PHYSICAL CHARACTERISTIC OF THE NEWBORN Normal range: 36.5C-37.

5C (axilla)

 Vital Signs Axillary: 36.4C-37.2C

 Anthropometric measurement
Skin: 36.0 C-36.5C
 General Appearance
Rectal: 36.6C-37.2C
Assessment of The Newborn
* Temperature 37.2 at birth
Initial Physical Examination:
Anthropometric Measurements (Vital Statistics)
A. General Guidelines:
BW: 2.5-3.4 kgs (5.5-7.5 lbs) * 1 K = 2.2 lbs
 Keep the NB warm during the examination.
 Begin with general observations and then perform BL: 47.5-53.75 cm (19-21 1/2 in)
assessment that are least disturbing to the NB first.
 Initiate nursing interventions for abnormal findings. Average: 50.8 cm/20 in * 1 inch = 2.54 cm
 Document all abnormal findings.
HC: 33-35 cm
1. Vital Signs
CC: 31-33 cm
A. Pulse - 1 full minute; use apical pulse - irregular, rapid
AC: 31-33 cm
>160-180 at birth
Chest circumference: Should be equal to or 2-3 cm Less than the
NORMAL: 120-160 bpm HC

During sleep - 90-110 bpm

If crying, up to 180 bpm Physiologic weight loss

B. Respirations - 1 full minute - 5-10 % in 10 days

- irregular, shallow, rapid w/ brief apneic spells < 15s Causes

60-80 breaths/min at birth 1. No longer under influence of maternal hormones

NORMAL: 30-60/minute 2. Voids and passes out stools

C. Blood Pressure - not usually measured 3. relatively low nutritional intake

80-60/45-40 mm Hg at birth 4. beginning difficulty establishing sucking

100/50 mm Hg at day 10

D. Temperature Immediate Assessment of the Newborn

General appearance
  Skin gland) can be found in the cheek or across the bridge of the
 Head nose of every newborn.
 Eyes  Disappears by 2-4 wks of age as the sebaceous glands
 Ears mature and drain.
 Neck  Parents should be instructed to avoid scratching or
 Chest squeezing the papules to prevent secondary infection.
 Abdomen  Benign cyst, Disappear Within few weeks After birth
 Genitalia
ERYTHEMA TOXICUM
 Back
 Extremities  In most normal mature infants, newborn rash.
 Full term newborns have a flexed posture  It usually appears in the 1st to 4th day of life, but may
 The head is flexed appear up to 2 wks of age
 Arms is flexed on the chest  Also called Flea bite rash
 Legs are flexed on the abdomen  One of the chief characteristics of the rash is the lack of
pattern.
Skin
 Lesion are most noticeable at 48H After birth but may
 Plethora (deep, rosy red color) more common in infants appear as late as 7-10 days
with polycythemia vera but can be seen in an  BENIGN RASH resolves spontaneously
overoxygenated or overheated infant.
Mottling lacy pattern
 Vernix caseosa – a white creamy substance may thinly
cover the skin. May be seen in the healthy infant or with
 Lanugo-fine downy hair, may still be seen on the forehead
and shoulders or it may all disappeared. 1. cold stress
 Pinkish red
2. Hypovolemia
 Vernix caeosa
 Lanugo 3. Sepsis
 Milia
Persistent mottling- referred to as cutis marmorata
 Dry peeling skin-
 Cyanosis – Candida albican rash
o Hypothermia
o Hypoglycemia  Appear erythematous plaque with sharply demarcated
o Infection edges Skin fold are involved
o Cardiac Treatment:
o Respiratory
o Neurological abnormalities  Nystatin ointment or cream Applied to the rash 4x daily for
7-10 days
MILIA

