NEWBORN ASSESSMENT

Assessment of Gestational Age

Objectives:  Ballard score
o Used to determine gestational age
 To provide assessment of the newborn state of
o 6 physical development; 6 nerve and
development of wellbeing
muscle development
 To detect any deviation from normal
o The scores may range -1 to -5
 To assess progress of the child
o Scores are added together to determine
 To detect disease in early age
baby’s gestational age
 To determine the nature of treatment or care
needed for the newborn
Indications:

 1st examination:
o Monitoring the baby inside the womb of
the mother before the delivery and 2
hours after birth
 2 examination:
nd

o Before Discharge
 3 examination:
rd

o After 6 – 8 weeks of neonatal life

Phases of Assessment
 Small Gestational Age (SGA)
o Initial o Newborn’s ideal weight is <10% at the
o Transitional time of birth. ( < 2500g )
o Assessment of gestational age  Large Gestational Age (LGA)
o Systemic Physical Examination o Newborn’s ideal weight is >90% at the
time of birth ( > 2500 – 4000g )
Initial Assessment
 Appropriate Gestational Age (AGA)
o APGAR Scoring system o Newborn’s birth weight is 2500 – 4000
grams
 Full Term
o 37 – 40 weeks of gestation
 Pre – Term
o 21 – 36 weeks of gestation
 Post term
o Extended or beyond 40 weeks

Vital Signs
Transitional Assessment
 Temperature
o 1st stage:
o Normal: 36.5 – 37.4
 Last for 6 hours
o Hypothermia: < 36 C
 1st 30 minutes awake; remaining
o Hyperthermia: >38 C
hours asleep
o 2nd stage:  Respiration:
o Normal: 30 – 60 cpm
 6 – 12 hours observation should
be made until the vital signs are o Tachypnea: > 60 cpm
established o Bradypnea: < 30 cpm
 Pulse
 o Normal: 120 – 160 bpm  Two main processes:
o Bradycardia: < 120 bpm  Area where the placenta
o Tachycardia: > 160 bpm is implanted
 Blood Pressure  Organ is reduced to its
o Average: 66/44 mmHg; 1-3 days of age approximate
 Head Circumference progestational size
o 33 – 35 cm  Weight of Uterus
 Chest Circumference  Right after delivery
o 31 – 33 cm o 1000 grams
 Abdominal Circumference  One week after
o 31 – 33 cm o 500 grams
 Body length  Two weeks after
o 47 – 54 cm delivery
o 300 grams
 Body Weight
o 2500 – 4000 g  Six weeks after
o 50 to 60 grams
o Fundus
 Immediately after the delivery,
Post-Partum Care
the fundus is located midway
Psychological Changes between the umbilicus and
symphysis pubis or slightly
o Rubin’s Postpartum Phase higher
 Taking in phase  It rises to level of umbilicus
 First 2-3 days of after several hours
Postpartum  Descend into the pelvic cavity
 Woman’s attention is by one cm a day
focused on her own  Postpartum day 1
needs (e.g. Sleep, rest o 1 cm or 1
and dependency on fingerbreadth
others) below
 Taking hold phase: umbilicus
 More ready to resume  Postpartum day 2
control on her body o 2 cm or 2
 Mothering role fingerbreadth
 3rd day up to 2 weeks of below
postpartum umbilicus
 Letting –go phase: o Decreases 1
 Woman finally finger breath
redefines her new role per day
 Gives up fantasies about  Postpartum day 10
the child o Cannot be
 Undergoes role palpated
transition o No longer
 Gives up role as palpable
childless woman and o Afterpains
adjust herself and  Contraction of uterus after birth
lifestyle to meet the causes intermittent cramping
needs of her child similar to that of during
o Uterine Involution menstrual period
 Uterus will never completely  Common to women that is
return to its pregnant state multipara, treated with oxytocin,
 breastfeeding mothers and  Does not return exactly to its
uterus were over distended. prepregnant state.
 Unusual to primiparas who have  Internal os will close as before
good uterine muscle tone but the external os will usualy
o Lochia slightly open and appear slitlike
 Never absent regardless of
method of delivery o Vagina
 Less lochia is expected in  Vagina is soft and has few rugae
women who delivered by CS  3 to 4 weeks, rugae reappears
 Ambulate early and those who but not as numerous as before
breastfeed their babies pregnancy
 Pattern is similar to menstrual  The vagina returns to its
flow prepregnant condition after 6 to
 Lochia Rubra 8 weeks but does not regain its
o Delivery up to original virginal state
3rd day. o Perineum
o Bright red in  Observed for signs of infection
color, fleshy and trauma
odor, may  Perineal care is observed
contain small  Ice pack is applied
clots  Sitz Bath is applied
 Lochia Serosa (Application of heat to the
o 4th to 7th day perineum to promote
o Pinkish to vasodilation)
brownish color  Perilight therapy is applied
 Lochia Alba Systematic Changes
o 7th day until 2 to
6 weeks o Hormonal Changes
postpartum, o Hormones: drop after delivery of
cream to placent
yellowish in o HCG & HPL gone by 24 hours
color o Week 1 – Estrogen and Progesterone at
prepregnancy levels
o FSH remains low for 12 days, then rises
to initiate menstrual cycle
o Urinary System
o The pressure that the fetal head might
give on the bladder and urethra may
leave a transient loss of tone and edema
surrounding the urethra makes voiding
difficult
o Assess the woman abdomen frequently
immediately, to avoid permanent
damage of the bladder due to
overdistention
o Cervix o During pregnancy, as much as 2000 to
 End of 7 days, external os is 3000 ml of excess fluid accumulates in
narrowed to the size of a pencil the body. Diuresis begins 12 hours after
opening and the cervix feels delivery andextendsuptothe5th day as
firm and non gravid again. body gets rid of extracellular fluid
accumulated during pregnancy.
 Diaphoresis is another way by which the
body get rids of excess fluid.
o Circulatory System
o Blood Loss – NSD 500 ml, CS 500 –
1000 ml
o Blood loss and diuresis contribute to
reduction in blood volume
o Returns to non pregnant levels one one
week after delivery
o Gastrointestinal System
o Hemorrhoids are present
o Bowel movement may be delayed for
days after delivery resulting in
constipation.
o Integumentary System

o Menstruation and Ovulation