NEWBORN SCREENING
Blood spot collection
RA 9288
Newborn Screening
- a simple procedure to find out if a baby has a
congenital metabolic disorder that may lead to
mental retardation or even death if left
untreated.
- To assess for genetic and metabolic
abnormalities, hearing problems, specific
heart problems, and other conditions that can
hinder their development.
Importance
- Most babies with metabolic disorder look
normal at birth.
- One will never know that the baby has the
disorder until the signs and symptoms are
manifested. By this time, irreversible
consequences are already present.
- helps us find babies who have certain serious
medical conditions so that they can begin
treatment right away.
When is newborn screening done?
- Ideally done on the 48th to 72nd hour of life
(first 2 to 3 days of life).
- May also be done 24 hours from birth since
some disorders are not detected if the test is
done earlier than 24 hours from birth.
 
PARTS of NBS
● Blood
● hearing
● heart screening.
How is newborn screening done?
- Using the heel prick method, a few drops of
blood are taken from the baby’s heel
- Blotted on a special absorbent filter card
- Blood is dried for 4 hours and sent to the
Newborn
- Blood spot collection can be performed by
trained perspnnel such as hospital nursery
staff, laboratory staff or out of hospital birth
providers
- TIMING OF COLLECTION: blood spots
drawn too early or too late may yield false
results
- Best collected between 24 and 48 hrs of age
( at least 24 hrs old)
- Blood spots collected before 24 hrs generates
an unsatisfactory results that require another
blood spot collection
- Avoid touching the area within the circles on
the filter paper section before, during and after
collection of th specimen since oils and other
materials from the hands might affect or
contaminate the card or specimen
- Do not allow water, feeding formulas,
antiseptic solutions, glove powder, hand
lotion or other materials to come into contact
with the specimen card before of after use
- Blood collection from the heel is the standard
for newborn screening
- The medial and lateral parts of the underfoot
are preferred
Blood should NEVER be collected from:
● The arch of the foot
● The fingers
● The earlobes
● a swollen or previously punctured site
● IV lines containing other substances (TPN, blood,
drugs)
- Warm the heel with a warm dampcloth or
commercially available heel warmer and
position the leg lower than the heart to
increase venous pressure before collecting the
blood spots.
- The infant should be swaddled in a blanket
with only one foot exposed.
- Powder free gloves are bestworn while
collecting the blood spots
- Lotion, vaseline and other substances which - Once the blood spots have dried completely,
can interfere with bloodspot analysis should the biohazard flap can be closed and the
be kept off the infant’s skin newborn screening card can be sent to the
- Wipe the skin clean with an alcohol wipe and Newborn screening program
allow to thoroughly air dry
- Use a sterile lancet or heel incision device to
make an incision 1mm deep and 2.5 mm long  When are newborn screening results available?
( shallow incision is more safer) - Seven (7) working days from the time the
- Wipe away the first drop of blood with a newborn screening samples are received
sterile gauze pad parents should claim the results from their
- Allow a large drop of blood to form using the physician, nurse, midwife or health worker.
thumb to intermittently apply gentle pressure - Any laboratory result indicating an increased
to the heel may be helpful in encouraging the risk of a heritable disorder (i.e. positive
drop to coalesce screen) shall be immediately released, within
- Touch the first circle on the newborn twenty-four (24) hours, so that confirmatory
screeningcare gently against the large blood testing can be immediately done.
drop and in one step, allow the blood to soak - A positive screen means that the newborn
through the filter paper and fill the circle. must be referred at once to a specialist for
- Do not press the paper directly against the confirmatory testing and further management.
baby’s heel. Each of the five/four circles need
to be filled and saturated through
- Apply the blood to any one side of the filter FIVE (5) DISORDERS CURRENTLY
paper INCLUDED IN THE NEWBORN SCREENING
- Do not apply multiple layers of blood drops to PACKAGE
the same circle
- The circles are measures and should contain a Screened Effect if NOT Effect if SCREENED
set volume of blood. Layering can interfere SCREENED and TREATED
with the accuracy of the test by providing
non-standard amount of blood on non-uniform Congenital Severe Mental Normal
analyte concentration Hypothyroidism Retardation
- Excessive milking or squeezing of the (CH)
puncture site can result in an unsatisfactory
Congenital Death Alive and Normal
specimen because of hemolysis breaking
Adrenal
down the blood cells to be analyzed or mixing
Hyperplasia
tissue fluids in the specimen which can dilute
(CAH)
the blood
- Allow the specimen to dry flat at room Galactosemia Death or Alive and Normal
temperature for at least 3 hours ( this is (GAL) Cataracts
essential in maintaning the integrity of the
blood spots) Phenylketonuri Severe Mental Normal
- Keep them out of direct sunlight and way a (PKU) Retardation
from other heat sources
G6PD Severe Anemia, Normal
- Avoid stacking the cards
Deficiency Kernicterus
- Do not close the biohazard flapover the spots
until they are completely dry
  that converts into tyrosine causing elevation
GALACTOSEMIA (GAL) of phenylalanine in the blood.
- Screening of newborns for PKU entails
simple heel stick blood sampling test called
Guthrie test
- Phenylalanine is neurotoxic
- Excessive accumulation of phenylalanine in
the body causes brain damage
- Phenylalanine hydroxylase (PAH) is either
missing or not working properly
- The first effects are usally seen arounf 6
- -GAL is a condition in which the bdy is
months of age
unable to process gaactose, the sugar present
- Untreated infants may be late in learning to
in milk.
sit, crawl and stand. They may pay less
- Accumulation of excessive galactose in tha
attention to things around them.
body can cause many problems including liver
- Without treatment, a child with PKU will
damage,brain damage and cataracts
become mentally retarded
 
