Download - Initial Assessment of the Neonate
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INITIAL ASSESSMENT OF THENEWBORN
Presented
ByBarbara D. Mlewah
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OBJECTIVES
1. To outline the techniques used inexamination of the newborn.
2. To outline the principles of newbornexamination.3. To describe the procedure of initial
assessment of the newborn.
4. To describe the characteristics of anormal newborn.
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TECHNIQUES USED
Observation/inspection (very importanttechnique)
Auscultation Palpation Percussion
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PRINCIPLES OF NEWBORNEXAMINATION
Necessary tools should be ready at hand;stethoscope, ophthalmoscope, tape measure,thermometer and watch
Create a conducive environment; clean, safe,flat surface, warm and out of draughts, well lit
Review records:
-antenatally; medical history that can be passed onto the baby, weight gain, obstetric complicationsduring pregnancy any STIs
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PRINCIPLES OF NEWBORNEXAMINATION
-labor; duration of first & second stages oflabor, time of rapture of membranes,
number of vaginal examination,medications received in labor, anyobstetric complications, mode of delivery,
fetal condition during labor, Apgar score Wash hands before touching the baby
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PRINCIPLES OF NEWBORNEXAMINATION
Calm the baby before beginning theexamination
Keep baby warm during the examination Handle the neonate gently Examination should be systematic
Complete the examination
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PROCEDURE FOR INITIALEXAMINATION
When examining the newborn start withinspection of the general condition, if
satisfactory continue with specific examinationas follows:
-check V/S starting with temperature
-temperature should be within the normal range
36 to 37.2 degrees Celsius, if not stop the wholeexamination- keep baby warm
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PROCEDUREArea examined Expected
characteristicof a termneonate
Abnormal
findings
Posture:
inspection
Head turned to 1
side, arms & legsflexed (supine orprone)
Extended limbs
or flog position-preterm, sick,nerve injury,fracture
Appearance No apparentinjury/abnormality
An apparentinjury orabnormality
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Well being:
inspection
Active, alert, normalmuscle tone
Lethargic & sick,twitches, fits &coma
color:
inspection
Face, chest, tongue & lipsare pink. Hand and feetmay be bluish
Cyanosis, pallor,jaundice, dark red,grey, meconeumstaining
Temperature(axilla)
36 to 37.2 degrees Celsius Less than 36 ormore than 37.2
Respirations: inspection&
auscultation
30-60 b/min (not crying)regular & quite, no chestin-drawings, no nasal
flaring, chest and abdomenmove with each breath
More than 60b/min,gasping, apnea withlow heart rate or
cyanosis, grunting,stridor, wheezes
Heart rate:auscultation
100-160b/min, shortperiods of change in heart
rate are normal (crying)
More than 160/lessthan 100
(persistent)
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Skin & scalp:
Inspect &palpate
Color: as above
State: soft & smooth,white bumps on the
face (milia), Vernixcaseosa and lanugo onthe face, slight bruises,birth marks, Mongolian
spots
Color as above
State: dry, peeling,very red, very thick
or thin. Little orexcessive vernix orlanugo, swelling
Measurements
Head circumference:33-37cm occipitalfrontal
Length: crown heel 48-54cm, average 51cm
Less than 33cm-microcephally, SGA,preterm.
More than 37cmLGA, hydrocephaly
Weight: after 1hour of birth
2500 to 3800gm.Newborns loose 5-10%
of bwt, but shouldth
Less than 2500-SGA,preterm more than
3800gm- LGA
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Head: shape
Inspect andpalpate
Elongated oruneven due tocaput and
moulding
Abnormal shape inanencephaly orhydrocephaly
Excessive caput &moulding, cephalo-hematoma due tovacuum extraction
Head: skull bones,sutures andfontanels
Inspect and
palpate
Bones: slightlymovable atsutures
Sutures: slightly
open or justoverriding
Fontanelles: open,soft and flat
Bones: very soft orhard & immobile
sutures: very wide,excessive
overriding, fusedFontanelles: verywide or not palpable
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Head: scalp &hair
inspect
Scalp: intact, slightswelling (caput)
Hair: good scalp
growth
Scalp: bruising andswellings, abrasionsand cuts
Hair: fine, downy forpreterm, low blackhair line (turnersyndrome)
Face: inspection Normal appearance Slight or grossanomalies, bruising,facial palsy
Eyes: inspection,
examine withlight orophthalmoscope
Normal size and
shape, correctplacement,symmetrical. Nodischarges & not
sticky 1.5cm- 2.5cm
Agenesis (one or
both), asymmetrical,eyelid edema,bruising, tears,discharge, ptosis
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Eyeballs: corneacorrect size, clear,bright and shiny. Nolesions or marks
Sclera: white
Eyeballs: corneasmall (rubella),large (glaucoma),sub-conjunctivableeding
Sclera: blue
(brittle bones)yellow
Pupils: react evenly tolight
Conjunctival sacs:
pink
Pupils: irregular,cataracts,abnormal eyemovements
Conjunctival
sacs: pale
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Nose:inspection
Midline, flattish, broad, lowbridge, wide & patentnostrils. Air from nostrils
