The Newborn 7.

Weight
A. Physiologic Functions and General
Appearance
1. Temperatures
 Range from 36.5 to 37 axillary
 Crying may elevate temperature
 Stabilizes in 8-10 hr/ after delivery
Signs of Potential Distress:
 Temperature is not a reliable indicator of
infection
2. Heart Rate
 Range from 120 to 160 bpm
 Range to 100 when sleeping and 180
when crying
 Maybe irregular when crying
Signs of Potential Distress:
 Murmurs
 Deviation from range
 Faint heart sounds
3. Respiration
 30 to 60 breaths per minute
 Bilateral bronchial breath sounds
 Moist breath sounds maybe present
shortly after birth
Signs of Potential Distress:
 Asymmetrical chest movements
 Apnea for more than 15 seconds
 Diminished breath sounds
 Soesaw respirations
 Grunting
 Nasal flaring
 Retractions
 Deep sighing
 Tachypnea
 Persistent irregular breathing
 Excessive mucus
 Persistent fine crackles
 Stridor
4. Blood Pressure
 Varies with change in activity level 65/41
mmHg 1 to 3 days in both upper & lower
extremities
 2500-40000 gm.
8. Length
 48-53 cm.
9. Skin
 Reddish, smooth and puffy at birth
 At 24-36 hrs skin is flaky, dry & pink in
color
 Edema around eyes, feet & genital Good
skin turgor w/ quick recoll
 Cord w/ 1 vein 2 arteries
 Cord clamp light & card drying
 Hair silky & soll w/ individual strands
 Nipples present in expected locations
 Nails to end of fingers & often extend
slightly beyond
 Presence of vernix caseosa
 Presence of lanugo
 May have acrocyanosis [Low oxygen
levels in the blood cause the lips, fingers,
and toes to look blue (cyanotic)]
 Mongolian spots
 Mottling
 Physiologic jaundice
 Milla
 Erythema toxicum
 Petechia or bruises over presenting part
 Skin sags
 Harlequin coloring
VERNIX
CASEOSA
LANUGO

5. Head Circumference
 33-35 cm/ 34-35 cm
 Molding may result in a lower head
circumference measurement

6. Chest Circumference
 30.5 to 33 cm/32-33 cm
 Head circumference may be equal for the
first 24-48 hrs. of life.
 MONGOLIAN HARLEQUIN
SPOTS COLORING

Signs of Potential Distress:

 Jaundice within 24 hrs.
 Forceps mark
 General cyanosis
 Circumoral cyanosis between feedings
 Petechiae or ecchymoses other than on
presenting part
 All rashes w/ exception of erythema
toxicum
MOTTLING  Pigmented nevi
 Yellow vernix
 Hemangioma
 Pallor
MILIA

PIGMENTED
NEVI

HEMANGIOMA
ERYTHEMA
TOXICUM

10. Head
 Anterior fontanel diamond shaped 2-3 to
PETECHIAE 3-4 cm
 Posterior fontanel triangular 0.5-1 cm
 Fontanels soft, firm and flat Sutures
palpable with small separation in between
 There maybe caput succedaneum
 Molding
 CRANIOTABES

CAPUT
SUCCEDANEUM

Signs of Potential Distress:

 Cephalhematoma 11. Eyes
 Hydrocephalus  Slight gray or blue eye color
 Macrocephaly  No tears
 Closed sutures  Fixation at times
 Caput succedaneum  Red reflex
 Craniotabes  Blink reflex
 Distinct eyebrows
 Cornea bright and shiny
 Pupils equal & reactive to light
 Edematous eyelids
 May focus for a few seconds
Uncoordinated movements
CEPHALHEMATOMA Signs of Potential Distress:
 Discharges
 Opaque lenses
 Absence of red reflex
 Epicanthal folds in newborn not of oriental
descent
 Reflexes absent
 Chemical conjunctivitis
 Subconjunctival hemorrhage

HYDROCEPHALUS

EPICANTHAL
FOLDS
 CHEMICAL
CONJUNCTIVITIS

SUBCONJUNCTIVAL
HEMORRHAGE

12. Ears
 Loud noise elicits startle reflex 13. Nose
 Flexible pinna with cartilage present  Nostrils patent bilaterally
 Pinna top on horizontal line with outer  Obligate nose breather
canthus of the eye  No nasal discharge
 Sneezes to clear nostrils
Signs of Potential distress  Bridge appears absent
 Low ear placement  Thin white nasal mucus discharge
 Cleft present
 Malformations Signs of Potential Distress:
 Cartilage absent  choanal atresia & discharge
 Preauricular sinus  Malformation
 Nasal flaring beyond first few moments
after birth