 
- An inherited disorder that lacks an enzyme
CLINICAL Manifestations:
(Galactose-1-phophate uridyl transferase/Gal-
- Severe intellectual impairment
1-PUT) which helps the body break down the
- Microcephaly
galactose
- Eczema
- Seizures
  
- Hypopigmentation
Management of Galactosemia
- Hyperactivity
- Avoid milk and milk products substituted
- Autistic behavior
with Lactose free or Galactose Free milk such
 
as Soy-based milk formula
Management:
- Galactose restricted diet must be followed for
- Should start as soon a possible but no later
life and requires close supervision and
than 7 to 10 days
monitoring
- Protein diet restriction
 
 
CONGENITAL ADRENAL HYPERPLASIA
- An endocrine disorder caused by
G6PD DEF
abnormalities in specific enzyme of the
- G6PD deficiency is an X-linked hereditary
adrenal gland that causes severe salt lose,
disease, which means it is caused by a
dehydration and abnormally high levels of
defective gene and effects males almost
male sex hormones in the both boys and girls.
exclusively and is transmitted by the mother
- If not detected and treated early, babies may
only to son or daughter who will become
die within 7-14 days
another carrier.
 
- Glocuse-6-Phosphate Dehydrogenase
PHENYLKETONURIA (PKU)
Deficiency
- PKU is an autosomal recessive metabolic
- An inherited condition in which the body
disorder in which the body cannot properly
lacks the enzyme glucose-6 phosphate
use one of the building blocks of protein
dehydrogenase which helps red blood cells
called phenylalanine, an essential amino acid
function normally
 - This deficiency can cause hemolytic anemia ● Phototherapy
usually after exposure to certain medications, ● Blood transfusion
foods or even infections
- G6PD is one of many enzymes that help the
body process carbohydrates and turn them CONGENITAL HYPOTHYROIDISM
into energy HYPOTHYROIDISM
- G6PD also protects RBC from potentially - is a condition in which the person does not make
harmful byproducts that can accumulate when enough thyroid hormone.
a person takes certain medications or when
the body is fighting an infection
- Without G6PD to protect the blood, RBC can
be damaged or destroyed
- Hemolytic anemia is a disorder in which the
RBCs are destroyed faster than the bone
marrow can produce them
Kids with G6PD deficiency typically do not show
any symptoms of the disorder until their RBC are
exposed to certain triggers which are:
● illness (bacterial and viral infections)
● certain painkillers and fever reducing dtugs
like aspirin
● certain antibiotics( especially those that
have”su;f” in their nameslike
sulamethoxazole- bactrim)
● certain antimalarial drugs ( those that with
“quine” in their names like chloroquine(
● Soya foods-taho, tokwa, soy sauce
- Red wine
- Legumes- monngo, garnazos, abitsuelas
- Vitamin K
- Naphthalene (moth balls)
- blueberries
- s/s: anemia like symptoms
● Paleness ) in darker-skinned children
paleness is sometimes best seen in the mouth,
especially on the lips or tongue)
● Extreme tiredness
● rApid heartbeat
● Rapid breathing or shortness of breath
