After birth, newborn babies are carefully checked for problems or complications.

Throughout the
hospital stay, physicians, nurses, and other care providers continually assess each infant for changes in
health and signs of illness. A baby born before 37 weeks of pregnancy is considered premature, that is,
born before complete maturity. Premature babies may not be fully developed at birth. Premature babies
may have more health problems than babies born later. These include problems with their brain, lungs,
heart, eyes and other organs and may need to stay in the hospital longer than the other babies.

Preparatory phase:
Organize the materials needed
Observe aseptic technique
Knowledge of the procedure
Always seek parental consent before examining their newborn
Applying standard precautions, and additional precautions as necessary, when delivering care
Ensure information is shared in a complete, unbiased and timely manner to ensure parents can
effectively participate in care and decision making

Ideally the physical exam should include:

-inspection
-palpation
-percussion
-auscultation
APGAR SCORE

One of the first assessments is a baby’s

Apgar score. At one minute and five
minutes after birth, infants are checked
for heart and respiratory rates, muscle
tone, reflexes, and color. This helps
identify babies that have difficulty
breathing or have other problems that
need further care.

APPEARANCE (skin color)

A premature baby's skin is red/pinkish and wrinkled and may appear almost transparent with tiny veins
visible below the skin's surface
(Pink, 2 points)

PULSE
The normal heart rate for a premature baby is between 120-160 beats per minute. 4 It is not uncommon
to see the baby's heart rate jump up to 200 when they are agitated, hungry, or upset.
(120/160, 2 points)

GRIMACE (reflex)
Premature babies in pain tend to display pain in their facial expressions, limb movements, cries, and
may show changes in their regular eating, moving and sleeping. Facial expressions are generally
regarded as the best single behavioral indicator of pain in all age groups. A grimace, eyes squeezed shut
and mouth stretched open with a tensed and curled tongue, are common expressions of pain.
(Minimal Response to stimulation, 1 point)

ACTIVITY (muscle tone)

Preemies often have very low muscle tone neonatal (e.g., they are "floppy") This means her muscles
are loose and floppy. It will often be hard for her to stay in a flexed position. Instead, she may end up
with a more “frog-like” posture. The abnormally increased muscle tone (the "tightness"
associated with spastic CP) is often not apparent until after the first few months at home. A premature
baby often has less muscle bulk and is usually “hypotonic”.
(Absent, 0 point)

RESPIRATION
Respiratory distress syndrome (RDS) is a common problem in premature babies. A condition in which
the air sacs cannot stay open due to lack of surfactant in the lungs. It happens when a baby's lungs are
not fully developed and cannot provide enough oxygen, causing breathing difficulties.
(Slow and irregular, 1 point)

Total of 6 points

An Apgar score of 7 to 10 is considered good. A baby who receives a score of 4 to 6 requires assistance,
and a baby with a score of 0 to 3 needs full resuscitation. Premature babies may receive lower Apgar
scores simply because they are somewhat immature and unable to respond with loud crying and because
their muscle tone is often poor.
BIRTH WEIGHT
Most hospitals use the metric system for weighing babies.
Prepare the scale: cover the pan with a clean cloth/autoclaved paper; ensure the scale reads zero
Preparing and weighing the baby
Remove all clothing
Wait till the baby stops moving
Weigh naked
Read and record
Return the baby to the mother
Scale maintenance
Calibrate daily
Clean the scale pan between each weighing
Newborns come in a range of healthy sizes. The average birth weight for babies is around 7.5 lb (3.5
kg), although between 5.5 lb (2.5 kg) and 10 lb (4.5 kg) is considered normal. In general: Boys are
usually a little heavier than girls.
4 pounds (1,800 grams)
Babies will usually gain this weight back within the first 2 weeks after birth. Premature and sick babies
may not begin to gain weight right away.

MEASUREMENTS
The hospital staff takes other measurements of each baby. These include:
Head circumference. (12.6inches/32cm) Distance around the baby's head.
Abdominal circumference. (9.4inches/24cm) Distance around the belly (abdomen).
Chest circumference. (20cm) Measured at the level of the nipple
Mid-arm circumference. (10cm) Measured around the middle of upper arm
Length. (16inches) Measurement from top of head to the heel.
The staff also checks these vital signs:
Temperature. (36 degrees celsius) This checks that the baby is able to have a stable body temperature
in a normal room environment.
Pulse Rate. A newborn’s pulse is normally. Faster rate than normal. (120 to 160 beats per minute.)
Respiratory rate. A newborn’s breathing rate is normally (40 to 60 breaths per minute.)
Blood pressure. (80/46) using Doppler.
PHYSICAL ASSESSMENT

General Appearance:
 Look very fragile. Skin: it might not be fully
developed, and may appear translucent, dry or
flaky.
 Fine, soft hair (lanugo) that may cover the
scalp, forehead, cheeks, shoulders, and back.
The hair should disappear within the first few
weeks of the baby's life
Growth Status
 small size
 tend to be shorter and lighter than full-term
Head, Face, neck
 have smaller heads at birth
 This baby might have fragile, translucent skin,
and his eyelids might still be fused shut.
 has a small amount of ear cartilage and/or a
flattened pinna
Shoulders, Arms, Hands
 proportion but smaller than normal
 arms grasp
Chest
 Respiratory distress
 Weak pulses
 Babies born before 34 weeks will probably not
have any nipples, although the areola (the
darker area of skin surrounding the nipple)
may be present.
Abdomen
 abdomen feels swollen and hard (Abdominal
Distention)
Genitourinary
 Urine passed within 24hrs
 Meconium passed within 24hrs
 Immature genitals/ Not yet fully developed
 In the female premature baby, there may be a
prominent clitoris
 In the male newborn, the testes might not be
fully descended at birth.
Hip, Legs, Feet
 has only an anterior crease on the sole of the
foot
 No hip dysplasia
Back
 No curvature spine
 Intact spine
Neurological
 Weak
 Slight responses
Neuromuscular Maturity
After your premature baby is moved to the NICU, he or she may undergo a number of tests. Some are
ongoing, while others may be performed only if the NICU staff suspects a particular complication.
Possible tests for your premature baby may include:

 Breathing and heart rate monitor. Your baby's breathing and heart rate are monitored on a
continuous basis. Blood pressure readings are done frequently, too.
 Fluid input and output. The NICU team carefully tracks how much fluid your baby takes in
through feedings and intravenous fluids and how much fluid your baby loses through wet or soiled
diapers.
 Blood tests. Blood samples are collected through a heel stick or a needle inserted into a vein to
monitor a number of critical substances, including calcium, glucose and bilirubin levels in your
baby's blood. A blood sample may also be analyzed to measure the red blood cell count and check
for anemia or assess for an infection.
If your baby's doctor anticipates that several blood samples will be needed, the NICU staff may
insert a central umbilical intravenous (IV) line, to avoid having to stick your baby with a needle
each time blood is needed.
 Echocardiogram. This test is an ultrasound of the heart to check for problems with your baby's
heart function. Much like a fetal ultrasound, an electrocardiogram uses sound waves to produce
moving images on a display monitor.
 Ultrasound scan. Ultrasound scans may be done to check the brain for bleeding or fluid buildup
or to examine the abdominal organs for problems in the gastrointestinal tract, liver or kidneys.
 Eye exam. An ophthalmologist (eye doctor) may examine your baby's eyes and vision to check
for problems with the retina (retinopathy of prematurity).

If your baby develops any complications, other specialized testing may be needed.

All of these exams are important ways to learn about your baby's well-
being at birth. By finding any problems, your baby's healthcare provider
can plan the best possible care.