VITAL STATISTICS

Vital statistics measured for a newborn usually consist

of the baby’s weight, length, and head and chest
circumferences.
Safety issues specific to newborn care when taking
these measurements, such as not leaving a newborn
unattended on a bed or scale and protecting against
hypothermia.
WEIGHT
As long as newborns are
breathing well, they are
weighed nude and without a
blanket soon after birth in the
birthing room.
Initial weight for baseline data,
an infant is weighed nude once
a day, at approximately the
same time every day, during a
hospital or birthing center stay.
The birth weight of newborns varies depending on the
racial, nutritional, intrauterine, and genetic factors
that were present during conception and pregnancy.
During the first few days after birth, a newborn loses
5% to 10% of birth weight (6 to 10 oz) (Thulier, 2016).
After 1day of stable weight begins to gain weight.
The breastfed newborn recaptures birth weight within
10 days; a formula-fed infant accomplishes this gain
within 7 days.
All infants begin to gain about 2 lb per month (6 to 8
oz per week) for the first 6 months of life.
Length

The average birth length (50th percentile) of a mature

female newborn is 49 cm (19.2 in.).
For mature males, the average birth length is 50 cm
(19.6 in.).
The lower limit of expected birth length is arbitrarily
set at 46 cm (18 in.).
Although rare, babies with lengths as great as 57.5 cm
(24 in.) have been reported.
Head Circumference
34 to 35 cm (13.5 to 14in.).
A mature newborn with a head circumference greater than
37 cm (14.8 in.) or less than 33 cm (13.2 in.) should be
carefully assessed for neurologic involvement, although
some well newborns have these measurements.

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 1in.) less than head circumference.
32-33 cm
 VITAL SIGNS
Temperature
99°F (37.2°C) at birth
The majority of heat loss
occurs because of four
separate mechanisms:
convection, radiation,
conduction, and
evaporation
a newborn’s temperature
stabilizes at 98.6°F
(37°C) within 4 hours
after birth.
Convection is the flow of heat from the newborn’s body surface to
cooler surrounding air. Eliminating drafts, such as from air
conditioners, is an important way to reduce convection heat loss.
Radiation is the transfer of body heat to a cooler solid object not in
contact with the baby, such as a cold window or air conditioner.
Moving an infant as far from the cold surface as possible helps
reduce this type of heat loss.
Conduction is the transfer of body heat to a cooler solid object in
contact with a baby. For example, a baby placed on the cold base
of a warming unit quickly loses heat to the colder metal surface.
Covering surfaces with a warmed blanket or towel is necessary to
help minimize conduction heat loss.
Evaporation is loss of heat through conversion of a liquid to a
vapor. Newborns are wet when born, so they can lose a great deal of
heat as the amniotic fluid on their skin evaporates.
Pulse
Within 1hour after birth, as the newborn settles down
to sleep, the heart rate stabilizes to an average of 120 to
140 beats/min.
Slightly irregular
Crying – 180bpm
Sleeping – 90-110 bpm
Femoral pulses can be palpated
Best determined by listening to apical heartbeat
Respiration
The first few minutes of life may be as high as 90
breaths/min
over the next hour, this rate will settle to an average of
30 to 60 breaths/min.
Depth, rate and rhythm are likely irregular, and short
periods of apnea (Periodic respirations) is common
and normal
Watch newborns abdomen; primary involves the use
of diaphragm and abdominal muscles
Newborns are obligate nose breathers and show
signs of distress if their nostrils become obstructed.
Blood Pressure
newborn is approximately 80/46 mmHg at birth
10th day, it rises to about 100/50 mmHg and remains at
that level for the infant year
Blood pressure tends to increase with crying
Hemodynamic monitoring is used when continuous
assessment is required.
Cardiovascular System
The peripheral circulation of a newborn remains
sluggish for at least the first 24 hours, which can cause
cyanosis in the infant’s feet and hands (acrocyanosis)
and for a newborn’s feet to feel cold to the touch.
Blood Values
Blood volume : 80 to 110 ml/kg of body weight or about
300 ml total
Hemoglobin level: averages 17 to 18 g/100 ml of blood
(the average for an adult is 11to 12 g/ml)
Hematocrit is between 45% and 50% (for an adult,
36% to 45%).
Red blood cell count is about 6 million cells/mm3 (for
an adult, 3.5 to 5.5 million cells/mm3 ).
Indirect bilirubin level is between 1and 4 mg/100 ml.
High white blood cell count, about 15,000 to 30,000
cells/mm3 at birth (40,000 cells/mm3 if the birth was
stressful).
Blood Coagulation
It will take about 24 hours for flora to accumulate and for
ongoing vitamin K to be synthesized. This causes most
newborns to be born with a lower than usual level of
vitamin K, leading to a prolonged coagulation or
prothrombin time.
Vitamin K (AquaMEPHYTON) is usually administered
intramuscularly into the lateral anterior thigh, the
preferred site for all injections in newborns, immediately
after birth (.5-1 mg IM 1st hour after birth)
Nursing Implications in giving Vitamin K

