NEW BORN

ASSESSMENT
 When should the Newborn
assessment be done?
Newborn Assessment is done as soon as after
birth as possible, the mother should be allowed
to spend some time with the baby immediately
after birth to initiate the bonding process.
• To understand the physical and mental well
being of the child.
• To detect disease in early stage.
• To determine the cause and effect of the
disease.
• To teach child and parent.
• To measure the health in future.
• To determine the nature of treatment or care
needed for the child.
 General Points to be
Remembered
• Examine 1 hour after feeding.  
• Examine in neutral thermal environment.  
• Examine the presence of the mother.  
• Examine gently and methodically.  
• Examine those system which require a quiet
child first and later do examination that tend
to disturb the child.
 Health Assessment of Newborn
after delivery can be divided into:
• Initial Assessment
• Assessment of gestational age
• Systemic physical examinations
INITIAL ASSESSMENT
 APGAR SCORING
• Apgar scoring is one of the first chechs of
your new baby’s health. The Apgar score is
assigned in the first few minutes after birth
to help identify babies that have difficulty
in breathing or have a problem that needs
further care.
• Virginia Apgar, MD (1909-1974)
introduced the Apgar score in 1952.
 How the test is Performed
The Apgar Test is done by a doctor, midwife,
or nurse. The provider examines the baby’s:
• Breathing Effort
• Heart Rate
• Muscle Tone
• Reflexes
• Skin Color
Each category is scored with 0,1,2 depending on
the observe condition.
Sign Score = 0 Score = 1 Score = 2

Heart Rate Absent Below 100 per Above 100 per

minute minute
Respiratory Absent Weak, irregular, Good Crying
Effort or gasping
Muscle Tone Flaccid Some flexion or Well-flexed or
arms and legs active
movements of
extremities

Reflex or No response Grimace or weak Good cry

Irritability cry
Color Blue all over, or Body pink, Pink all over
pale hands and feet
blue
 Causes of Low Apgar Score
• Asphyxia
• Maternal Drugs
• Central nervous system disease
• Congenital muscular disease
• Prematurity
• Fetal sepsis
 VITAL SIGNS
Respiratory Rate:
• 30-60 breaths/ min.
Heart Rate: 110-160 BPM
• Can be 180 if crying
• Can be 100 if sleeping
• Take apical pulse for 1 full min.
 
Temperature (auxiliary)
• 97.7 - 99.5 F
• 36.5 - 37.5 C
Blood Pressure:
• -Not done routinely
• -Systolic 60-80 mm Hg
• -Diastolic 40-50 mm Hg

Map:
• Equal to the # of weeks gestation or higher

Signs of respiratory distress:

• -Retraction
• -Nasal Flaring
• -Grunting
 GENERAL
CHARACTERISTICS
(Head and Chest Circumference)
 
• Head circumference
• 32-39 cm
• 14-15 inches
• *measures above eyebrows
 
• Chest circumference
• 30-36 cm
• 12-14 inches
• *measure above nipple line
(Length & Weight)

Expected Length
• 44-55 cm
• 17-22 in

Expected Weight
• 2500-400g
• 5 lb , 8 oz- 8 lb , 14 oz
 
 HEAD
Caput Succendeum:
• Edema (collection of fluid)
• Crosses the suture lines
• (Like a baseball cap)
• Molding: abnormal head shape that results from pressure
(normal)
• Fontanelles:
• -Bulging = increase ICP or Hydrocephalus
• -Sunken = dehydration
Cephahemtaoma:
• Birth trauma (collection of blood)
• Does not cross the suture lines

• -Fontanelles may be bulging when the

newborn cries, vomits or is lying down.
This is normal.
 UMBILICAL CORD
• -Should have 2 arteries & 1 vein
• -Should be dry, no odor & no drainage
 TEMPERATURE
• Evaporation- moisture from skin and
lungs
• Convection- body heat to cooler air
• Conduction- body heat to a cooler surface
in direct contact
• Radiation- body heat to a cooler object
nearby
 
Assessment of Gestational Age
 Gestational Age
• how long is the pregnancy.
• measured from the first day of the woman's
last menstruation (LMP) up to current date.
• can also be measured before birth and after
birth.

