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●To provide assessment of the

newborn state of development of
wellbeing
●To detect any deviation from
normal
NEWBORN OBJECTIVES
●To assess progress of the child
ASSESSMENT ●To detect disease in early age
OUR LADY OF FATIMA UNIVERSITY ●To determine the nature of
COLLEGE OF NURSING
treatment or care needed for the
newborn

●First examination: monitoring

the baby inside the womb of the ●Initial
mother before the delivery and 2
hours after birth ●Transitional
PHASES OF
INDICATIONS
●Second examination: before ASSESSMENT ●Assessment of gestational age
discharge ●Systemic physical
●Third examination: after 6- examinations
8weeks of neonatal life

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●1ST STAGE: lasts for 6 hours, first 30

minutes awake and remaining hours
INITIAL TRANSITIONAL the newborn will be sleeping
ASSESSMENT ASSESSMENT ●2ND STAGE: 6 – 12 hours
observation should be made until
the vital signs are established

●Ballard score is commonly used to determine

gestational age. Scores are given for 6 physical
and 6 nerve and muscle development
(neuromuscular) signs of maturity.
ASSESSMENT OF The scores for each may range from -1 to 5.
GESTATIONAL The scores are added together to determine BALLARD
AGE the baby's gestational age. SCORE
●NEUROMUSCULAR MATURITY – include
posture, square window, arm recoil, popliteal
angle, scarf sign, heal to ear
●PHYSICAL MATURITY – skin, lanugo, plantar
surface, breast, eye/ear, genitalia(male/female)

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●Small for gestational age (SGA) – the
newborn is less than 10% of the ideal weight at
the time of birth, less than 2500 gms
ASSESSMENT OF ●Large for gestational age (LGA) – the
GESTATIONAL newborn is more than 90% of the ideal weight
AGE at the time of birth, more than 4000 gms
●Appropriate for gestational age (AGA) – the
newborn is within the ideal range of birth
weight 2500 – 4000 gms
●VITAL SIGNS:
●TEMPERATURE: can be taken through rectal (to
check also for the patency of the anus) or axilla
● Normal temperature: 36.5 to 37.5C
GENERAL ● Hypothermia: less than 36C
● Hyperthermia: more than 38C
PHYSICAL ●RESPIRATION: count by observing the abdominal
EXAMINATION movements and count in one full minute for
accuracy
● Normal respiration – 30 to 60 cpm
● Tachypnea – more than 60 cpm
● Bradypnea – less than 30 cpm
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●FULL TERM – pregnancy that reached
37 to 40 weeks age of gestation
ASSESSMENT OF ●PRE-TERM – pregnancy that reached
GESTATIONAL 21 to 36 weeks age of gestation
AGE
●POST TERM – pregnancy that has
extended to or beyond 40 weeks of
gestation
●VITAL SIGNS
●PULSE – you may use the apical pulse which is
located on the midclavicular between 4th and
5th inter coastal space left. Count in one full
GENERAL minute for accuracy
●Normal pulse rate – 120 – 160 bpm
PHYSICAL
●Bradycardia – less than 120 bpm
EXAMINATION ●Tachycardia – more than 160 bpm
●BLOOD PRESSURE – blood pressure
monitoring is not routinely done. The average
systolic and diastolic pressure is 66/44mmHg at
1-3 days of age
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●To assess the body size, shape and the
composition of the newborn’s body
ANTHROPOMETRIC ●To compare the size with estimated
MEASUREMENT period of gestation
●To identify if there are abnormalities in
newborn
● ABDOMINAL CIRCUMFERENCE – 31 – 33cm
ANTHROPOMETRIC
MEASUREMENT
● BODY LENGTH – 47 – 54cm
● BODY WEIGHT – 2500 – 4000GMS
● HEAD CIRCUMFERENCE – 33 – 35 cm
ANTHROPOMETRIC
MEASUREMENT
● CHEST CIRCUMFERENCE – 31 – 33 cm
NORMAL
- Newborn’s head appears
disproportionately large because it is
HEAD ¼ of the total body length
- Head circumference is 33 – 35cm
- Fontanelles
- Anterior fontanelle – soft and closes
9 – 18 months, diamond shape
- Posterior fontanelle – soft and
2 – 4 months, triangular in shape
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DEVIATION
- Microcephaly – Hc >33cm/> 2.5 cm
- Macrocephaly – HC < 35cm/ < 2 cm
- Widely separated sutures: preterm,
hydrocephalus, cerebral edema
- Bulging fontanelle: subdural
hemorrhage, hydrocephalus, CHF
- Delayed closure: rickets,
hypothyroidism, down syndrome
- Caput succedaneum – swelling or
edema or a bump on newborn’s head
shortly after delivery
- Cephalhematoma – a collection of
blood between a newborn’s scalp and
the skull.
CAPUT SUCCEDANEUM
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NORMAL DEVIATION NORMAL DEVIATION

