

44. . EXTREMITIES:
We should observe for
syndactyly or
polydactyly.

45. SIMIAN CREASE
Unusual curvature of the little finger and a simian crease (a
single palmar crease) are signs of Down syndrome.

46. SOLES
• A full term newborn have
creases covering the
entire sole of the foot
• Post –mature infants
have deep crease over
the foot
• A premature infant sole
crease mat partially
cover the upper two-third
or may be absent

47. MECONIUM
MECONIUM
It is the first fecal material ,
is a sticky , odorless
material, greenish black
to brownish green which
is passed from 8-24
hours after birth
URINE
The first urine is diluted
because of immaturity of
the kidneys and lack of
ability to concentrate
urine.

48. NEONATAL REFLEXES
• Also known as developmental, primary, or
primitive reflexes.
• They can provide information about lower
motor neurons and muscle tone.
• They are often protective and disappear
as higher level motor functions emerge

49. BLINKING OR CORNEAL
REFLEX
• Infant blinks at sudden
appearance of a bright
light or at approach of an
object towards cornea.
• It persists throughout life.
PUPILLARY REFLX
• Pupil constricts when
a bright light shines
toward it.
• It persists throughout
life

50. DOLL’S EYE REFLEX
• As head is moved
slowly to right or left ,
eyes lag behind and
do not immediately
adjust to a new
position of head
• Disappears as fixation
develops.
• If persists, indicate
neurologic damage.

51. SNEEZING REFLEX
Spontaneous response of
nasal passages to
irritation or obstruction
Persists throughout life.
GLABELLAR REFLEX
• Tapping briskly on
glabella (bridge of nose)
causes eyes to close
tightly. Disappers as brain
matures

52. SUCKING
REFLEX
Disappears: around 12 months.
Elicited by the examiner stroking the lips of
the infant; the infant’s mouth opens and
the examiner introduces their gloved finger
and sucking starts.

53. ROOTING REFLEX
Disappears: 3-4 months
Elicited by the examiner stroking the cheek or
corner of the infant’s mouth. The infant’s head
turns toward the stimulus and opens its mouth.

54. GAG REFLEX
• Stimulation of posterior pharynx by food,
suction or passage of a tube causes infant
to gag
• Persists throughout life.

55. EXTRUSION REFLEX
• When tongue is touched or depressed ,
infant responds by forcing it outwards.
• Disappears by age 4 months.

56. YAWN
Spontaneous
response to
decreased oxygen by
increasing amount of
inspired air

57. PALMER GRASP REFLEX
• Disappears: 2 months
• Elicited by the examiner placing his finger on the
palmar surface of the infant’s hand and the infant’s
hand grasps the finger.

58. TONIC NECK (FENCING POSTURE)
• Disappearance:7 months
• Elicited by rotating the infants head from
midline to one side. The infant should respond
by extending the arm on the side to which the
head is turned and flexing the opposite arm.
The lower extremities respond similarly.

59. MORO’S REFLEX
• Onset: 28-32 weeks GA
• Well-established: 37 weeks GA
• Disappearance: 6 months
• The examiner holds the infant so that one hand
supports the head and the other supports the
buttocks. The reflex is elicited by the sudden
dropping of the head in her hand. The response
is a series of movements: the infant’s hands
open and there is extension and abduction of
the upper extremities. This is followed by
anterior flexion of the upper extremities and
audible cry.

60. • MORO’S REFLEX

61. MORO’s SIGNIFICANCE
• An absent or inadequate Moro response
on one side : hemiplegia, brachial plexus
palsy, or a fractured clavicle
• Persistence beyond 5 months of age is :
indicate severe neurological defects
STARTLE REFLEX

62. STEPPING(DANCING) REFLEX
• Disappearance: 3-4 months
• Elicited by touching the top of
the infant’s foot to the edge of
a table while the infant is held
upright. The infant makes
movements that resemble
stepping.

63. BABINSKI REFLEX
• Disappearance: 12 months
• Elicited by stimulus applied to the outer
edge of the sole of the foot.
The infant responds by plantar
flexion and either flexion or
extension of the toes

64. CRAWLING REFLEX
• When placed on abdomen, infant makes
crawling movements with arms and legs
• Disappears at about age 6 weeks.

65. HARLEQUIN COLOR CHANGE
• Color changes as the
infant lies on the side,
lower half of the body
becomes pink or red,
and upper half is pale
• It is entirely harmless
and never been
associated with
permanent problem

66. TORTICOLLIS (WRY NECK)
• Head held to one side
with chin pointing to
opposite side due to
positioning in the womb
Exercise the neck gently
in opposite direction

67. FOOD FOR THE BRAIN

68. THANK YOU