Before Birth After Birth

-Using ultrasound to -Assessing the physical
measure the size of the maturity of the baby.
baby's head, abdomen and
thigh bone.
McDonald's Rule
• Has two ways to calculate AOG.
• Using long method AOG is determined
using the number of days since LMP to the
present day divided by 7.
Using Fundal Height
Bartholomew's Rule
• "Age of gestation can be determined using
the height of the fundus."
 USING FUNDAL HEIGHT TO
GET AOG
A. Bartholomew's
B. McDonald's Rule
1. Length of fundus in cm x B÷7= AOG in
weeks
2. Length of fundus in cm x 2÷7= AOG in
months
3.Getting AOG using MacDonald's Long
Method
Sol:
LMP + succeeding days up to present day = n
n÷7= AOG
EDD
"Estimated Date of Delivery“

Naegele’s Rule
• Use LMP to calculate EDD
• If the LMP is January, February ,March + 9
(months) + 7 (days)
• If the LMP is April to December - 3
(months) + 7 (days) + 1 (year)
Systematic Physical
Assessment
 Systematic Physical
Examination for Newborn 
Examination of the Cardio Vascular System
-Requires with the techniques of inspection, palpation,
and auscultation.
Inspection of the general activity of the neonate-
breathing patterns, presence or absence of cyanosis, and
activity of the precordium are all important.
 Palpation -palpating of pulses, peripheral perfusion, and
thrills are also imperative.
Auscultation- assesses heart rate, rhythm, regularity, and
heart sounds (especially murmurs). 
• The provider will listen/count for heart rates
within the normal range, abnormal sounds such as
certain murmurs or clicks, and irregular beats.
• Heart rate and rhythm are assessed by palpating
the carotid or radial pulse or by cardiac
auscultation if arrhythmia is suspected.
• Heart sounds can also be heard in the back.
• 120-160 beats/ min pical pulse normally taken
• Average BP – term baby: 70/45 mmhg
• Preterm: 60/20 mmhg
Auscultation Palpation
 Respiratory System
- Examination of the respiratory begins with
observation of the color of the skin and
mucous membranes, respiratory rate, breathing
pattern, and work of breathing.
- It requires the techniques of
Inspection,Auscultation and Palpation.
Inspection
Respiratory rate, rhythm, and Depth.
• Auscultation - stethoscope (diaphragm),
when listening of infants.
• Palpation - wash and warm hands to gently
examine the tracheal
mobility,alignment,head.and lymph nodes.
• Pulse. 120-160 beats per minute
• Breathing rate 40-60 beats per minute
Examination of the Respiratory System
History of cough
• Pneumonia
Diabetes mellitus
• RDS
Preterm
• RDS
Polyhydromnios
• Asphyxia , respiratory distress
Character : dyspnoea, tachypnoea, apnoea , grunting ,
 Central Nervous System 
• Examining this area involves determining the
newborn's level of alertness, muscle tone, and
ability to move arms and legs equally. Unequal
movement could be a sign of an abnormality of
the nerves (such as a nerve palsy). 
• In line with the examination, there are few tools
that might aid in the examination of the newborn.
This includes: 1) bell, 2) ophthalmoscope, 3)
reflex hammer, 4) cotton-tipped application, 5)
measuring tape. 
Behavior
As early as 5-day old, we can already observe
spontaneous movements of the newborn as being
associated with normal factors regarding the CNS. They
might have movements and characteristics such as: 

• Non-excessive and smooth flowing body movements

• Slightly attentive to the environment
• He makes attempts to organize and comfort himself
by sucking on his fists
• definite response of the eyes
• Response to sound
Cranial Nerves
Examination of the baby’s cranial nerve function is
often accomplished by observing spontaneous
activity. 
CN VII (Facial nerve): As the newborn is crying,
his/her facial movements are observed for fullness
and asymmetry.