Fine and silky hair Preterm – fuzzy hair - Top portion of the external ears Low set ears would indicate genetic
Turner’s Syndrome – low hair line should be at the level of the eye syndrome
HAIR and - Eye movements are not yet - Upper slant eye would indicate
EARS and - Ear cartilage: pinna is firm, cartilage

EYES coordinated down syndrome NOSE can be felt at the edges

- Eyelids maybe edematous for 2
days
- Sclera may be pale in color
- Iris is round
- No tears because lacrimal ducts
are not yet fully mature. It will
mature after 3 months
- Instant ear recoil
- Cataract is a signed of rubella and - Tympanic membrane is grey
others - Normal infant can hear sound and can
- Conjunctivitis stimulate moro reflex due to sudden
- Nystagmus noise
- Corneal reflex should be checked - Neonates are also nose breathers - Obstruction of mucus plugs
- Nose are usually flattened after birth - Flaring of nares
- Patency of the nasal passages should
be assessed

Cataract caused by Down Syndrome

Congenital rubella eyes

Different abnormalities in Polyps on the nose Flat nose for client

the ear with down syndrome

NORMAL DEVIATION
SKIN NORMAL
- Pink in color, ruddy or reddish in
DEVIATION
- Pallor would indicate anemia, edema,
- No deviation - Excessive salivation
- Intact palate - Cleft lip color because of the increased shock hypoxia, and hypotension
MOUTH and - EPSTEIN PEARLS are one or two - Cleft palate concentration of red blood cells in the - Cyanosis
blood vessels and a decrease in the - Central Cyanosis – indicates
NECK small round well circumscribed cysts
are present in the palate, a result of amount of subcutaneous fat. This decreased oxygenation
extra load of calcium that was color will fades slightly over the 1st - Peripheral Cyanosis – due to
deposited in the utero month immature peripheral circulation and its
- Skin turgor: sensation of fullness normal within 24 – 48 hours after birth
- Newborn’s neck are usually short - Webbing of neck would indicate
derived from the presence of - CHD
- Head should be extended when turner’s syndrome
hydrated subcutaneous tissue - Severe respiratory distress
examined - Swelling of the neck maybe due to
- Elasticity: when the skin is pinched - Jaundice if within the first 24hours, it
tumor and other abnormalities
and release, it will go back again to could be hemolytic disease. Rh
normal incompatibility. ABO incompatibility,
- Lanugo known also as physiologic jaundice
- Vernix caseosa - Petechiae would indicate infection
- Mongolian spots - Edema indicate over hydration, renal
- Millia failure, coronary heart disease,
anemia
- Forcep mark

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NORMAL DEVIATION NORMAL DEVIATION

- Normal and absence of retractions - Chest retractions MALE - Phimosis
- Prepuce covers the glans penis - Hypospadias - is a birth defect in which
CHEST and -
-
Proportion to the body
Normal circumference is 31 – 33cm
- Crackles sounds during auscultations
- Scrotum with rugae and descended the opening of the urethra is located on

ABDOMEN -
-
Heart rate is 120 – 160bpm
Nipple size 5 - 10mm
testes the underside of the penis instead of the
tip
- Epispadias - is a rare congenital (present
- Witch’s milk - or neonatal milk is milk at birth) abnormality that involves the
secreted from the breasts of some opening of the urethra is on the top rather
newborn human infants of either sex. than on the tip
Neonatal milk secretion is considered MALE and - Cryptorchidism - undescended testes
a normal
- Abdomen is protuberant - Distended abdomen
FEMALE FEMALE
- Labia majora covers the labia minora
- Labia majora does not cover the labia
minora indicate that the newborn is
- Normal abdominal circumference 31 –
33cm
- Prominent liver
- Umbilical hernia
GENITALIA and urethra
- Pseudomenstruation – tinge of blood
preterm

- Liver can be felt at 1 – 2cm below the

right coastal margin
- Bowel sound is present
- Umbilical cord two artery and one
vein

NORMAL DEVIATION NORMAL DEVIATIONS

SPINE - Spina bifida - is a condition that HANDS - Simian usually presence of one
- No mass or nodules
- Normally straight
affects the spine and is usually
apparent at birth. It is a type of neural
EXTREMETIES - Creases
- Complete Fingers
straight crease in the hand and can be
seen in client with down syndrome
tube defect - Syndactyl - the fingers or toes are
- Meningomyelocele - is a sac that FEET webbed or joined and that the
contains: part of the spinal cord. - Creases condition was present at birth
ANUS - No opening - Fullterm –creases covering the entire - Polydactyl - is when a baby is born
- Patent sole with an extra finger on the hand or an
- Post mature – deep creases over the extra toe on the foot
SPINE and - Passes of meconium within 24hours
after birth foot - Clubfoot is a

ANUS - Premature – no creases or partially

covering the upper 2/3 of the sole
- Complete fingers
- no abnormal curvature
congenital foot deformity that affects
a child's bones, muscles, tendons, and
blood vessels

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REFLEXES - are
involuntary
movements or
actions. Some
movements are
spontaneous and REFLEXES
occur as part of
the baby's normal
activity. Others
are responses to
certain actions.

REFLEXES