NEWBORN ASSESSMENT - It is a systemic examination

of newborn from head to toe. After birth, newborn

babies are carefully checked for problem or
complications.

VITAL STATISTICS - Vital statistics measured for a

newborn usually consist of the baby`s weight, length
and head and chest circumferences.

CHEST CIRCUMFERENCE – Chest circumference is

measured at the level of the nipples. The chest
circumference in a term newborn is about 2 cm (0.75 to
1 in.) less than the head circumference.

VITAL SIGNS - Vital signs measurement begin to change

from those present in intrauterine life at the moment of
birth.

TEMPERATURE - The temperature of newborns is about

99° F (37.2° C) at birth because they have been confined
in their mother`s warm and supportive uterus. The
major heat loss occurs because of four separate
WEIGHT - As long as the newborns are breathing well, mechanisms: convection, radiation, conduction and
they are weighed nude and without blanket soon after evaporation.
birth in the birthing room. Measurements such as body
Types of heat loss in Solution:
length and head, chest and abdominal circumferences
newborn:
are also done but can be obtained later so that the
newborn isn`t unnecessarily exposed to chilling. A. Convection – is the flow Eliminating drafts, such
of heat from the as from air conditioners.
LENGTH - A newborn`s length at birth in relation to newborn`s body surface
weight is a second to important determinant used to to the surrounding air.
confirm that a newborn is healthy.
B. Radiation – is the Moving the infant away
• The average birth length of a mature female transfer of the body heat as far as from the cold
newborn is 49 cm or 19.2 in. to a cooler solid object surface as possible.
• For mature males, the average birth length is 50 not in contact with the
cm or 19.6 in. baby, such as cold
• The lower limit of expected birth length is window or air
arbitrarily set at 46 cm or 18 in. conditioner.
HEAD CIRCUMFERENCES - Is measured with a tape
measure drawn across the center of the forehead and C. Conduction – is the Covering surfaces with a
around the most prominent portion of the posterior transfer of body to a warmed blanket or
head (the occiput). cooler solid object with a towel.
baby.
• In a mature newborn, the head circumference is
usually 34-35 cm or 13.5 to 14 in.
• A mature newborn with a head circumference
D. Evaporation – is the Lay a newborn on the
greater than 37 cm (14.8 in.) or less than 33 cm loss of heat through the mother`s abdomen
(13.2 in.) should be carefully assessed for neurologic
conversion of liquid to immediately after birth
involvement, although some well newborns have
vapor. and cover with warm
these measurements.
blanket for skin-to-skin
contact.

PULSE - The heart rate of a fetus in utero average 120-
160 beats/min. Immediately after birth, as the newborn
struggles to initiate respirations, the heart rate may be
as rapid as 180 beats/min. Within 1 hour after birth, as
the newborn settles down to sleep, the heart stabilizes
to an average of 120 to 140 beats/min.
RESPIRATION - The respiratory rate of a newborn in the
first few minutes of life may be as high a 90
breaths/min. As respiration activity is established and
maintained over the next hour, this rate will settle to an
average of 30 to 60 beats/min.
COLOR - All infants appear cyanotic at the moment of
birth. They grow pink with or shortly after the first
breath, which makes the color of newborns correspond
to how well they are breathing.
Apgar scoring is done at one and five minutes after
birth. The newborn is considered to be “vigorous” if the
initial scores are 7 and above. If the five-minute score is
than 7, scoring is done every five minutes thereafter
until the score reaches 7.

BLOOD PRESSURE - The blood pressure of a newborn is

approximately 80/46 mmHg at birth. By the 10th day, it
rises to about 100/50 mmHg and remains at that level
for the infant year.

ASSESSMENT FOR WELL-BEING

APGAR SCORING - At 1 minute and 5 minutes after
birth, newborns are observed and rated according to an
Apgar score. The following points are considered in
obtaining the rating: heart rate, respiratory effort,
muscle tone, reflex irritability, color.
HEART RATE - Auscultating a newborn heart with a
stethoscope is the best way to determine the heart
rate; however, it may be also obtained by observing and
counting the pulsation of the umbilical cord at the
abdomen if the cord is still uncut.
RESPIRATORY EFFORT - Respirations are counted by
observing chest movements. A mature newborn usually
cries and aerates the lungs spontaneously at about 30
seconds at birth.
MUSCLE TONE - Term newborn hold their extremities
tightly flexed, stimulating their intrauterine position.
Muscle tone is tested by observing their resistance to
any effort to extend their extremities.
APPEARANCE OF NEWBORN - Although all newborns
have similar physical findings, each is unique and has
individual differences from all others.
• The Skin - general inspection of a newborn`s skin
includes color, any birthmarks and general
appearance.
• The Color - most term newborn have a ruddier
complexion for their first month than they will have
later in life because of the increased concentration
of red blood cells in their blood vessels and a
decrease in the amount of subcutaneous fat, which
makes blood vessels more visible.
• Birthmarks - several common types of birthmarks
occurs in newborns. It is important to be able to
differentiate the various types of hemangiomas that
occur because some are more serious than others.
• Hemangiomas - are vascular tumors of the skin and
occur in three distinct types.