● Jaundice or yellowing of the skin and eyes
particularly on newborns
● Enlarged spleen
● Dark-tea-colored urine
- Prevention/treatment
● Limit exposure to the triggers
● Folic acid

APGAR SCORE
What is the APGAR SCORE?
- The Apgar score is a scoring system doctors
and nurses use to assess newborns one minute
and five minutes after they’re born.
- Dr. Virginia Apgar created the system in
1952, and used her name as a mnemonic for
each of the five categories that a person will
score. Since that time, medical professionals
across the world have used the scoring system
to assess newborns in their first moments of
life.
- Medical professionals use this assessment to
quickly relay the status of a newborn’s overall
condition. Low Apgar scores may indicate the
baby needs special care, such as extra help
with their breathing.
What is the Apagar Score?
● the first test given to a newborn to
determine it's physical condition (occurs right
after birth)
● recorded at 1 and 5 minutes after birth
● calculated by adding points, either 2,1, or 0
● best possible score is out of 10
● points given for muscle tone, skin color,
heart rate, respiratory effort, and response to
stimulation
What do the Apgar Scores mean?
● after the 1 minute Apgar evaluation, if the
newborn scores between a 7 and 10, it will
receive normal care from there on out
● if the newborn scores between a 4 and 6,
they may need help breathing
● anything lower than a 4, would mean that
the infant needs extreme measures to save it's
life
A is for Activity
-         How is your baby’s movement?
● 0 point - no movement. Almost “limp’’
● 1 point - some flexing in the arms an/or legs
● 2 points - active. Arms and legs flex resist to extend
P is for Pulse
-         How fast is baby’s heart rate? (in 1 minute)
● 0 point - no pulse
● 1 point - less than 100 beats per minute
● 2 points - higher or equal to 100 beats per minute
 
G is for Grimace
-         How does your baby react when being
irritated?
● 0 point - no response
● 1 point - only facia; expression
● 2 points - pulls away, cries, sneezes etc
 
A is for Appearance
-         What color is your baby?
BLUE (WHERE)
● 0 point - Everywhere
● 1 point - everywhere but the torso
● 2 points - normal (PINK)
 
R is for Respirations
-         What is the baby’s breathing like?
● 0 point - absent
● 1 point - slow,weak.irregular
● 2 points - strong cry, normal effort and rate

APGAR SCORE
SCORE OF 0 SCORE OF 1 SCORE OF
2
ACTIVITY absent Flexed arms and active
legs
(muscle tone)

PULSE RATE absent Below 100 bpm Above

100 bpm
(heart rate)

GRIMACE floppy Minimal Prompt

response to response
(reflex irritabilty) stimulation to
stimulatio
n
APPEARANCE blue/pale Pink body wih pink
blue
(skin color)
extremities

RESPIRATION absent Slow and Vigorous

irregular cry
(breathing)

 
DUBOWITZ/BALLARD SCORING

 Based on the neonate's physical and

neuromuscular maturity

 can be used up to 4 days after birth

  evaluates a baby's appearance, skin texture, NEUROMUSCULAR MATURITY

motor function, and reflexes.