Give within an hour after birth.

Administer IM injection into a large muscle, such as the
anterolateral muscle of a newborn’s thigh.
Be certain to administer the injection at a time it doesn’t
interrupt parent–child bonding or beginning breastfeeding.
If giving vitamin K for treatment, obtain prothrombin time
before administration (the single best indicator of vitamin K–
dependent clotting factors).
Assess for signs of bleeding in the infant, such as black, tarry
stools (different from meconium stools, which have a greenish
shade), hematuria (blood in urine), decreased hemoglobin and
hematocrit levels, and bleeding from any open wound or at the
base of the cord. (These signs would indicate more vitamin K is
necessary because bleeding control has not been achieved.)
The Respiratory System
A first breath is a major undertaking because it
requires a tremendous amount of pressure (about 40
to 70 cm H2O) for a newborn to be able to inflate
alveoli for the first time.
The reflex to breathe is initiated by a combination of
cold receptors (a lowered partial pressure of oxygen
(PO2 ), which falls from 80 mmHg to as low as 15
mmHg before a first breath) and an increased partial
carbon dioxide pressure (PCO2), which rises as high as
70 mmHg before a first breath.
The Gastrointestinal System
Although the gastrointestinal tract is usually sterile at
birth, bacteria may be cultured from the tract in most
babies within 5 hours after birth and from all babies at
24 hours of life.
Newborn stomach holds about 60 to 90 ml
Newborn has limited ability to digest everything taken
in, especially fat and starch because the pancreatic
enzymes, lipase and amylase, remain deficient for the
first few months of life.
Stools - usually passed within 24 hours after birth
Meconium, a sticky, tar-like, blackish-green, odorless
material formed from mucus, vernix, lanugo,
hormones, and carbohydrates that accumulated in the
bowel during intrauterine life.
2nd and 3rd day – changes in color and consistency
(transitional stool: appear loose and green)
4 th day (breastfed babies; pass three or four light
yellow stools per day that have a soft consistency.
newborn who receives formula usually passes two or
three bright yellow stools a day of soft consistency.
Newborn placed under phototherapy lights as therapy
for jaundice will have bright green stools because of
increased bilirubin excretion.
Newborns with bile duct obstruction have clay-
colored (gray) stools because bile pigments cannot
enter the intestinal tract.
Blood-flecked stools usually indicate an anal fissure.
Newborn has swallowed some maternal blood during
birth and either vomits fresh blood immediately after
birth or passes a black tarry stool after two or more
days.
If mucus is mixed with stool or the stool is watery
and loose, a milk allergy, lactose intolerance, or some
other condition interfering with digestion or
absorption is suspected.
The Urinary System
Average newborn voids within 24 hours after birth
Newborns who do not void within this time need to be
assessed for the possibility of urethral stenosis or absent
kidneys or ureter
usually light colored and odorless
6 weeks of age before much control over reabsorption of
fluid in tubules and concentration of urine becomes
evident.
Single voiding in a newborn is only about 15 ml
Specific gravity ranges from 1.008 to 1.010
Output: first 1or 2 days is about 30 to 60 ml total
Week 1, total daily volume rises to about 300 ml.
The Immune System
Do not produce antibodies until 2 mos
Born with passive antibodies (Immunoglobulin G)
(Poliomyelitis, measles, diptheria, pertussis,
chickenpox, rubella, and tetanus)
Hepa B vaccine is administered before leaving the
birth setting
The Neuromuscular System
Neuromuscular function by moving their extremities,
attempting to control head movement, exhibiting a
strong cry, and demonstrating newborn reflexes.

