Unit 6-Newborn Development

and Nursing Care

Topic 6.1: Assessment of the Newborn
 Topic 6.1-Assessment of the
Newborn
• Describe:
• Standardized assessment of newborn-APGAR scoring
• Gestational age
• Explain Physiological changes of the newborn to extrauterine
life and assessment of each system
• Identify genetic screening and assessments commonly
performed
• Describe:
• Hypo/hyperglycemia
• Hypothermia
• Infection
• hyperbilirubinemia
 LPN Scope of Practice in Newborn
Assessment
• Competency L
• http://www.clpna.com/wp-content/uploads/2013/02/AB%20LP
N%20Competency%20Profile%20-%20K-Maternal%20Newborn
%20Care.pdf
 Apgar Scores

• What are we measuring?

• Heart rate, respiratory effort, muscle tone, reflex
response, colour. Appearance
• How do we “test” reflex response?

Done at 1 & 5 & 10 minutes.

Totals:
0-2 = severe distress
3-6 = moderate distress
7-10 = minimal/ no distress
 Gestational Age Assessment

• Gestational Age assessment

• Refer to Newborn Care Map on Moodle

• Done on all newborns regardless of weeks

gestation or size.
• Helpful in determining maturity of infants
designated term by dates, but may actually be
preterm due to miscalculated dates.
 General Appearance

• Weight: varies-dependent on nutrition, genetic, race. Lose 5-

10% of birth weight in first few days of life.
• Height: average length is 46-54 cm
• Head circumference: usually 34-35 cm
• Temperature: normal about 37C at birth
• HR: 110-160bpm
• RR: 40-60/minute
 Physiologic Function & Adjustment
of Newborn to Extrauterine life
• Cardiovascular
• Shunts start to close
• Acrocyanosis
• What is this?
•When is cyanosis not normal?
• Blood coagulation
• Vitamin K
• Respiratory
• First breath a lot of work
• Lung sounds – Vag vs. C/S delivery
• Gastrointestinal
• Stools
• Meconium – first stool black and tarry
• Day 2 – 3 transitional stool (usually green and loose)
 Physiologic Function & Adjustment
of Newborn to Extrauterine life
• Urinary
• Should void within 24 hours
• First void only about 15 mL
• Immune
• Have passive antibodies from mother
• Are at risk of infections first 2 months
• Neuromuscular
• Should never be limp or absent muscular response
• Many reflexes – What do we assess in AHS/Covenant?
• Moro – startle reflex: drop a bit
• Root reflex: stroke cheek should move towards
• Suck reflex: can it suck?
• Grasp: hand grasp
• The senses
• Hearing, vision (black & white 9-12”), touch, taste, smell
 Newborn Assessment

• Initially start by:

• LOOK, LISTEN & FEEL

• Listen to heart, lungs & bowel sounds first.

• Then work head to toe.

**It is very important to keep baby dry to

prevent heat loss
 Newborn Assessment

Cardiopulmonary Exam
• Look at the chest
• Observe colour, symmetry, work of breathing,
resp rate.
• Heart sounds; rate, rhythm. 2 distinct sounds.

• Listen to lungs – bilateral breath sounds.

Adventitious sounds
 Newborn Assessment

Head
• Head circumference – average 34-35cm
• Fontanels
• Molding
• Cephalohematoma
• DO NOT cross suture lines
• Caput Succedaneum
• Can cross suture lines
 Newborn Assessment

Ears, Eyes, Nose & Mouth

• Ears
• Cartilage formation (gestational age)
• Position, size, visible auditory canal
• Eyes
• Discharge, pupil size (equal), hemorrhages
• Nose
• Nares patent bilaterally
• Mouth
• Palate intact, Epstein pearls (cysts on palate), suck
reflex
 Newborn Assessment

Gastro-Intestinal
• LOOK & LISTEN first
• Inspect
• Auscultate bowel sounds
• Feel the tummy – should be soft

• Anus Patent
• Cord Clamp secure
• What do we teach about cord care? Water, keep dry
• What does an infected cord look like? Red, pusy
 Newborn Assessment

Genitourinary: Male
• Penis:
• Do not attempt to retract foreskin over glans
• Look for epi- or hypospadias

Testes:
• Feel both testes (support), look for hydroceles, hernias any
abnormalities
• Assess rugae for gestational age assessment

Ambiguous genitalia
Note first void
 Newborn Assessment

Genitourinary: Female
• Labia:
• Large labia major is common due to maternal hormones
• Observe size & separation of labia for gestational age.