 The physical maturity part of the examination

is done in the first 2 hours of birth.

 The neuromuscular maturity examination is

completed within 24 hours after delivery.

 This scoring allows for the estimation of age

in the range of 26 weeks-44 weeks.

 an extension of the above to include

extremely pre-term babies i.e. up to 20 weeks.

 The scoring relies on the intra-uterine changes

that the fetus undergoes during its maturation.

POSTURE

 Total body muscle ton is reflected in the

infant’s preferred posture at rest and
resistance to stretch of individual muscle
group
 To elicit the posture item, the infant is placed
supine (if found prone) and the examiner
waits until the infant settles into relaxed or
preferred posture.

PHYSICAL MATURITY
SQUARE WINDOW POPLITEAL ANGLE

 Wrist flexibility and/or resistance to extensor
strethching are responsible for the resulting
angle of flexion at the wrist.
 The examiner straightens the infant’s fingers
and applies gentle pressure on the dorsum of
the hand, close to the fingers. From extremely
pre-term to post-term, the resuling angle
between the palm of the infant’s hand and
forearm is estimated at; >90 degrees, 90
degrees, 45 degrees, 30 degrees, 0 degree
 The appropriate square on the score sheet is
selected.
 This maneuver assesses maturation of passive
flexor tone about the knee joint by testing for
resistance to extension of the lower extremity.
With the infant lying supine, and with the
diaper re-moves, the thing is placed gently on
the infant’s abdomen with the knee fully
flexed. After the infant has relaxed into this
position, the examiner gently grasps the foot
at the sides with one hand while supporting
the side of the thigh with the other.

SCARF SIGN

 This maneuver tests the passive tone of the

ARM RECOIL flexors about the shoulder girdle.
 The examiner nudges the elbow across the
 This maneuver focuses on passive flexor tone
chest, felling for passive flexion or resistance
of the biceps muscle by measuring the angle
to extension of posterior shoulder girdle flexor
of recoil following very brief extension of the
muscles.
upper extremity.
 With the infant lying supine, the examiner
places one hand beneath the infant’s elbow for
support. Taking the infant’s hand, the
examiner briefly sets the elbow in flexion,
then momentarily extends the arm before
releasing the hand.
HEEL TO EAR

 The examiner supports the infant’s thigh

laterally alongside the body with the palm of
one hand. The other hand is used to grasp the
infant’s foot at the sides and to pull it toward
the ipsilateral ear.

NEWBORN ASSESSMENT

ANTHROPOMETRIC MEASUREMENT

Weight

 2.5-4.5 kg

Length

-measured from the top of the head to the bottom of

one of their heels
  Female – 53 cm (20.9 in)
 Males – 54 cm ( 21.3 in)
Head circumference
-Wrap a flexible, non-stretchable measuring tape
around their head at the widest part – just above the
eyebrows( 1-2 fingers) and ears, and around the back
where the head slopes up prominently from the neck
 34-35cm
Chest circumference
-measured at the level of the nipple, at the end of
expiration
-2 cm less than the head circumference
 30-33 (12-13 inches)
Vital signs
1. TEMPERATURE
 99F ( 37.2 C) at the moment of immature
temperature regulating mechanisms
 birth bec they have been confined in an
internal body organ.
 Falls immediately because of heat loss
 Convection – flow of heat to body surface to
cooler surrounding air.
 Conduction- transfer of heat to a cooler solis
object in contact with the baby.
 Radiation – transfer of heat to a cooler
solid/object not in contact with the baby.
 Evaporation – loss of heat through
conversion of a liquid to a vapor.
 loses heat easily
 has difficulty conserving heat under any
circumstances.
INSULATION
–effective for adults but not for newborns because
they have little subcutaneous fats to provide
insulation
-Constricting blood vessels
BROWN FAT
–a special tissue found in a mature newborns helps to
conserve or produce body heat by increasing
metabolism.
-Found in the intrascapular region, thorax, perineal
area
-Because newborns have difficulty conserving heat,
exposure to cold is detrimental, newborns tends to
kick and cry to increase metabolic rate to produce
more heat.
 newborns tends to kick and cry to increase
metabolic rate to produce more heat.
HOW TO CONSERVE HEAT:
 Drying and wrapping newborns
 Placing them in a warmed crib
 Placing them in a radiant heat source
 KANGAROO CARE– placing the newborn
against the mother’s skin and covering the
newborn to help transfer heat from the mother
to the newborn.
2. PR - ruddy/red ( term)- RBC and less SQ fats