Twitching or flailing movements of the extremities in

the absence of a stimulus because of the immaturity of
the nervous system; common and normal
 NEWBORN REFLEXES
Blink Reflex
Elicited by shining a strong light such as a flashlight
into an eye.

Rooting Reflex
Cheek is brushed or stroked near the corner of the
mouth, the infant will turn the head in that direction.
This reflex serves to help a newborn find food.
Disappears at about the 3-4 months
Sucking Reflex
When a newborn’s lips are touched, the baby makes a
sucking motion.
This reflex also helps a newborn find food
Diminish at about 6 months of age.

The Swallowing Reflex

The same as in the adult
Food that reaches the posterior portion of the tongue
is automatically swallowed.
Gag, cough, and sneeze reflexes also are present in
newborns to maintain a clear airway.
Extrusion Reflex
Newborn extrudes any substance that is placed on the
anterior portion of the tongue
Fades at 4 months

Palmar Grasp Reflex

Newborns grasp an object placed in their palm by
quickly closing their fingers on it
Disappears at about 6 weeks to 3 months
After it fades, a baby begins to grasp meaningfully
Step (Walk)-in-Place Reflex
Newborns who are held in a vertical
position with their feet touching a
hard surface will take a few quick,
alternating steps
Disappears by 3 months

Placing Reflex
is elicited by touching the anterior
lower leg against a surface such as the
edge of a table.
The newborn makes a few quick
lifting leg motions, as if to step onto
the table.
Plantar Grasp Reflex
When an object touches the sole of a
newborn’s foot at the base of the toes, the
toes grasp in the same manner as the fingers.
Disappears at about 8 to 9 months
Preparation for walking.

Tonic Neck Reflex

When the arm and leg on the side toward
which the head is turned extend, and the
opposite arm and leg contract
Also called a “boxer” or “fencing reflex.”
Strong for the first 8 weeks of life and then
fades by the end of the fourth or fifth month
Moro Reflex (Startle Reflex)
Elicited with a loud noise or by jarring
the bassinet.
Most accurate method of eliciting the
reflex is to hold a newborn in a supine
position and then allow the head to drop
backward about 1in. In response to this
sudden backward head movement, the
newborn first extends arms and legs,
then swings the arms into an embrace
position and pulls up the legs against the
abdomen (Lehman & Schor,2016).
Strong for the first 8 weeks of life and
then fades by the end of the 4th or 5th
month.
Babinski Reflex
When the sole of a newborn’s foot is
stroked in an inverted “J” curve from the
heel upward, a newborn fans the toes
(positive Babinski sign)
Reflex remains positive (toes fan) until
at least 3 months of age

Magnet Reflex
If pressure is applied to the soles of the
feet of a newborn lying in a supine
position, he or she pushes back against
the pressure.
Test of spinal cord integrity (Crossed
extension reflex and Trunk Incurvation
Reflex)
Crossed Extension Reflex
When a newborn is lying
supine, if one leg is extended
and the sole of that foot is
irritated by being rubbed
with a sharp object, such as a
thumbnail, the infant raises
the other leg and extends it
as if trying to push away the
hand irritating the first leg.
Trunk Incurvation Reflex
A newborn lies in a prone position and is touched
along the paravertebral area on the back by a probing
finger, the newborn flexes the trunk and swings the
pelvis toward the touch
Landau Reflex
newborn is supported in a prone
position by a hand, the newborn
should demonstrate some
muscle tone.

Deep Tendon Reflexes

Both a patellar and a biceps
reflex are intact in a newborn
Hearing
Newborns appear to recognize their mother’s voice almost
immediately
Respond with generalized activity to a sound such as a bell
Have difficulty locating where a sound is coming from.

