TOPIC : NEWBORN ASSESSMENT

SUBJECT : Community Health Nursing - II

COURSE : M.Sc. Nursing 2nd year.

DURATION : 1 hour

STUDENT TEACHER NAME : Ms. THONDYNALU

NAME OF THE EVALUATORS : MRS. VEMBU K.

METHOD OF TEACHING : TUTOR

A-V AIDS : Charts, chalk board and PPT.

DATE AND TIME :

GENERAL OBJECTIVES

On the completion of class, students will be able to gain knowledge regarding the concept of newborn assessment and will also be able
to demonstrate the techniques of newborn assessment which will help to develop a positive attitude towards it and utilize the same in
practice setting in future.

SPECIFIC OBJECTIVES

At the end of the class the group will be able to

 Define the term and preterm newborn

 List down the pre requisites of new born assessment
 Explain the history collection collection in new born assessment
 Demonstrate the newborn assessment technique including checking vital sign on therapeutic measurement, general
examination of new born and neurological assessment
Specific Time Content Teacher Teacher Evaluation
objectives activity learner
activities
Introduce 1 mit INTRODUCTION:
the topic
The incidences of anomalies in newborn babies are more
common today The occurrences of congenital as well as acquired
anomalies in preterm babies are twice in frequency as compared
to term appropriate for gestational age babies. In small for date
the incidence of anomalies is 10-20 times higher. A thorough
examination and observation of their babies is essential for early
diagnosis of anomalies.

The student 2 mits DEFINITION: Teacher Listen to What do you

will be able New born at term :A healthy infant (newborn) at term, (between defines the the topic mean by pre-
to define 38 weeks and 42 weeks) should have an average birth weight of term and pre- term baby?
new born at the country (usually exceeds 2500 gm) cries immediately term
term following birth, establishers independent arithmetic respiration
and quickly adapts to the changed environment.
Preterm baby:-A baby born before 37 completed weeks of
gestation calculating from the first day of last menstrual period is
defined as preterm baby.
Students 3 mits PRE REQUISITES OF NEWBORN ASSESSMENT: Lecture cum Listening What are the
will be able 1. Conduct examination in a warm and comfortable room. discussion and pre-
to list down 2. Undress the baby completely and place on a flat surface answering requisites of
the pre- convenient for the nurse. newborn
requisites of 3. Good source of light is needed. assessment?
newborn 4. Hands of the examines should be clean and warm.
assessment 5 .The baby may need to be picked up and cuddled at times for
reassurance.
6 Examination is to be carried out systematically.

List down 2 mits FREQUENCY OF ASSESSMENT: Lecture cum Listening What are the
the Detailed newborn assessment is conducted at discussion to the objectives of
frequency 1. Birth topic new born
and its 2. Weight in 24 hours assessment?
objectives 3. At the time of discharg
OBJECTIVES OF NEWBORN ASSESSMENT:
a. To ensure that the lung is expanded (at birth).
b. To assess the satisfactory pulmonary respiration at birth and
assess for any obstruction in their passage.
c. To diagnose life threatening congenital malformation and birth
injuries.

ASSESSMENT OF NEWBORN:
HEALTH HISTORY:
1. Demographic data
Name
Age /sex
Gestational age at birth
Ward/unit
Room no/bed no
IP no
Date of admission
Diagnosis
2. Chief complaints
3. History of present illness
4. History of past illness
5. Obstetric history
a. Previous obstetrics history:
Past history still birth, neonatal death, preterm delivery,
LBW babies, congenital malformation, Rh
immunization etc.
b. Prenatal history:
Antenatal check up (regular/ irregular)
c. Intranatal history:
Expected date of conferment / actual date of birth (mode
of delivery/prolonged rupture of membrane/duration of
labor/maternal fever/ meconium stained or foul smelling
amniotic fluid/ fetal distress/ birth asphyxia/ APGAR
Score 1min, 5min, 10 min)
d. Post natal
First cry after birth, feeding, birth weight, passage of
meconium and urine for first time, any illness or
complication during the neonatal period.

6. Nutritional status:
 Type of feeding: exclusive breast feeding/ breast feeding
and formula feeding/ parental feeding/ others.