 Transient murmurs - incomplete closure of - cyanosis- decrease oxygenation

fetal circulation shunts
- hyperbilirubinemia- yellow /jaundice
 Immediately after birth - 180bpm
- pallor- pale( anemia)
 Within an hour after birth- 120-140bpm
B. Birthmarks
 Irregular because of the immaturity of the
C. Vernix caseosa
cardiac regulatory center in the medulla.
D. Lanugo
 Femoral pulses can be felt readily in a
newborn. If absent = suggest possible - fine downy hair
coarctation ( narrowing) of the aorta.
- disappears by 2 weeks
 Radial and temporal pulses are difficult to
- covers NB’s shoulders, back, upper arms, forehead
palpate
and ears

E. Desquamation
3. RESPIRATION
-dryness ( palms of the hand soles of the feet)
 1st few minutes of life - 80 breaths/min
-No need treatment
 Average- 30-60 breaths/min -seen on postmature babies
 Respiratory depth, rate and rhythm are F. Milia
irregular and short periods of apnea
sometimes called PERIODIC -Pinpoint white papule foundon the cheeks and on the
RESPIRATIONS which are normal. bridge of the nose

 Coughing and reflexes are present at birth to -Disappear by 2-4 weeks( maturation of sebaceous
clear the airway. glands)

 Nose breathers -Don’t squeeze or scratch

G. Erythema Toxicum

4. BLOOD PRESSURE -Newborns rash

 at birth - 80/46 mm Hg -Appears in the 1st to 4th day of life-2 weeks of age

H. Forcep Marks
 10th day - 100/50 mmHg
-Disappears 1-2 days

APPEARANCE OF A NEWBORN
HEAD
SKIN
A. Fontanelle- shd not ne indented
A. Color
B. Sutures
-Wide separation( increased ICP, hydrocephalus, opens evenly
accumulation of blood from birth injury)
-large tongue
C. Molding
-Epstein pearls (palate)
D.Caput succedaneum

-edema of the scalp

NECK
- disappear- 3 day
rd

-short and chubby, rotates freely

E. Craniotabes
CHEST
-localized softening of cranial bones
-witch’s milk
-Common in 1 born infants
st

-rhonchi
-Cranium – skull
-location of nipples
-Tabes- wasting

F. Cephalhematoma
ABDOMEN
-collection of blood between the periosteum of the
skull -slightly protuberant, umbilicus

EYES ANOGENITAL AREA

-no tears until 3 month EXTREMITIES

-subconjunctival hemorrhage

-periorbital edema( 2-3 days) NEWBORN REFLEXES

Blink Reflex

EARS  to protect the eye from any object coming

near it by rapid eyelid closure.
-not completely formed
Rooting reflex
-term – pinna recoils
 Serves to help the baby find food.
-visualizing tympanic membrane is difficult
 Newborn’s cheek is brushed or stroked near
the corner of the mouth, the child will turn the
head in that direction.
NOSE
 Disappears abt the 6th week of life. - at this
-large
time, the eyes can already focus and can
already see.