heard & felt duringbreathing
Squashed, no bridge(syphyillis) blocked,mucus ++ (choanal
atresia) purulent orbloody secretions,cleft
Lips:
inspection
Pink, normal size and
shape
Blue, bruised
Cleft lip
palate:inspection
Both soft and hard Clefts, high arch,congenital defects
Gums:
inspection
Pink, symmetrical, horse
shoe shape, smallretention cysts
Cyanosed,
asymmetrical due toclefts, jaundice,teeth, sweeling,bleeding
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Mucusmembranes:inspection
Pink, moist and shiny Cyanosed, yellow,pale
Saliva: inspection Normal: drooling Excessive bubbles
Ears: inspection Upper ear in linewith outer corner ofthe eye. Pinna
vertical, ears wellformed, symmetrical
Low set ears (downssyndrome)
Poorly formed
Neck: inspect &palpate
Short, thick with skinfolds. Head in
midline, no masses,some head control,side to sidemovement,
extension and flexion
Webbing, extended,goiter, no head
control, restrictedmovement, fracturedclavicle, swelling
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Chest: inspect Barrel, prominent end ofximphsternum,symmetrical movements
with respirations
Funnel or bulgingchest, rib recessionin respiratory
distressBreast:inspect andpalpate
Palpable breast nodules0.51 cm diameter
Enlarged and lactating
witches milk
Mastitis, smallnodules poorlydeveloped nipples
Mal-positionednipples
Theabdomen:
shape &movement
Inspect &auscultate
Rounded, bowel soundpresent 1hr after birth,
moves with respirations
Distended or hollow,no bowel sounds or
bowel sounds heardin the chest withproblems
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Umbilicus: inspect 2 arteries, 1vein,grayish white,drying around
base, no bleeding
1 artery, 1 vein,redness, soggy,smelly, bleeding,
hernia, meconeumstaining
Abdominal organs:palpate
Liver palpable 2cmbelow right costal
margin, softSpleen: tippalpable in thininfants
kidneys: lowerborder palpableback flank in thininfants only
Liver: enlarged, firm,tender
Spleen: enlarged,firm
Kidneys: enlarged,firm, malformation,
absent
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Female genitalia Clitoris & labiaoften edematous.Labia majora well
developed, vaginaorifice present,white discharge,mucoidal blood
tinged discharge(up to 7 days)hymenal tags seen
Clitoris enlarged,labia fusion,absence of vaginal
orifice orimperforatedhymen
Male genitalia Scrotum welldeveloped, testespalpable in a sac
Penis: urethralopening at centreof glans
Undescendedtestes, inguinalhernia
Penis: micro-penis
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Anus: inspection Correct positionand patent,meconeum passed
Imperforated anusor displacedanteriorly, no
stools, blood instools
Arms and hands:inspect and
palpate
Arms: full range ofmovement,
brachial pulsepalpable 80-150b/min in 1st24hours, equal andstrong
Hands wellformed, all digitspresent , palmercreases well
developed
Arms extendedwith no movement
(Erb-Duchenneparalysis)
Fractured clavicle
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Lower extremities:inspection,palpation- Ortolan or
Barlow test fordislocated hip
Hips & legs: semi-flexed, full rangeof motion
includingabduction, longbones normal size,femoral pulses
felt. Welldeveloped plantercreases
Legs extended(fractured),dislocated, abduction
limited, reducedfemoral pulses, extraabnormal digits,clubfoot or talipes
Back and spine:inspect
Spine: straight,easily flexed
limited movement,neural tube defect,spina bifida
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NEUROLOGICAL ASSESSMENT
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A. MORO REFLEX
1. Grasp thebaby's hands,
extend thearms andreleasesuddenly
-gives a startledresponse. Arms
fling out inembracingmovement, fingersfan out
symmetrically
-asymmetricalbody response
(fractured clavicle,injury to brachialplexus)
2. Lift the baby'shead off thelying surface
in the palm ofthe hand, thenallow head tofall back in thepalm about
2cm
-Legs may extend,eyes wide open
Slow return of
limbs to the flexedposition. Presentup to 8 months
-weak incompleteor absent- grossimmaturity
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B. GRASP REFLEX
1. Palmer: placethe tip of your
finger in thebaby's hand
Baby will firmlygrasp tip of the
finger
2. Plantar: placefinger at baseof baby's toes
Toes curldownward
Present from birthto 8 months
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C. WALKING REFLEX
Hold baby aroundupper thorax, under
arms, in a standingposition with the feeton a flat surface
-baby simulateswalking by lifting
and placing onefoot in front of theother
-asymmetry ofwalking
(neurologicalabnormality)
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D. ROOTING ANDSUCKLING REFLEX
Touch baby's
cheek, corner ofmouth or lip withnipple or finger.Must be done
before breastfeeds
-baby turns headtowards stimulusseeking nipple.Opens mouth,accepts nipple and
sucks strongly-Both present frombirth, rooting goesafter 6 months
-preterm infantswill not root
-weak suck-preterm, sedation
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E. SWALLOWINGREFLEX
Offer a breast -sucklingcoordinated withswallowingwithout gaggling,coughing or
vomiting
-weak suck atpreterm, sedation,jaundice, infection,breathingproblems, cerebral
injury, mentalretardation, cleftlip/palate
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THE END