 Method of feeding: sucking of breast/ paladai/ bottle

 feeding/ others
 Feeding problem if any

7. Immunization status:
VACCINE DATE OF
ADMINISTRATION
BCG
OPV
HEPATITIS B

PHYSIAL ASSESSMENT:
Demonstrate 30 Teacher is Group is Demonstrate
1. General assessment
the new mits a. Term / preterm / post term demonstrating observing the new born
b. Alertness : alert and active/ dull/ sleeping
born assessment
c. Posture : flexion of head and extremities/ extended legs
assessment and technique
extremities.
technique including
d. Birth injuries / congenital anomalies
including PROCEDURE RATIONALE vital signs,
vital signs, general
general 1. Vital signs examination
examination a. Respiration &
 The respiration must be  Normal respiration rate is
& conducted for full 1 30-60 beats/ min. neurological
minute by looking at the  Sign of respiration distress
neurological examination?
chest and noting the include nasal flaring,
examination respiration. retraction or grunting with
respiration.

b. Pulse  Normal rate is 120-160 b/mt

 Place the stethoscope at and when asleep it is around
the 4th intercostal space 70-80/ mt.
and count heart rate for  Persistent tachycardia or
full 1 min. bradycardia shows
respiratory distress and
suggest cardiac anomalies.

c. Temperature  Normally the temperature is

 It is taken by axillary 37C at birth, it stabilizes by
placement of 8 -10 hours of birth and
thermometer. ranges between 36.537.2 C.

 If the temperature is below

normal, it may indicate
prematurity infection,
dehydration, inadequate
clothing etc.
  Increasing temperature
indicate the infection, high
ambient temperature over
clothing etc

2. Anthropometry

a. Weight  Average Indian newborn

weight is 2.7-3.1 kg
 Put the protective line
cloth or paper on the  Low weight < 2.5kg may be
scale and adjust the scale due to prematurity or small
at ‘zero’. Protect the for gestational age.
newborn from heat loss
during weighing. Hand  Weight more than 3.5kg, the
of the observer is held common cause is GDM of
over the infant as mother.
important safety
measure.

b. Length
 Measure the crown to  Normal length is 45-55cm
rump and crown to heal  Length <45 cm or >55cm
length. may indicate the
chromosomal abnormality

c. Head circumference
 Head is measure as the  Small head if less than 32
greater diameter i.e cm is microcephaly and
occipito frontal may be due to TORCH
circumference. infections.
 Tape should be placed
 above the eyebrows over  In hydrocephaly HC is more
the tape of the ears and and sutures are found
around fullest part of the widely separated and ICP is
occiput. high.
 It measure 32-36 cm and
is approximately 2-3cm
more than the chest
circumference.

d. Chest circumference
 The tape should be  The chest circumference
placed across the lower less than 30cm indicate the
border of scapula and prematurity.
over the nipples.
 Usually it is 2cm less
than the head
circumference and
average between 30-
33cm.

3. Skin
a. Colour  Blueness of body part is
 Assess the color to cyanosis may be due to
cyanosis and pallor. hypothermia, respiratory
Generally the newborn is origin.
pink in color and it
varies with ethnic origin.  Pallor may due to anemia,
birth asphyxia or shock.

 Central cyanosis (bluish

skin including the tongue
and lips) is caused by low
 O2 saturation. It may be due
to congenital heart disease
or lung disease.

 In peripheral cyanosis (
bluish skin with pink lips
and tongue ). It may be due
to drugs or hereditary.

 Acrocynosis, here bluish

hands and feet only. It may
be due to cold stress.

b. Molting

 A temporary pattern of  It is due to vasomotor

pink and white lace like instability especially when
patches on the skin. the baby is cold.

c. Herlequine sign
 One side of the body is  It is also due to the
pink and the other side is vasomotor instability.
pale .

d. Prethora
 A deep red discoloration  It may be seen in over
of skin. It is often heated or over oxygenated
exaggerated by crying infants.

e. Jaundice
 Yellowish discoloration  Bilirubin level >5mg/dl
of the skin and sclera.
 Inspection of skin for
any rashes like

-Milia: On nose. check or  It is due to plugged sweat

forehead gland.

-Mongolian spot : at back,  It is due to increase no of

buttock and thigh capillaries.

-Diaper rashes: found at skin  Due to contact dermatitis

fold with Candida albicans.