MOUTH Sucking Reflex

  When a newborn’s lips are touched, the baby
makes a sucking motion.
 Diminish at 6 months of age
 Disappears immediately if not stimulated.
Swallowing reflex
 Food that reaches the posterior portion of the
tongue is automatically swallowed.
 Gag,cough and sneeze reflex are also present
to maintain a clear airway in the event that
normal swallowing does not keep the pharynx
free of obstructing mucus.
Extrusion Reflex
 Extrude any substance that is placed on the
anterior portion of the tongue.
 This protective reflex prevents the swallowing
of inedible substances.
 Disappears about 4 months of age- until then,
an infant may seem to be spitting out or
refusing solid food placed in the mouth.
Palmar Grasp Reflex
 Grasp an object placed in their palm by
closing their fingers on it.
 Mature newborns grasp so strongly they can
be raised from a supine position and be
suspended from the examiner’s fingers.
 Disappears at 6 weeks to 3 months
 A baby begins to grasp meaningfully at about
3 months of age.
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 of age
Tonic neck Reflex
 When newborn’s lie on heir backs, their head
usually turn to one side of the other.
 The arm and the leg on the side to which the
head turns extend, and the opposite arm and
leg contract
 Movement is evident in the arms
 Also called the Boxer or fencing reflex
 Disappears between the 2nd and 3rd month of
life.
Moro / Startle Reflex
 Can be initiated by startling the newborn with
a loud noise or by jarring the bassinet
 The most accurate method to elicit reflex is to
hold newborns in a supine position and allow
their heads to drop backward an inch .
 They abduct and extend their arms and legs.
 Fingers assume a typical “C” position
 The reflex stimulates the action of someone
trying to ward off an attacker, then covering
up to protect himself.
 Strong for the 1st 8 weeks
 Disappears at the end of 4th or 5th month when
the infant can roll from danger.
Babinski Reflex
 When the side of the sole of the foot is stroked
in an inverted “J” curve from the heel upward.
 This reaction occurs because nervous system
development is immature.
 Remains positive until 3 months of age
 SKIN, HAIR, NAILS

HEAD AND NEACK

-assess shape of head, movement of neck

EYES AND EARS

MOUTH, THROAT, NOSE, SINUSE

-assess opening of mouth, moisture, check palate,

assess tounge, check potency, nasal falring,
respiratory distress, check sinuses

HEART AND NECK VESSEL

-indicate heart rate

ABDOMINAL

-assess bowel sound

EXTREMITIES

-assess movement of extremities

GENITALIA

-assess scrotum

NEUROLOGIC

-describe mental assessement

RESPIRATORY RATE- first vital sign to be

monitored

NURSING CARE PLAN

ASSESSMENT
NOTES  Subjective- patient only
 Objective-observed, parents, relatives

PHYSICAL ASSESSMENT
NURSING DIAGNOSIS
GENERAL ASSESSMENT
PLANNING
-Vital signs
 SMART
-Anthropometric measurements
 State the exact nursing intervention
-Cry
RATIONALE  Bacillus Calmette Guerin
 .05 ml
EVALUATION
 Given only at birth
 Intradermal-perpendicular, deltoid, 15 degrees
angle, insert the bevel not the needle, and
FDAR observe bleb or wheel
FOCUS  Class- immunological, antisera/antiserum
 Use to prevent tuberculosis among newborns
DATA  Treat tb
-assess positioning and attachment  Contraindication- severe illness, seve fever,
malnourished
-describe mouth of newborn  Side effect- small swelling in injection site,
absessforsome, fever, rashes
-describe the position of baby
 Responsibilities- advise parents not to scratch
-related to problem it, assess if there is fever, assess allergic
reactions
-there should be introduction (received baby boy