Vagina:
• Vaginal discharge is common.
• Pseudomenses is possible due to maternal hormones

Ambiguous genitalia
Note first void
 Newborn Assessment

Musculoskeletal
• Clavicles – Feel for fractures

• Arms/ Legs – Range of motion, tone, symmetry

• Positional Feet
• Also assessing creases on soles for gestational age assessment

• Digits – Number & abnormalities

 Newborn Assessment

Musculoskletal – Spine
• Turn infant over onto your forearm & look at entire spine
• Feel vertebral column for defects

• Examine sacral area

• Clefts, hairy tufts, change in pigmentation
• These can indicate spina bifida

Look for Major defects

• meningomyelocele, sinus tracts
 Newborn Assessment

Neurological
• Look carefully and evaluate neurological status during
exam of other systems
• Symmetry of motion, tone, response to stimuli, pitch
of cry, repetitive motions, palsies

Reflexes:
• Moro - startle
• Grasp – palmar, plantar
• Suck
• Rooting
 Newborn Assessment

Skin
• Look at entire skin throughout the exam
• Jaundice
• Mongolian spots
• Rashes
• Milia
• Cradle Cap
• Stork bites - telangiectatic nevus

Be sure to document any abnormal skin findings!!!!

 Newborn Metabolic Screen - Alberta

• http:/Alberta Metabolic screen

• PKU phenyleketonuria (disease of defective protein metabolism)
• Need to have been fed for 24 hours prior to test as it measures
metabolism
 Common Complications in the
Newborn
• Hypoglycemia
• Hyperglycemia
• Hypothermia
• Infection
• Hyperbilirubinemia
 Hypo/hyperglycemia

Hypoglycemia:
• Often seen in Large for gestational age (LGA) and macrosomic
babies
• Can result from the effort the newborn needs to expend to establish
respirations
• Energy expended to regulate heat
• Babies of GDM moms – rebound hypoglycemia
• Babies are prone to hypoglycemia; need to be assessed carefully
Hyperglycemia
• Often do not see in the newborn
• Could be due to infection in the newborn
• Often have no symptoms; can produce large urine output and become
dehydrated
 Hypothermia

• Rub baby dry and remove wet linen

• Swaddle in dry warm blankets
• Place a cap on the baby’s head
• Any extensive procedure should be done under heat source to
maintain temperature
• Can be a sign of underlying condition – Hypoglycemia, RDS,
jaundice
• Temperature:
• Usually have temp of 37C by 1 hour post birth
• First day measure q4 hours; after that it should be stabilized
 Infection

•Can be caused by:

•Group B Strep (GBS)
•Chlamydia
•Gonorrhea
•Umbilical cord

•Watch out for thrush – side effect of

antibiotics
 Hyperbilirubinemia-Jaundice

Physiological Jaundice: 50% of newborns develop jaundice.

Breakdown of RBC’s and immature liver result in backlog of fat
soluble bilirubin in the blood. It stains the skin and sclera.
Liver enzyme (glucuronyl transferase) makes it water soluble and
baby pees and poops it out. It might take a few days for liver
enzyme to mature FOR SOME BABIES
 Hyperbilirubinemia-Jaundice

Physiological versus Pathological Jaundice

• High levels of bilirubin could become
pathological and cause Kernicterus which
is bilirubin staining the brain tissue. Can
result in mental retardation.
 Hyperbilirubinemia-Jaundice

Treatments of Jaundice
• Mild Jaundice - Keep baby warm, feed baby
• Moderate Jaundice - As above, plus more frequent checking of
bilirubin levels, may use phototherapy
• Severe Jaundice - As above, plus phototherapy,IV fluids and
possibly exchange transfusion
 Hyperbilirubinemia-Jaundice

PHOTOTHERAPY
• Protect eyes
• Check temperature
• Encourage more fluids(breast milk/formula)
• Monitor bilirubin levels
• Monitor intake and output
• Observe neurodevelopmental

• Kernicterus – bilirubin in brain tissue