-Vernix, edema around face,

eye , scortum, labia.

4. Head

 Palpate the scalp and  The new born head is large

inspect the shape and (approximately 25% of the
size. total body size).
 It has prominent cranium
and forehead.

 Absence of molding
 Absence of molding indicate prematurity, breech
(round appearance of presentation or caesarean
head few days after birth. section.

 The cranial bone are

 Palpating the cranium for palpable.
assessing the 7 major
bones and sutures  Widely spread sutures
indicates hydrocephaly.
 -Frontanells
 Layer soft frontanells show
 Frontanells are the malnutrition,
membrane opening at the hydrocephalus,
junction of three cranial  Depressed frontanells
bone. indicates dehydration.

-Anterior frontanells /
brigma

 It is the largest and

located at the junction of
frontal bone and parietal
bone.

 It is diamond shape
measure of 3-4cm long
and 2-3cm wide closed by
18-24momhs.

-Posterior frontanells

 Found at the junction at 2

parietal bone and one
occipital bone, it is
triangular in shape,
measure of 0.5-1cm and
close at l 1/2 -2 months
 It may result from sustained
-Caput succedaneum pressure of persistent part
 against the cervix during the
 Localized soft tissue labor (it resolve with in 24
edema of the scalp to 48 hours after birth.)

-Cephal hematoma

 Collection of blood
between the periosteal
membranes and the
cranial bone.

 Inspect the scalp for any

other bruising, redness or
the lactation.

5. Eyes
 Upto 3cm is normal.
 Imagine shape and
symmetry in size and
shape.  Normal eye balls are equal
 Estimate the distance size, both round and firm.
between 2 eyes.
 The epicanthal folds
 Assess the eye lids for suggest the presence of
size movement and blink. Down’s syndrome.

 Check for the presence of

 Absence of one or both
any discharge Check for
eyeballs.
any sign of
 Small eyeballs rubella
syndrome.
 It is indication of
 Agenisis
 congenital cataract.

 Lens capacity  Absence of part of iris.

 Pink colour of the iris.

 Yellowish discoloration of
 Coloboma lesion sclera.

 Albinism  Decreased ICP or tumors

shows unequal, constricted,
 Jaundice dilated and fixed pupils.

 Check papillary size  Normally the nose is in

and its reaction to midline, there is apparent
light lack of bridge and nose is
flat and broad.

6. Nose
 Observe for shape,
placenta patency and
configuration of bridge of
nose.

 A wisp of cotton can be

placed at the open raise to
check the movement of
air.
  Facial impression gives an
7. Face idea about the overall
 Check the overall impression of health status
appearance of the face of the infant .
especially for
hypertelorism and low set
of ears.
8. Mouth  The cyanosis or pallor
indicates the hypothermia
 Observe the lips for colour or respiratory distress.
configuration and
movement.  Helps to identify the cleft
lip or cleft palate.
 Assess for any
abnormality in size, shape  It allow the visual
and placement. inspection of tongue, gums
 Pressing against the angle and palate.
of jaw can open the
mouth. Inspect the
presence of lingual
frenulum oral thrush and
natal teeth also.

9. Ears
 Evaluate the ears for
position, placement, size,
shape and firmness of the
cartilage.
 Low placement of ears
indicate downs syndrome,
 The top of the ear should mental retardation and
be at or above the level kidney disorder.
of imaginary line drawn
 from inner or outer canter
of the eye to the ear.  They are isolated finding.
It can be removed and
 Check the audibility with separated.
loud noise (stratile
reflex).

 Check for any para

auricular skin type in
front of ear
 Normally neck is short
10. Neck thick and has several fold
 Check the neck for of skin
movement, thyroglossal
neck, steno mastoid  Webbing of neck is found
hematoma . Check the in turners syndrome.
head lag and the skin
fold.

11. Chest  Nipple and areola are

pigmented in full term,
 Place the infant in supine infant and they are
position on a flat surface permanent and
and inspect the chest for symmetrically placed.
shape, that is almost
circular and broad  Breast nodules
shaped. approximately 6mm in
term infants.
 Lack of breast tissue shows
prematurity.