Vision
Pupillary reflex or ability to contract the pupil is present
from birth
Newborns demonstrate they can see by blinking at a strong
light (blink reflex) or by following a bright light or toy a
short distance with their eyes as soon as they are born
(Clark-Gambelunghe & Clark, 2015).
Black and white; distance 9-12 inches
Touch
The sense of touch is also well developed at birth
Quiet down at a soothing touch, cry at painful stimuli,
and show sucking and rooting reflexes that are elicited
by touch.
Taste
Has the ability to discriminate taste because taste buds
are developed and functioning even before birth.
baby continues to show a preference for sweet over
bitter tastes.
Smell
Present in newborns as soon as the nose is clear of
lung and amniotic fluid.
The Physiologic Adjustment to
Extrauterine Life
 Assessments of Well-being
APGAR SCORING
At 1minute and 5
minutes after birth
An assessment
scale used as a
standard for
newborn
evaluation since
1958 (Apgar,
Holaday, James, et
al., 1958).
THE ASSESSMENT OF
GESTATIONAL AGE
Newborns are said to be term if they are born between
37 and 42 weeks of gestation or within 2 weeks of their
due date.
The Health History
Important information to gather includes:
Any complications of pregnancy such as gestational
diabetes, hypertension, premature rupture of
membranes, serious falls, or other injuries
Length of pregnancy and length of labor
Type of birth (vaginal or cesarean) and whether the
infant breathed spontaneously or needed assistance at
birth
The Physical Examination
THE APPEARANCE OF A
NEWBORN
The Skin
General inspection of a newborn’s skin includes color,
any birthmarks, and general appearance.
The Color
Most term newborns have a ruddier complexion for
their first month
a) Cyanosis
b) Hyperbilirubinemia
c) Pallor
d) Harlequin Skin
Birthmarks
Several common types of birthmarks occur in
newborns
a) Hemangiomas
b) Mongolian spots
Collections of pigment cells (melanocytes) that appear
as slate gray patches across the sacrum or buttocks and
possibly on the arms and legs of newborns.
They tend to occur most often in children of Asian,
Southern European, or African ethnicity and disappear
by school age without treatment (Smith & Grover,
2016).
Be sure to educate parents that these are not bruises.
Vernix Caseosa
noticeable on a term newborn’s skin, at least in the
skin folds, at birth.
Lanugo
fine, downy hair that covers a term newborn’s
shoulders, back, upper arms, and possibly also the
forehead and ears.
37-39 weeks – generous amount
Postterm – rarely have lanugo
2 weeks usually diappears
Desquamation
Within 24 hours after birth, the skin of
most newborns begins to dry
Postterm – extremely dry skin; leathery
appearance and there are actual cracks in
skin folds
it helps to diagnose the newborn as
postterm.

Milia
At least one pinpoint white papule (a
plugged or unopened sebaceous gland) is
usually found on a cheek or across the
bridge of the nose of every newborn.
disappear by 3 to 4 weeks of age
avoid scratching or squeezing the papule,
which could lead to secondary infection.
Erythema Toxicum
commonly presents on the
skin of most term
newborns
The rash usually appears
in the first to fourth day of
life but may appear as late
as 2 weeks of age.
It occurs sporadically and
unpredictably and may
last hours or days.

Skin turgor
newborn skin should feel
resilient if the underlying
tissue is well hydrated.
 THE HEAD
head usually appears disproportionately large because it is
about one fourth of the total body length
Other features include:
• The forehead appears large and prominent.
• The chin appears to be receding, and it quivers easily if the
infant is startled or cries.
• If a newborn has hair, the hair should look full bodied; both
poorly nourished and preterm infants have thin, lifeless hair.
•If internal fetal monitoring was used during labor, a
newborn may have a pinpoint ulcer at the point where the
monitor was attached.
Fontanelles

Fontanelles are the spaces or openings where the skull

bones join
It is diamond-shaped and measures 2 to 3 cm (0.8 to
1.2 in.) in width and 3 to 4 cm (1.2 to 1.6 in.) in length.
Posterior fontanelle is located at the junction of the
parietal bones and the occipital bone; closes by the
end of the second month.
Anterior fontanelle can be felt as a soft spot; normally
closes at 12to 18 months of age.
Sutures
The skull sutures, the separating lines of the skull, may
override at birth because of the extreme pressure
exerted on the head during passage through the birth
canal.
The overriding subsides in 24 to 48 hours
Molding
After birth, this area appears prominent and
asymmetric
Caput Succedaneum
is edema of the scalp that forms on the presenting part
of the head. It occurs in cephalic births and can either
involve wide areas of the head or be so confined that
it’s the size of a large egg.
No treatment is needed (Gooding & McCLead, 2015).
 THE EYES
Tears are rare; lacrimal ducts do not fully mature until
about 3 months of age.
The iris will assume its permanent color between 3 and 12
months of age.
should appear clear, without redness or purulent discharge.
Slight edema is often present around the orbit or on the
eyelids and remains for the first 2 or 3 days
cornea of each eye appears round and proportionate in size
to an adult eye
The pupil, as in adults, should appear dark.
 THE EARS
newborn’s external ear is not as completely formed as
it will be eventually, so the pinna tends to bend
forward easily.
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
The AAP recommends all newborns be screened for
hearing before discharge from their birth setting (AAP,
2013).
A hearing infant will blink, attend to the bell’s sound,
and possibly startle.
 THE NOSE
newborn’s nose usually has milia present and tends to
appear large for the face.