ACTION

-past tense

RESPONSE

-state interventions
VITAMIN K

 0.1 ml
 Use to prevent further bleeding
 Neweborn does not have the bacteria to
produce vitamin k
DRUG STUDY  Intramuscular
HEPATITIS B VACCINE  Vastus lateralis
 Given ate left thigh when hep in on right
 Intamuscular  Monitor for bleeding episodes, assess if there
 0.5 ml is darkening of skin, assess for gengival
 Vastus lateralis- first dose bleeding, check platelet count, check if there
 Engerix-a is a presence of blood in urine
 Contraindication-hypersensitivity to yeast  Given after delivery
 Side effect- dizziness, inflammation
 Given after delivery
 Second dose- after 1 month (left thigh)
 3rd dose- after 2 months
NEWBORN ASSESSMENT

 Dry from head to toe

BCG VACCINE  Skin to skin
  Place bonnet
 Place towel
 Wait 2-3 mins before cutting umbilical cord
 Inject oxytocin to mother
 Observe, initiate breastfeeding
 Do anthropometric measurements
 Give eye ointment to baby (inner to outer
canthus), do not touch eyes, do not remove
excess
 Give hepa b, bcg, and vitamin k vaccines
 Rest the baby
 Transient murmurs is normal
 When palpating femoral pulse, you can feel it,
but if you can’t, there is a contraction of aorta
 Radial and tempral pulse are hard to palpate
RESPIRATORY RATE
 1 min- 80 bpm
 Average- 30-60 bpm
 Irregular and shallow for newborn, they also
cough to clear airways
 Remove secretion on mouth and nose

ANTHROPOMETRIC MEASUREMENTS

 Weight- undress, consider time, done at the BLOOD PRESSURE

same time (at morning, then another
morning), no diaper  At birth- 80/46 mmHg
 Length- head to heels, side lying, female- 53  10th day- 100-50 mmHg
cm (20.9 inches), males- 54 cm(21.3 inches)
 Head circumference- place tape measure
around occiput, above eyebrows, 34-35 cm, SEQUENCE OF GETTING VITAL SIGNS
<33 is microcephaly
1. RR
 Chest circumference- at level of niple, taken
2. PR
at end of expiration, bigger head-smaller chest
3. TEMP
4. BP

VITAL SIGNS

TEMPERATURE

 99 farenheit (37.2 degree celcius)- they have APPEARANCE OF NEWBORN

this temp. because they are in uterus
SKIN
 drop in temp. (hypothermia, no clothing)
 newborn have no brown fat, especially Color
immature, but term baby have which warm
their bodies  ruddy/red- RBC, less subcutaneous fat- grade
 brown fat (thorax, perineal) of 2
 cyanosis- decrease oxygen
 they are crying and kicking to produce
metabolism for heat  yellow/jaundice
 pallor- pale (grade of 0)

Birth marks
PULSE RATE
 vernix caseosa- skin folds, provides warmth,
 180 beats per min., but after 3 mins or 1 hour, acts as a thermoregulator, do not remove
it becomes 120-140 bpm
  lanugo MOUTH
 desquamation- leather-like skin
 open evenly, if not, there is a problem in CN
 milia- bridge of nose, cheeks, related to
7, tounge is large, epstein pearls (palate)-
immature sebaceous glands, just like white
calcium
heads, do not scratch because it causes
infection
 erythema toxicum
 forcep marks- assisted forcep delivery NECK

HEAD  short and chubby, rotates freely

Fontanelle

 when palpated, not intended, but if, it is CHEST

abnormal condition  nipples (inflamed) and secretions
 baby should not be crying and eating  witch’s milk related to maternl hormones
Sutures

Molding ABDOMEN
 head is deformed- caused by mother’s  slightly protuberant, umbilicus (check color,
pushing, disappears in how many days 6-7 days will fall off)
 caput succedaneum- pressure during delivery
 craniotabes- palpate head (soft)- related to ANOGENITAL AREA
pressure
 testes (pendulous)
 cephalhematoma
 female (big labia)

EYES
EXTREMITIES
 no tears until 3 months because of immature
 check for extra toes
sweat glands
 check palms/soles for creases
 presence of blood on conjunctiva related to
pressure

EARS

 not completelt formed

 preterm- stays that way
 ears are still occupied with vernix and
amniotic fluid

NOSE

 large