 Inspect the nipple, areola  Chest retraction may seen

and sternum. in respiratory distress or
 prematurity.
 Assess the respiratory
movement during
respiration.  Breast engorgement may
be evidence in 2-3 days
after birth due to effect of
 Asses the breast nodules withdrawal of maternal
also. estrogen and secretion of
cloud fluid i.e witches milk
 Asses the
synchronization
between the chest wall
movement and the
abdominal during
respiration.

12. Abdomen

 Inspect the abdomen

when supine and quite.
Assess the shape of the
abdomen.
 Normal shape is round or  Due to the weakness of
protuberant. abdominal musculature.
 Scaphoid abdomen.  Found in diaphragmatic
hernia.
 Flat abdomen covered by  Chronic intrauterine
loose wrinkle skin. malnutrition.

 Inspect the umbilical  Greenish or meconium

cord (it is white and stain cord moderate
gelatinous in first few intrauterine distress
 hours of life) Three
vessels may be seen at
the cut edge of the cord
(2arteries +1 veins).

 Asses for any bleeding or  It may indicate loose

purulent discharge from corties,hemorrhage disease.
the cord.

 Mild distention may occur

 Examine for any due to over feeding. But
abdominal distension. marked
detention may occur due
to lower GI obstruction,
 Palpate for any masses. imperforated anus and
sepsis

 Auscultate the bowel  Bowel sound are present

sounds. after3-4 hours after birth.

13. Genitals

 Inspect the genitals

finding

 In full term labia majora

covers the labia minora.

 Labia majora large and  Due to influence of

 swollen. maternal hormone.

 In preterm there is little

adipose tissue in labia
majora and labia minora
and are small and
incompletely developed.

 Asses for any  Enlarge clitoris with

abnormalities in the urinary meatus on the tip is
clitoris. indicative of ambiguous
genitals.

 Inspect for any blood  Due to influence of

stained mucoid vaginal maternal hormone it is
discharge. called pseudo
menstruation.

For male babies

 Inspect and palpate the  It helps to identify

genitalia hypospadias (mentus is
found ventral surface of
 Examine the urinary penis) epispaedias (meatus
meatus (it is normally at dorsal surface)
seen in the tip of penis as
a slit)

 Inspect the scortum. It is

large, edematous and
pendular and Is covered with
engage in term infant.

 Inspect the prepuce (fore

skin of penis).
 Also asses the length of  Normally it is> 2cm
penis
 Palpate the scrotum for
the assessment of
cryptorchidism.
 Examine the pattern of
urination of the baby

14. Extremities, spine,

joints

 Inspect the extremities

for:

 Syndactyl (fusion of
digits)

 Polydactyl

 Simian crease  Sign of down syndrome.

 Falipes equirovaens  Poor muscle tone is seen in

(persistent plantar flexion prematurity.
with foot deviation).

 Spontaneous movement  The limitation of motion

should be observed for should rise the suspicion of
 symmetry and normal birth injuries, obstetrics
range of motion in palsy or congenital
extremities confirmed by malformations.
gently palpation.

 Palpate the cervical for

crepitus and fractures.

 Extending both the legs  Helps to rule out the

simultaneously assess the asymmetry in lower limbs.
leg length.

 Examination of  Uneven fold indicate

symmetry of buttocks, ‘congenital hip dysplasia’.
skin folds in prone
position

 Hip dislocation is  The presence of checks/

assessed by ortholans clunles, unequal movement
maneuver. or asymmetrical skin fold
indicate that hip
 The infant is placed in dislocation.
supine position. The
index and middle finger
of each hand are placed  It occurs due to traction
over the greater injuries of C5 and C6 nerve
trochanters of the hips at root while the delivery of
the same time. The shoulder.
downward pressure is
exerted on the hips while
the knees are flexed the
 knees are abducted to at
least 70 degree and then
abducted.

 In normal cases the

motion should be smooth
without any checks or
clunks.

 Asses for any sign for  Because of normal fIexed

erbs palsy (shoulder posture.
abduction with elbow
extended and forearm
proneted).

15. Back and buttocks

 Place the newborn in  To identify and mass or

prone position so that the opening
back and buttocks can be
examine.
 The back appears round  That indicate spina bifida
Spine is straight and does (incomplete closure of
not develop lumbar or vertebral column).
sacral curve.
 Helps to identify and
 The spine palpated and tissues imperforated anal or
inspected rectal atresia, any discharge
etc.