REFLEX IRRITABILITY - One of the two possible cues is

used to evaluate reflex irritability: response to a suction
catheter in the nostrils or response to having the soles
of the feet slapped. A baby whose mother was heavily
sedated for birth will probably demonstrate a low score
in this category.
 NEVUS FLAMMEUS
INFANTILE HEMANGIOMAS
CAVERNOUS HEMANGIOMA
The Head – A newborns head usually appears
disproportionately large because it is about one fourth
of the total body length compared with an adult, whose
head is one eight of total height.
The Eyes - to inspect the eyes of a newborn, lay the
infant in a supine position and lift the head; this
maneuver usually causes the baby to open his or her
eyes. The eyes should appear clear without redness or
purulent discharge.
The Ears - the level of the top part of the external ear
should be even to a line drawn from the inner canthus
to the outer canthus of the eye and back across the side
of the head. Ears that are set lower than this are found
in infants with certain chromosomal abnormalities, p
Normal Anatomy of the Infant Ear (Pinna or Auricle)
The pinna, also referred to as the auricle, is the outer
part of the ear that collects sound. At birth, the external
ear is made of a soft, thin and pliable cartilage. Sound
travels to the ear canal (auditory canal) and ends at the
eardrum (tympanic membrane).
The Nose - Always test for choanal atresia (blockage at
the rear of the nose) when examining a newborn by
closing the infant`s mouth while compressing one naris
at a time your fingers. Note any distress with breathing
Do babies noses change shape?
Your newborn's nose may be pushed in or flat because
of the tight squeeze during labor and delivery. It may
take a week or longer before his or her nose looks more
normal.while one side of the nose is blocked this way.
The Mouth - A newborn`s mouth should open evenly
when he or she cries. If one side of the mouth curves
more than the other, facial nerve injury may have
occurred. Also inspect the palate of a newborn to be
certain it is intact. If Epstein pearls are present be sure
to inform the parents that these require no treatment
and will eventually disappear after a week.
The Neck - the neck of a newborn appears short with
creased skin folds. The head should rotate or turn
freely.
At first, your baby's neck is far too weak to support her
head. As he/she grows, though, the neck muscles will
quickly get stronger.
By 2 months, you may notice her briefly popping her
head up during tummy time, even if only for a few
wobbly seconds. He/She might also be able to turn her
head at a 45-degree angle.
The Chest - the chest in most newborns looks small
because of the head is so large in proportion to it (an
important finding at birth so the largest diameter of the
baby is born first).
-the clavicle should appear straight and feel smooth. A
crepitus (crackling) or an actual separation of one or
both clavicle suggests a fracture occurred during birth
(can happen with large infants).
- infants breast may be engorged because of maternal
hormone during pregnancy. And occasionally, breast
may secretes a thin, watery fluid popularly termed
witch`s milk. As soon as the hormones are cleared from
the infant`s system (about 1 week) the engorgement
and fluid will subside.
What is possible treatment if a baby has a broken
collarbone?
In most cases, clavicle fractures in newborns heal very
quickly without any problems. Usually no treatment is
required; however, the parent may be instructed to pin
the child's sleeve of the affected arm to the front of
their clothing to avoid moving the arm while it heals.
The Abdomen - a contour of a newborn abdomen looks
slightly protuberant. A scaphoid or sunken appearance
suggest missing abdominal contents or a diaphragmatic
hernia (bowel or other abdominal organs positioned in
the chest instead of the abdomen).
Diaphragmatic hernia - is a birth defect where there is a
hole in the diaphragm (the large muscle that separates
the chest from the abdomen). Organs in the abdomen
(such as intestines, stomach, and liver) can move
through the hole in the diaphragm and upwards into a
baby's chest.
The Abdomen - for the first hour after birth, the stump
of the umbilical cord appears as white, gelatinous
structure marked with the blue and red streaks of the
one umbilical vein and two arteries. Any child with a
single umbilical artery needs close needs and
assessment for anomalies that are frequently associated
with the lack of an umbilical artery.
- always inspects the cord clamp to be certain its secure.
After the first hour of life, the cord will begin to dry,
shrink and turn brown as if it were the dead end of the
vein. By the second or third day, it will have turned
black. On the 6 to 10 day, it breaks free, leaving a
granulating area a few centimeters wide that will heal
during the following week.
The Anogenital Area - examine the anus to ascertain its
presence and patency. Test for anal patency and that
the anus is not covered by a membrane (imperforate
anus) by gently inserting the tip of your gloved and
lubricated little finger.
The Male Genitalia - the scrotum in most male
newborns is edematous and has rough rugae on the
surface. Both testes should be palpable in the scrotum.
If one or both testicles are not present (cryptorchidism),
referral is needed to further investigate the problem.
The penis of a newborn appears small, approximately 2
cm long.
The Female Genitalia - the vulva in female newborns
may appear swollen because of the effect of maternal
hormones during intrauterine life. Some female
newborns have a mucus vaginal secretion, sometimes
blood tinged (pseudomenstruation), which is caused of
maternal hormones. The discharge does not indicate
infection or trauma and disappears in 1 to 2 days.
The Extremities - the arms and legs of a newborn
appear short in proportion to the trunk. The hands
seem plump and are typically clenched. Newborn
fingernails feel soft and smooth and extend over the
finger tips.
- Test the upper extremities for muscle tone by
unflexing the arms for approximately 5 seconds then
letting them return to their flexed position (which
typically occurs immediately if the muscle tone is good).
Next hold the arms down by the sides and note their
length. The fingertips on both sides should reach as far
as the mid-thigh. Usually short arms may signify
achondroplasia (dwarfism) and would require further
evaluation.

The Back - the spine of a newborn typically appears flat

in lumbar and sacral area; these curves appear after a
child is able to sit and walk. Inspect the base of a
newborn`s spine carefully to be certain there is no
dimpling, pinpoint opening, or sinus tract in the skin,
which suggest a dermal sinus or spina bifida occulta.