14. Mouth and Throat

 Uvula midline
 Minimal or absent salivation
 Tongue moves freely & does not protrude
 Well developed fat pads on bilateral cheeks
 Sucking reflex
 Rooting reflex
 Gag reflex
 Extrusion reflex
 Moist mucosa
 High arched palate
 Epstein’s pearls on ridges of the gums
 EPSTEIN
PEARLS
Signs of Potential Distress
 Cleft lip/palate
 Circumoral pallor
 Asymmetrical lip movement
 Absent or incomplete reflexes
 Protruding tongue
 Diminished tongue movement
 Candida albicans
 Precocious teeth
CIRCUMORAL
PALLOR
CANDIDA
ALBICANS
15. Neck
 Short & thick
 Turns easily on sides
 Clavicles intact
 Tonic neck reflex present
 Neck righting reflex present
 Some head control
Signs of Potential Distress:
 Torticollis
 Resistance to flexion
 Webbing of neck
TORTICOLLIS
WEBBING OF
NECK
16. Chest
 Evident xiphoid process
 Bilateral synchronous chest movement
 Symmetrical nipples
 Equal anteroposterior and lateral diameter
 Witch’s milk
 Enlarge breasts
 Accessory nipples
Signs of Potential Distress
 Asymmetrical chest movements
 Depressed sternum
 Marked retractions
 Absent breast tissue
 Flattened chest
 Supernumerary nipples
 Nipples widely spaced
 Bowel sounds auscultated
ACCESSORY
NIPPLE
DEPRESSED
STERNUM
17. Abdomen
 Dome-shaped abdomen
 Abdominal respirations
 Soft to palpation
 Well-formed umbilical cord
 Three vessels in cord
 Cord dry at the base
 Liver palpable
 Bilateral equal femoral pulses
 Bowel sounds
 Voiding w/in 24 hrs. of birth
 Meconium w/in 24-48 hrs of birth
  Small umbilical hernia 19. Male genitalia
 Urinary meatus at the top of the glans
Signs of Potential Distress: penis
 Distress  Palpable testes in scrotum
 Absent bowel sounds  Large, edematous, pendulous scrotum, w/
 Visible peristaltic waves rugae
 Abdominal distention  Smegma beneath prepuce
 Palpable masses  Stream adequate voiding
 Scaphoid shaped abdomen  Prepuce covering urinary meatus
 Omphalocele  Erections
 Base of cord w/ redness or drainage  Increased pigmentation
 Gastrochisis  Edema & ecchymosis
 Pyloric stenosis
 Intussusception Signs of Potential Distress
 Non palpable testes
 Hypospadias
SCAPHOID  Epispadias
SHAPED  Scrotum smooth
ABDOMEN  Ambiguous genitalia
 Cryptoorchidism

20. Back and Rectum

 Intact spine w/o masses or openings
 Trunk incurvature reflex
 Patent anal opening

Signs of Potential Distress

 Limitation of movement
 Fusion of vertebrae
 Spina bifida
 Tuft of hair
 Imperforate anus
 Anal fissures
 Pilonidal cysts
18. Female genitalia
 Edematous labia & clitoris
 Labia majora are larger
 Vernix between labia
 Hymenal tag
 Pseudomenstruation
 Smegma
 Increased pigmentation
 Ecchymosis
 Brick red, pink stained urine

Signs of Potential Distress

 Labia fused
 Fecal discharge from vaginal opening
 Imperforate hymen
 Ambiguous genitalia
 Widely separated labia
20. Neuromuscular System
 Maintains position of flexion
 When in prone position, turns the head side
to side
 Holds head & back in horizontal plane
when held in prone
 Ability to hold head momentarily erect
25. Urinary System/Renal
 Voids w/in 24 hrs after birth
 System does not fully mature until after the
first year of life
26. Immune System
 Difficulty of antibody formation

Normal Newborn Reflexes Extremities

 Blink reflex Assess the following conditions:
 Rooting reflex  Symmetrical movement
 Sucking reflex  Presence of congenital defects of the
 Swallowing reflex limbs:
 Extrusion reflex o Amelia – absence of one or more limbs
 Palmar grasp reflex o Phocomelia – absence of the upper part of
 Step in place reflex one or more of the limbs.
 Placing reflex o Hemimelia – absence of gross shortening
of the lower part of one or more of the
 Plantar grasp reflex
limbs.
 Tonic- neck reflex
 Presence of weakness & paralysis
 Moro reflex
 Assess the digits
 Babinski reflex
o Polydactylism
 Magnet reflex o Syndactylism
 Crossed extension reflex o Adactylism
 Trunk incurvation reflex  Assess the lower extremities
 Landau reflex o Genu Varum – bow legged
 Deep tendon reflex o Genu Valgum – knocked knee
 Further assess the feet
Signs of Potential Distress o Equinos – toes lower than the heel
 Hypotonia o Varus – toes points inwardly
 Quivering o Valgus – toes points outwardly
 Limp extremities o Calcaneus – heel lower than toes
 Clonic jerking  Congenital hip dislocation or dysplasia
 Paralysis o Sublaxation – mild
o Dislocatable – moderate
22. Cardiovascular System o Complete dislocation – severe
 Functional closure of the ductus arteriosus,
foramen ovale & closure of the ductus
venosus & umbilical arteries
 Blood volume is 80-100mlml/kgBW or total APGAR SCORE
of 300 ml  By Dr. Virginia Apgar
 High Hgb, Hct and WBC count  The evaluation of an infant’s physical
 Pronlonged coagulation or prothrombin condition.
time  Performed I minute and again 5 minutes
after birth.
23. Respiratory system  Based on a rating of five factors that
 Onset of breathing occurs as air replaces reflects the infant’s ability to adjust to
the fluid that filled the lungs during the extrauterine life.
intrauterine life

24. Gastrointestinal System

 The GIT at birth is sterile
 Limited ability to digest fats & starch
 Immature cardiac sphincter between the
stomach & esophagus
 Immature liver functions
 Meconium to transitional stool
APGAR SCORING

Interpretation of Scores:
0-3 – poor , serious or severely depressed, needs
immediate CPR
4-6 – fair, guarded or moderately depressed,
needs further observation & suctioning
7-10 – good & healthy

*the higher the Apgar score, the better!!!

RESPIRATORY EVALUATION