 Assess for any pigmented

nerve with draft of hair
 along with spine.

 The buttocks should be

separated and anal
opening is inspected for
patency and sphincter
response.

NEUROLOCICAL ASSESSMENT:

Neonate is equipped with the range of flexed activities at birth,

some are retained as the neonate matures, others disappear within
first weeks to the first year of life. These reflex behavior are
necessary for the survival and safety of neonate. The absence of
reflex may indicate the CNS damage.

PROCEDURE RATIONAL
1. More Reflex

 Holding the baby at an angle

of 45 degree and then
permitting the head to drop
1 or 2cm can elicit it.

 Response : The infant  Absence of this reflex

response by abducting and indicates brain damage or
extending his arms with immaturity.
fingers fanned, sometimes
decompanied with tremors.  Persistence of the reflex
The reflex is symmetrical. beyond age of 6 months
 indicates mental
retardation.

2. Rooting reflex:

 In response to stroking the

check or side of mouth, the
baby will taken towards the
source of stimulus and
open his mouth ready to
suckle.

3. Sucking and  Indicate safe feeding and

swallowing well adequate nutrition.
developed in normal
baby.
4. Gag, cough and sneeze  This reflex protect the
reflex. infant from airway
obstruction.
5. Blinding and corneal  These reflex pretest the
reflex eyes from trauma.

6. Grasp reflex

 A palmar grasp is
detected by placing a
finger or pencil in the
palm of baby hand. The
finger response is
checked by stroking the
base of the toes (plantar
group).
 7. Walking or stepping
reflex

 When supported upright

with his feet touching a
flat surface the baby
stimulate the walking.

8. Asymmetrical tonic
neck reflex
 In the supine position the
limbs on the side of the
body to which the head in
turned, are extended
while those on the
opposite side flex.

 The muscle tone is

reflexed in the baby
response to passive
movement.

9. Traction response

 When pulled upright by

the wrist to sitting
position the head will leg.  The amount of head lay
Initially the neonate noted depends on the
response by lifting the maturity and muscle tone
head and holding it of the neonates.
upright before allowing
the head to fall and on the
chest.
 10. Ventral suspension:

 When held the baby

prone, suspended over
the examines arm the
baby momentarily hold
her head level with her
body and flexes her
limbs.

11. Startle reflex:

 Loud noise of sharp clap

(hand clap) elicit.
 Response: There is
abduction
of the arm with flexion of
elbow with hand
clenched. This disappear
in 4 months.

12. Babinski‘s sign

 Beginning of heel, upward

stoke is given on the sole  Absence of this reflex
of the foot along the requires the neurological
lateral aspect. Then move evaluation.
the finger across the ball
of the foot. Response :
Infant response with
hypertension of all toes
with dorsiflexion of big
 toe. It should disappear
after one year of age.

13. Crossed extension

reflex:

 With neonate laying on

the back, then extended

one leg and pressing the
knee down to the surface
examining table. The foot
of the extended leg is
stimulated. Response: The
opposite leg responds by
flexing adducting and
extending.

14. Magnet reflex:

 The neonate is placed on

the back. Then the both
legs flexes partially and
applying gentle pressure to
the soles of the feet.
Response: The neonate
responds by extending both leg
against the source of pressure.

15. Glabellar reflex

 With the neonates eyes

 Continued blinking with
 Open, the nurse taps repeated taps may indicate
an extra pyramidal
lightly over the forehead
disorder.
or bridge of the noise. The
neonate responds by
blinking for the first or
five taps.

CONCLUSION:

The newborn assessment is a essential part of the postnatal

assessment, it is effective way to assess she congenital and
acquired anomalies to take appropriate treatment (corrective
measures for anomalies) at the proper time.

RECAPITULATION:

1. What are the pre requisites of newborn assessment?

2. What are the objectives of newborn assessment?
3. What do you meant by a newborn at term?
4. What are the reflexes that are assessing in the
neurological assessment of a newborn?

REFERENCE:
1. Snehlata manocha. “procedure and practice in
midwifery”, kumar publishers page no: 145-168.
2. DC. Dutta“ Text book of obstetrics”, 8th edition, Jaypee
Publication, page no : 514-517.