MSU - COL L E GE OF ME D ICINE

LEVEL 1 | Growth and Development Module

Physical Diagnosis - NEWBORN

RECOMMENDED NEWBORN PRACTICES:

NEWBORN
Oct. 15, 2020 – Dr. Apipa Domato
OUTLINE
THE NORMAL NEWBORN……………. 1
ESSENTIAL INTRAPARTUM
AND NEWBORN CARE (EINC)…...………….…1
APGAR SCORE…………………………………...1
NEWBORN CLASSIFICATION…………………..1
ASSESSMENT OF GESTATIONAL AGE………2
NEW BALLARD SCORE……………………….…2
EXTREMITIES AND SKELETAL SYSTEM.…….2
NEUROLOGICAL EXAM…………………...…….3
KANGAROO MOTHER CARE…………………...3
THE NORMAL NEWBORN
COMPONENTS OF NEONATAL HISTORY:
• Complete Maternal History:
- Age, parity, prenatal history
- Blood type, occupation
- Illnesses, STDs, maintenance
medications
- Previous pregnancy
- Prohibited drug intake, alcohol
- Current pregnancy- AOG, fetal
testing, infection
• Natal History:
- Labor; duration, presentation,
distress, fever
- Delivery; caesarean vs. normal,
sedation, assisted, APGAR score,
resuscitation
• Antenatal steroids
- For preterm babies ( <37 weeks)
• Thermoregulation (25 – 28 C)
• Dry cord care
• Early breastfeeding
• Eye care, weighing, PE, injection last
• Bathing
- 6 – 24 hours after birth
APGAR SCORE (AS)
• Appearance (color)
• Pulse (heart rate)
• Grimace (reflex irritability)
• Activity (muscle tone)
• Respirations
- Cursory assessment of cardiopulmonary/
neurologic systems
- Done at 1, 5 minutes; every 5 minutes until 20
minutes or 2 successive scores of 7
- Subjective; may not be accurate
- Low score not diagnostic of asphyxia
SCORE:
• 10: Perfect score
• 7 – 10: Normal
• 0 – 3: at 5 minute, increase risk for cerebral
palsy from 0.3% to 1%.
- at 10, 15, 20 minutes, have higher
correlation with future neurological
handicaps but still not specific in
absence of other clinical evidence
like encephalopathy.

ESSENTIAL INTRAPARTUM AND NEWBORN BIRTH WEIGHT

CARE (EINC) Classification Weight
- Prevention and management of premature Micropreemie < 800g or 1.8lb
birth and low birth weight Extremely LBW < 1000g or 2.2lb
- The 4 Core Steps of immediate newborn care
Very LBW < 1500g or 3.3lb
- Postnatal care of mother and newborn
- Basic Newborn Resuscitation Low BW < 2500g or 5.5lb
- Evidence-based practices Normal BW 2500g (5.5lb) – 4000g (8.8lb)
- Time-bound, chronologically ordered High BW 4000g (8.8lb) – 4500g (9.9lb)
standard procedures Very HBW > 4500g (9.9lb)
- Baby receives at birth • 3kg for Filipino baby

4 CORE STEPS OF EINC: NEWBORN CLASSIFICATION

1. Immediate and thorough drying
2. Skin-to-skin contact Category Abbr. Percentile
3. Properly-timed cord clamping Small for gestational age SGA <10th
- 1-3 minutes or when pulsations stops Appropriate for gestational age AGA 10-90th
4. Nonseparation of mother and baby Large for gestational age LGA >90th

NORONSALIH JRA. ALI 1

 MSU - COL L E GE OF ME D ICINE
LEVEL 1 | Growth and Development Module
Physical Diagnosis - NEWBORN

SMALL FOR GESTATIONAL AGE (SGA) RAGING FOLLOWING DELIVERY:

• SYMMETRIC: 33% of SGA FIVE PHYSICAL PARAMETERS:
(Head circumference = Weight = Length, all <10%) 1. Creases in the sole of the feet
- Genetic 2. Breast nodule
Small maternal size 3. Scalp hair
Chromosomal abnormalities 4. Earlobe
(Trisomy 13, 18, 21 and 5. Testes and scrotum
Turner’s syndrome)
Congenital abnormalities ASSESSMENT OF GESTATIONAL AGE
- Intrauterine infections
• Old Ballard Score:
Viruses (rubella, CMV, HIV)
- Overestimated age of PT,
Bacteria (tuberculosis)
underestimated age of postterm,
Spirochete (syphilis)
inaccurate in VLBW
Protozoan (toxoplasmosis,
• New Ballard Score:
malaria)
- Extended range and accuracy within
• ASSYMETRIC: 55% of SGA
2 weeks; useful among < 28 weeks if
(Head circumference = Length <10%, Weight <10%)
done after stabilization or by 12h.
- Uteroplacental insuffieciency
Chronic hypertension
Preeclampsia NEW BALLARD SCORE
Renal disease SCORE WEEKS
Cyanotic heart disease -10 20
Hemoglobinopathies
-5 22
Placental infarcts or chronic
abruption, velamentous 0 24
insertion, circumvallate 5 26
PRETERM
placenta, multiple gestation 10 28
Altitude 15 30
• COMBINED: 12% of SGA
- Environmental 20 32
Drugs (including ethanol) 28 34
Smoking 30 36
- Placental unit insufficiency 38 38
Placental infarcts or chronic
40 40 TERM
abruption, velamentous
insertion, circumvallate 48 42
placenta, multiple gestation 50 44 POSTTERM

LARGE FOR GESTATIONAL AGE (LGA)

EXTREMITIES AND SKELETAL SYSTEM
• Large mother (familial)
• Infants of diabetic mothers ORTOLANI MANUEVER
- To check for developmental
• Beckwith-Wiedemann syndrome
dysplasia of the hip
• Hydrops fetalis
- Gently abduct infant’s leg with thumb
while placing anterior pressure on
GESTATIONAL AGE
the greater trochanter using
Classification Gestational age
examiner’s index and forefinger.
Preterm <34 weeks - (+) sign: distinctive ‘clunk’ which can
Late preterm 34-36 weeks be heard and felt as the femoral head
Term 37- 42 weeks relocates anteriorly into the
Postterm >42 weeks acetabulum
- This tests for posterior hip dislocation

NORONSALIH JRA. ALI 2

 MSU - COL L E GE OF ME D ICINE
LEVEL 1 | Growth and Development Module
Physical Diagnosis - NEWBORN

NEUROLOGICAL EXAM
REFLEXES APPEARS DISAPPERS
Moro Newborn 3 months
Grasp Newborn 3 months
LE crossed Birth 1 month
extensors
Extensor plantar Newborn 8 – 12 months
Placing/Stepping Birth 1 – 2 months
ATNR Newborn 3 months

KANGAROO MOTHER CARE

- 1978, Instituto Materno Infantil in Bogota,
Columbia
- Dr. Edgar Rey and Dr. Hector Martinez
- Humane, low cost method of care for LBW
infants
- Concept/method of care for the baby/mother
dyad and the family
1. Skin to skin contact
- Intermittent (8 hrs/day)
- Continuous (20 cumulative hrs/day)
2. Breastfeeding the premature infant
3. Empowerment of the mother and the family
(KMC rooms)
4. Home discharge in kangaroo position
5. Appropriate growth and development in a
healthy enviroment

• Show the mother how to hold her baby

- She should hold the baby’s head and
body straight
- Make the baby face her breast, the
baby’s nose opposite her nipple
- Hold the baby’s body close to her
body
- Support the baby’s whole body, not
just the neck and shoulders.
• Show the mother how to help her baby. She
should:
- Touch her baby’s lips with her nipple
- Wait until her baby’s mouth is
opening wide
- Move her baby onto her breast,
aiming the infant’s lower lip more of
areola below nipple in mouth.
• Look for the signs of good attachment and
effective sucking (that is slow, deep sucks,
sometimes pausing)
• If breast engorgement, express a small
amount of breast milk before starting
breastfeeding to soften nipple area so that it
is easier for the baby to attach.

NORONSALIH JRA. ALI 3