CN IX & X: quality and strength of the cry

CN V, VII, IX, X, & XII: swallowing and sucking 
CN III, IV, VI: Various eye movements
CN II: Baby’s response to light
The assessment of tone and posture can be made both
from observing the posture, activity of the infant when
undisturbed, and by handling the baby. Infants with
normal tone will not feel “floopy” when held by the
examiner. Few tome procedures are:
• Resting Posture
• Arm Traction
• Arm Recoil
• Upper extremity tone
• Hand position
• Lower extremity tone
• Tone leg traction
• Leg recoil
• Popliteal Angle
• Heel to ear
• Neck tone
• Head lag
• Head control
• Prone
Resting Posture Upper Extremity Tone
Arm Traction Leg Traction
Popliteal Angle Head Control
 Reflexes of Normal Newborn
Sucking Swallowing
Sneezing and Coughing
Foreign substance entering the upper or lower
airways.
Some of the reflexes that last till adulthood
are:
• Blinking reflex: blinking the eyes when
touched or when a sudden bright light
appears.
• Sneeze reflex
• Cough reflex
• Gag reflex: gagging when the throat or back
of the mouth is stimulated
• Yawn reflex: yawning when the body needs
more oxygen
 Other Infant Reflexes
Moro Reflex (Startle reflex)
A reflex is a type of involuntary (without trying)
response to stimulation. The Moro reflex is one of
many reflexes that are seen at birth. It normally goes
away after 3 or 4 months.
Response: when the infant hears a sudden loud sound
or experiences unexpected movement like falling, the
infant will extend the arms with palms up, and then
move the arms back to the body. The infant will have
a “startled” look and sometimes crying is noted
afterwards.
Tonic Neck Reflex (fencing reflex)
Response: when an infant’s head is turned to a particular side,
the leg and arm on that side will extend, while the leg and
arm on the other opposite side will flex. Turning the baby's
face in the other direction reverses the position. The tonic
neck position is often described as the fencer's position
because it looks like a fencer's stance. Disappears at about 4
months of age.
Step Reflex
Response: when holding the infant upright
with legs and feet touching a surface, the
infant will move the legs like taking steps or
walking. Disappears at about 3-4 months of
age.
Grasp Reflex (palmar & plantar grasp
reflex)
Response:
• Palmar Grasp: when placing a finger or
stroking the inside of the infant’s palm, the
hand will close around it.
Disappears at about 4-6 months of age.
Plantar Grasp: when a finger is placed under the
toes, the toes will curl. Disappears at about 9 months
to 1 year of age.
Crawl Reflex (Bauer Crawling Reflex)
Response: when the infant is placed on the stomach
and pressure (such as a hand) is applied to the sole of
the foot, the infant will attempt to push against the
hand and move the arms and legs in a crawling-like
motion.
Disappears after a few weeks to months after birth.
Doll’s Eye Reflex (oculocephalic reflex)
Response: with the infant in a supine position and
slowly turning the head to either side. The infant’s
eyes will remain stationary or the infant moves their
eyes opposite of the direction of the head so that the
eyes stay looking forward (like a doll’s eyes)
Disappears at about 3-4 months of age.
 GROUP 5:
DIANA AME GERONA
JADE CAROLINE ORBASE
JAN MARIE EDER
THERESA ALPAJARO
CRISTINE B. DIESTA
ANGELICA BOLA
XYRA JOY GEROLIA
XYRA MAE CERUOLOS
ROXANE EVA
JUSTIN GALAN
CELLINE ISABELLE REYES
MAE YZABEL SANTILLAN
PRINCESS JAMELA CAMU
THANKYOU!