THE MOUTH
newborn’s mouth should open evenly when he or she cries.
The tongue may appear short or “tongue tied” because the
frenulum membrane is attached close to the tip.
Inspect the palate of a newborn to be certain it is intact.
Well-circumscribed cysts (Epstein pearls) can be seen on the
palate from extra calcium that was deposited in utero. Be sure to
inform parents that these pearl-like cysts are insignificant,
require no treatment, and will disappear spontaneously within a
week.
 THE NECK
newborn appears short with creased skin folds.
head should rotate or turn freely on it.
The neck of a newborn is not strong enough to support the
total weight of the head but in a sitting position, a newborn
should make a momentary effort at head control.
When lying prone, newborns can raise the head slightly,
usually enough to lift the nose out of mucus or spit-up milk
Trachea usually appears prominent on the front of the
neck.
Thymus gland also appears enlarged because of the rapid
growth of glandular tissue early in life
 THE CHEST
Chest in most newborns looks small because the head is so
large in proportion to it (an important finding at birth so
the largest diameter of the baby is born first).
Both right and left sides should appear symmetric.
Clavicles should appear straight and feel smooth
A supernumerary nipple (usually found below and in line
with the normal nipples) may be present.
both female and male infants, the breasts may be engorged
because of the influence of maternal hormones during
pregnancy.
RR: 30-60 b/m
listening to lung sounds often reveals rhonchi—the sound
of air passing overmucus.
 THE ABDOMEN
The contour of a newborn abdomen looks slightly
protuberant
Bowel sounds show the bowel is beginning peristalsis and
should be present within 1hour after birth.
On the right side, the edge of the liver is usually palpable 1
to 2 cm below the costal margin.
On the left side, the edge of the spleen may be palpable 1to
2 cm below the left costal margin.
Always inspect the cord clamp to be certain it is secure; On
day 6 to 10, it breaks free, leaving a granulating area a few
centimeters wide that will heal during the following week.
When a newborn voids, it demonstrates that there is at
least one kidney functioning (but not necessarily two).
To finish an abdominal assessment, elicit an
abdominal reflex. Stroking each quadrant of the
abdomen with a finger should cause the umbilicus to
move or “wink” in that direction.
 THE ANOGENITAL
AREA
Male Genitalia
scrotum in most male
newborns is edematous and
has rough rugae on the
surface.
deeply pigmented in dark-
skinned newborns
Both testes should be
palpable in the scrotum.
Penis of newborns appears
small, approximately 2 cm
long.
The prepuce (foreskin)
slides back very little from
the meatal opening
The Female Genitalia
female newborns may
appear swollen because
of the effect of maternal
hormones during
intrauterine life.
newborns also have a
mucus vaginal secretion,
sometimes blood tinged
(pseudomenstruation)
The discharge does not
indicate an infection or
trauma and disappears in
1or 2days.
 THE BACK
normally assumes the position maintained in utero for
days after birth, with the back rounded and arms and
legs flexed across the abdomen and chest.
spine of a newborn typically appears flat in the lumbar
and sacral areas
Inspect the base of a newborn’s spine carefully to be
certain there is no pinpoint opening, dimpling, or
sinus tract in the skin, which suggest a dermal sinus or
spina bifida occulta
 THE EXTREMITIES
The arms and legs of a newborn appear short in proportion
to the trunk
hands seem plump and are typically clenched.
fingernails feel soft and smooth and extend over the
fingertips.
When a newborn moves, the arms and legs should move
symmetrically (unless the infant is demonstrating a tonic
neck reflex).
Newborn legs appear bowed and short.
Sole of the foot is flat because of an extra pad of fat in the
longitudinal arch.
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