*Newborn Assessment*

Period
Weeks From birth to 4 weeks
Months From birth to 1 Month
Gestational Age Between 38 and 42 weeks
Initial Assessment “Apgar Score”
Done in 1st & 5th minute immediately after birth
8-10= absence of difficulty in adjusting to extra-uterine life
Scores 4-7= signify moderate difficulty
0-3= severe distress
Transitional Assessment “Periods OF Reactivity”
A. Stage 1
During: first 30 min
1st Period B. Stage 2
Lasts For: about 2-4 hours
2nd Period Lasts For: about 2-5 hours
Gestational Assessment “New Ballard”
Done in 72 hours after birth
Physical Growth “Wt, Ht, HC & CC”
= 2700 - 4000 grams “3400 grams Average”
Loss 5 - 10 % of birth weight in the first week
Weight “Wt” * Regained by the 10th day of life
* Gain 3/4 kg in the 1st month
* Gain 30 gm daily during neonatal period
Length “Ht” = 48 - 53 cm “50 cm Average”
Grow 2.5cm per month for first 6 months
= 33 - 37 cm “35 Average”
Head Circumference * Microcephaly: <32 cm
“HC” 2 cm greater than chest circumference
* Hydrocephaly: >4 cm from chest
Chest Circumference = 31 - 33 cm “30 Average”
“CC” 2 cm less than head circumference
Physiological Assessment
HR = 120-160 b/min, Increased during activity
= 70/50 mm Hg (At birth)
BP = 80/55 mm Hg (by the fourth day)
RR = 30- 60 breaths\min
SaO2 = 96 to 100 %
= 36.5- 37.5 c
Axillary= 36.4- 37.2 c
Temp. Rectal= 36.6 - 37.2 c
Skin= 36 - 36.5 c
 General Appearance
1. Skin
Vernix caseosa Disappear by: about 24 – 48 hours
Lanugo hair Disappear by: before birth or shortly after birth
Mongolian spots Disappear by: during first year of life
Physiologic * Appear by: 24 hours after birth and peaks at 72 hours.
Jaundice * Disappear by: 5 to 7 days
Milia Disappear by: few weeks
Desquamation Appear by: within 2 - 4 wks. of life.
General Appearance
2. Fontanels
* 2-3 cm wide
Anterior Fontanel * 2.5- 4 cm long
“Diamond Shape” * Closed at: 12-18 month
Posterior Fontanel * 0.5-1 cm at birth
“Triangle Shape” * Closed at: 6-8 weeks (2 months).
General Appearance
3. Birth Head Injuries
* Onset of appearance: Few hours after birth
Cephalhematoma * Resolution: 2 wk-3 months
Caput * Onset of appearance: At birth
Succedaneum * Resolution: Few days
General Appearance
4. Eyes
Eye Color Not determined until the age of 3-6 months
Absence of Tears Lacrimal ducts mature at 3 months
General Appearance
5. Chest
Cough * Absent at birth
Reflex * Present by 1-2 days
Apex of Heart Assessed at the 4th to 5th intercostal space.
General Appearance
6. Abdomen
Stomach Capacity = 30 – 60 cc
Bowel Sound Heard shortly after birth
Liver 1-3cm below right costal margin
General Appearance
7. Umbilical Cord
Color Bluish white at birth with 2 arteries & one veins.
Drops off 7 – 10 days
General Appearance
8. Endocrine system
Swollen Breasts Appears on 3rd day in both sex, & lasts for 2-3 weeks
 General Appearance
9. Urinary system
Voiding at birth or some hours later
Passing Urine within 24 hours after birth
General Appearance
10. Back & Rectum
Passage of Meconium within 48 hours
General Appearance
11. Nervous System
Cough Reflex Present after 1st day of life
Rooting Reflex Disappears at 9 or 12 weeks
Extrusion Disappears by age 4 months
Moro Reflex Disappears after age of 3 to 4 months
“Startle Reflex”
Tonic Neck * Present at one month of age
Reflex * Disappears by age 3 to 4 months.
Babinski Reflex Normal reflex up to about 2 years of age.
Step Reflex * Present at Birth
“Walk/Dance * Disappears at 6 weeks “as an automatic response”
Reflex” * Reappears at around 8 months to a year “as a voluntary behavior”
Palmer Reflex Disappears at 6 weeks to 3 months
Planter Reflex Disappears at 8 to 9 months of age
Crawl Reflex Disappears at age of 6 weeks
Sensory Assessment “Senses”
Hearing Within days after birth hearing become acute
Vision See best when objects are about 9-12 inch (22.86-30.48 cm) away.
Smell Recognize smell of their mother within the 1st few days of life
Newborn’s States
Average of 16-18 hours daily.
Sleeping * 4 hours of sleep followed by 1 hour of wakefulness “Sleep-Awake Cycle”
Signs of Illness
Temp. Above 38 c or below 36.6 c axillary
Breathing Absence of breathing longer than 20 seconds
Feeding Refusal of two feedings in a row
* No wet diapers for 18 to 24 hours.
Diaper * Fewer than 6 to 8 wet diapers per day after 4 days of age
Care of the Newborn
Vitamin K 1 mg. given IM (Vastus Lateralis)
Blood Sugar If below 40 mg/dl, start feeding protocol per hospital.