 Newborn sebaceous gland is immature. At least one pin-

point white papule (a plugged or unopened sebaceous  Acne Neonatorum
 Lesion typically seen over the check, chin and forehead
  Benign and requires no therapy 5. Turning the baby q2hours.
 Severe cases may require treatment with mild keratolytic
6. Hydration.
agent such as 3% sulfur salicylic acid
NURSE ALERT!!!
FORCEPS MARK
Most accurate method of assessing the presence of jaundice: Use
 There may be a circular or linear contusion matching the rim
natural light and blanch skin on the chest or tip of the nose
of the blade of the forcep on the infant’s cheek.
 The mark disappears in 1-2 days along with the edema that  Acrocyanosis
accompanies it.  Harlequin sign
 ✓ Deep pink or red color develop over one side while the
Jaundice
other side remain PALE or normal color
Types:  Indicative of shunting of blood with cardiac problem or
sepsis
1. Physiologic Jaundice / Icterus Neonatorum
 Birthmarks
2nd day-7th day-TERM (12mg/dl- indirect bilirubin)
Birth marks
2nd day-10th day-PRE-TERM
Telangiectatic Nevi (stork bites) - disappear age 2yrs.
2. Pathologic Jaundice- before the first 24 hours of life
 pale pink or red, flat, dilated capillaries
✓Causes:  Nevus Flammeus (port-wine stain)
 No fading with time
 Infection  Require surgery in the future
 Hemolytic disorders Inability of the newborn to conjugate  Common on face
bilirubin  Non-elevated, sharply demarcated red to purple dense area
of capillaries
Breastfed babies have longer physiologic jaundice because human
milk has PREGNANEDIOL, which depresses the action of glucoronyl Nevus Vasculosus (strawberry mark)
transferase (enzyme responsible for converting indirect bilirubin to
direct bilirubin)  Disappear @ 7-9 yrs old
 Common in head
Goal of treatment: to decrease the bilirubin levels  Dark red
 Mongolian Spot - fades 1-2 years old
Management: Bililight (Phototherapy)
 Bluish black pigmentation
Nursing Care:  Lumbar dorsal area or buttocks

1. Cover eyes with an opaque mask to prevent blindness.

2. Maintain a distance of about 18-20 inches from source of light. Head

3. Monitor V/S especially temp.  25% of the body length (cephalocaudal development).
Larger Part
4. Cover the genitalia to prevent PRIAPISM (continuous erection).
 Sutures are palpable
  Fontanels are unossified membranous tissue at the junction Craniotabes - localized softening of cranial bones; indented by
of the sutures pressure of a finger.
 Molding is asymmetry of the head resulting from the
➤Corrects w/o treatment in weeks or months.
pressure in the birth canal, overlapping of sagittal and
coronal suture line ➤ Common to first born because of early lightening
Fontanels Hydrocephalus - anterior fontanel open after 18 months
1. Anterior - diamond shape Microcephaly - small growing brain.
- closes 12-10 months Anencephaly - absence of cerebral hemisphere
- 3-4 cm long/2-3 cm wide Seborrheic dermatitis - " Craddle cap"
- junction of 2 parietal bones and 2 fused frontal bones ✓Scaling greasy appearing salmon-colored patches, seen on the
scalp behind ears and umbilicus
- not indented depressed
✓CAUSE:
- suture lines - never appear widely separated
Improper hygiene
2. Posterior - triangular in shape
✓Mgt:
- junction of the parietal bones and the occipital bones.
 Proper hygiene
- 1 cm wide
 Oil before shampoo
- closes months of age
Eyes
Masses from birth trauma
 Symmetrical and clear
Caput succedaneum - edema of the soft tissue over bone  Pupil equal, round, react to light by
(crosses over suture line)  accommodation
 Blink reflex present
✓ No treatment subsides in few days
 Strabismus common - weak EOM
Cephalhematoma - is swelling caused by bleeding into an area  Ability to track and fixate momentarily
between the bone and its periosteum (does not cross over suture  Red reflex present
line)  Eyelid often edematous
 Visual acuity = 20/200;20/800
✓ Absorbed within 6 weeks

✓ No treatment
EARS

 Symmetrical
CRANIOSYNOSTOSIS - suture lines separated or fontanels  Firm cartilage with recoil
prematurely closed; leads to mental retardation.  Pinna on or above line drawn from canthus of eye.
  sense of Hearing - highly developed in NB  Nipples prominent & edematous
 Milky secretion common (witch milk)
Nose
 Breast tissue present
 Nasal obligates  Clavicles need to be palpated to assess for fracture
 Note for marked flaring of alae nasi.
- Indicative of airway obstruction
 Causes of obstruction: abdomen

1. Secretions  Umbilical cord

 monitor cord for meconium staining
2. septal deviation
 Assess for umbilical hernia
 Sense of smell - least developed  Note for abdominal depression
 Assess for abdominal distention
Mouth  Monitor bowel sound- occur 1-2H after, birth
 Gastroschisis
 Pink, moist gum
 Omphalocele
 Soft and hard palates intact
 Umbilical cord
 Epstein pearl (small, white cyst) that may be present on
hard palate ANUS
 Uvula on midline
 Symmetrical and free moving tongue ✓ Ensure anal opening is patent
 Sucking & crying movement symmetrical
✓ First stool meconium should pass within first 24H
 Able to swallow
 Gag reflex present Genitals

NECK Female:

 Thyroid gland not palpable  Labia edematous, clitoris enlarged

 Soft, palpable and creased with skin folds  Pseudomenstruation (+)
 Head - rotate freely on the neck and flex forward and back.  First voiding occurs within 24H
 (+) rigidity of the neck- CONGENITAL TORTICOLLIS (injury to
Male
SCM)
 NB whose membranes ruptured 24 hours before birth-nuchal  Prepuce covers glans skin
rigidity → meningitis  Scrotum is edematous
 Verify meatus at tip of penis
 Testes descended, retract @cold temp.
CHEST  Assess for hernia or hydrocoele
 First voiding occur w/in 24H
 Circular appearance - AP and Lateral diameter are about
EQUAL.
 Diaphragmatic respiration
o Ambiguous Genitalia
 Bronchial sounds heard on auscultation
 o Hypospadia Care of the Newborn at DELIVERY ROOM
o Epispadia
>Establish and Maintain AIRWAY (Respiration)
o Hydrocoele
o Inguinal Hernia >Test for Patency

SPINE A. Suctioning

 straight >Turn the baby's head to one side.

 Posture flexed
>Suction gently and quickly (5 to 10 seconds). Prolonged and deep
 Supportive of head momentarily when prone
suctioning of the nasopharynx during the first 5 to 10 minutes of
 Arms and legs flexed
life will stimulate the VAGUS NERVE (located in the esophagus) and
 Chin flexed on upper chest
cause bradycardia.
 Well-coordinated, sporadic movement
 Hypotonic or hypertonic indicate CNS damage POSITIONING OF THE NEWBORN
Extremities The position when suctioning should be one that promotes drainage
of secretions -
 Flexed
 Symmetrical movement ✓ HEAD LOWER THAN THE REST OF THE BODY BUT head should be
 Fists clenched higher than the rest of the body
 Ten finger, 10 toes
 Leg bowed C.l if there are signs of increased ICP:
 Creases on soles of feet  Vomiting
 Pulse palpable  Bulging, tense fontanels
 Slight tremor common but could be sign of hypoglycemia  Dilated scalp veins
 Assess for hip dysplasia- no click should be heard  Abnormally large head
 Increased BP
 Decreased PR and RR
 Polydactyly  Widening pulse pressure
 Syndactyly  Shrill, high-pitched cry-late sign
 Polydactyly and syndactyly
NURSING ALERT
BACK
1. Always humidify to prevent drying of mucosa
•On prone appears flat, (curves start to form when child learns to
sit or stand) •Note: for mass, hairy nodule and a dimple along axis. 2. Over dosage of 02 can lead to scarring of retina leading to
This may be indicative of Spina Bifida. blindness (RETROLENTAL FIBROFLASIA or RETINOPATHY OF
PREMATURITY

Establishment of extra uterine circulation Circulation is initiated by

IMMUNE SYSTEM lung expansion completed by cutting of cold

(Pic)
Establishment of extra uterine circulation Failure to Pass:

CIRCULATION - several circulatory changes are necessary for THINK OF HIM

successful changes from FETAL circulation to NEONATAL circulation.
1.Hirschsprung dse
A. Pulmonary Blood vessel - dilation, begins at first breath
2.Imperforate Anus
results: lower pulmonary resistance this allows the blood to freely
3. Meconium Ileus
circulate through the lungs to be oxygenated.

B. Ductus Arteriosus
2. Transitional - passed from 3rd to 10th day
- reversal blood flow increased pressure in aorta and increase O2 in
the blood→ more blood flowing through the pulmonary arteries for 3. Milk stool
oxygenation.
a. Breast fed infant stool - loose golden yellow in color with sweet
- closure complete w/in 24H odor; 2- 3 times a day
- permanent: 3-4 weeks b. Bottle fed infant stool - formed, pale yellow with a typical odor;
usually passed 1-2 times a day
C. Foramen Ovale

- closes within minutes after birth → because of the higher pressure

in the LA than in the RA→ Increase blood flow in the lungs → DIFFERENT STOOL
decreases pressure in the RA→ the return of blood from the lungs
increases the pressure in the LA Jaundice baby Light stool

✓ Closure: permanent approximately 3 months Under phototherapy Bright green

✓ Failure to close becomes ASD Mucus mixed with stool Milk allergy
D. Ductus Venousus
Obstruction to bile duct Clay colored
- cord clamped blood ceases flowing from umbilical vein to ductus
After Barium enema Chalk clay colored
venosus and into IVC blood now flows through the LIVER and is
filtered as in adult circulation GIT bleeding Black stool
Obliterate: @2 months become Ligamentum venosum
Anal fissure Blood flecked stool
Waste Elimination
Intussusceptions Currant jelly stool
3 types of stools passed by NB:
Hirsch jump Ribbon like stool
1. Meconium - greenish-blackish viscous; - amniotic fluid, Intestinal
secretions and cells shed from mucosa Malabasorption Steatorrhea (fatty foul-
syndrome (celiac, cystic smelling stool),
- take note of time when meconium first passed (Normally : 24-36H) fibrosis)