ASSESMENT OF NEWBORN

INTRODUCTION
The most important activity incare of newborn is to perform
physical assessment.As an infant is born he/she requires a thorough skilled observation
and adjustment to the extra uterine life.During physical assessment it is required that you
should not disturb the infant so that successful examination can be done.The physical
examination represents the screening procedure to identify likelihood of disease conditon
or the abnormality present in the system.
PURPOSES
 To identify the normal characteristics in the newborn.
 To identify existing abnormalities ifany.
 To carry out immediate actions if there is any deviations.
 To establish a baseline for future physiologic changes.
PRECAUTIONS
 Keep your hands neat ,clean ,dry and warm.
 Keep your nails sahort and free from nail polish.
 Do not expose the baby unnecessarily.
 Do not expose the baby to drafts and chill.
 Eamine the baby swiftly and notmore thsn 8-10 minutes.
 Inform the baby about the outcome of the baby.
IMMEDIATE EXAMINATION AT BIRTH
 Apgar score
 Estimatuion of gwestational age
 Neuroplogical assessment
 Neurological function
 General and specific examination
 Reflexes
A) APGAR SCORE
Apgar score is the best indicator to tell the
physiological status of the neonate and its ability to adjust to the extrauterine
life. Record the apgar score at 1 minute and at 5 minute.If the score at 1
minute is low it indicates the respiratory distress and the neonate requires
immediate resuscitative measures.If score is less even after 5 minutes it
indicates neurological damage due to hypoxia and brain damage.

Serial no. Sign 2 1 0

1 Heart rate Less than 100 Absent
100beats/min beats/min
2 Respiratory Good ,strong Weak,irregular No cry
rate cry cry
3 Activity Active Some floexion Limp/no
movements of extremities response
4 Grimace Coughing or Facial grmace No reponse
sneezing
5 Appearance Completely Body pink and Completely
 pink the extremities blue/pale
blue

7-10 indicates neonate is normal

4-6 indicates moderate asphyxia
0-3 indicates severe distress/asphyxia.
B)ESTIMATION OF GESTATIONAL AGE OF THE NEONATE
It is essential to estimate the gestational age of neonate as
it tell the maturity of the systems.A newborn at each gestational age has has its special
problem.Dubowitz and ballard scoring are the most widely used system to assess
gestational age.
Dubowitz scoring system scale consist of 11 physical characteristics used in
the first 24 hours .The external characteristics assessed are breast size,ear cartilage ,skin
texture and plantar creases etc.
DUBOWITZ SCALE

Serial no. Characteristics Preterm Term

1. Breast tissue Below 5mm More than
10mm may
have breast
milk.
Nipple level No areola Raised above
formation the skin.
2. Skin texture Abdominal Some large
and opacity veins clearly veins distinctly
visible visible.
3. Hair texture Wooly /fuzzy Individual
and distribution very fine hair strands visible.
4. Plantar creases Few if any Entire sole
creased.
5. Genitals
Male Scrotum Testes in canal
empy,no rugae scrotum rugated
Female Prominent labia Clitoris and
and clitroris labia minora
skin covered.

C)NEUROLOGICAL ASSESSMENT
It is made up of eight neurological criteria which have high
significance with gestational age.
a)posture
place the infant supine and quiet.observe the arm, hip and knee for
extension and flexion.
b)Square Window
 hand is flexed upon the wrist .Gentle pressure is exerted to obtain as
much flexion as possible.The wrist should not be rotated .The square window is the angle
formed between the hypothenar eminenceand anterior forearm.
c)Ankle dorsiflexion
The foot is flexed on the ankle with gentle pressure but sufficient
pressure to obtain maximum flexion.The angle between the top of the foot and front of
the leg is measured.
d)Popliteal Angle
The infant is placed on his back with pelvis flat on a firm surface .The
legs are first flexed on the thigh then flex the thigh fully with one hand,with the other
hand extend the leg until maximum angle is obtained.
e)Heel to Ear
The infant still lying on his back.Grasp each forearm just above the
wrist and gently pull the infant to the sitting position .Observe the relation between head
and the trunk as the infant is raised forward beyond 90 degree from the body’s surface

D)NEUROLOGICAL FUNCTION ASSESSMENT

This helps to identify the neurological disorder
 State of alertness
 Posture
 Muscle strength
 Muscle tone
 Spontaneous/elicited muscle movements.
 Cranial nerves
 Reflexes
 Autonomic nervous system
GENERAL AND SPECIFIC EXAMINATION
 Temperature
Normal will be 37
 Heart rate
Normal heart rate is 120-140 beats/minute.
 Respiratoay rate
Normal respiratory rate is40-60 breath/minute.
ANTROPOIMETRIC MESUREMENTS
 WEIGHT