Lec07 Physical Assess Neonates

King Faisal University

College of Applied Medical SciencesRespiratory Care Department

MSRT411: Perinatal and Pediatric Respiratory Care

Physical Assessment of Neonates

Ghazi Alotaibi, PhD, RRT

Lec07-Oct04

Assessment of Neonates

• Neonates pass through transitional period after birth.

• Assessment is aimed to evaluate how well the extrauterine transition is taking place.

• RT must be familiar with assessment of respiratory system, and be aware of major abnormalities of other body systems.

Assessment of Gestational Age

• In the past, weight was the only determinant of maturity (or immaturity).

• Different Techniques are employed nowadays:– Dubowitz Gestational Age Assessment.– Ballard Gestational Age Assessment.– Physical Examination to determine GA.

Dubowitz Gestational Age Assessment

• Assesses 11 physical signs, and 10 neurological signs.

• Physical criteria are more accurate to determine GA.• Physical + neurological : more accurate. • Points are added up, and each number corresponds

to GA.• Accuracy: ± 2 W, if done during first 5 days of life.• Disadvantage:

– Takes time to perform !

Ballard Gestational Age Assessment

• Simpler than Dubowitz’s.• Takes less time to performs• Includes 6 physical sings, and 6 neurological sings. • Accurate if performed between 30-42 hrs after

delivery.• Disadvantage: • less signs to assess each score has more effect on

the total score.

Ballard GA Assessment

Physical Examination to determine GA

• Uses only physical signs to assess GA.• Quicker, and simpler.• Provides roughly estimation of GA.• Some of physical signs used to assess GA:

– Vernix– Skin Maturity– Lanugo– Ear Recoil– Sole Creases

VERNIX• Gray-white cheese-like substance that covers

the fetus body.• Begin to disappear in W 36, disappears by W

41-42.• Presence of vernix, indicates premature baby.

SKIN MATURITY

• Gelatinous, transparent, with visible blood vessels indicates immature baby.

• Mature baby: should have skin with wrinkles, and no visible blood vessels.

LANUGO• Fine hair covering shoulder,

back, forehead, cheeks.• Disappears around W 40.• It’s presence indicates immature

baby.

EAR RECOIL

• Cartilage in the external portion of the ear starts to develop by W 28.

• If ear remain folded < W28

• If recoiled instantly term baby

SKIN CREASES:• Wrinkles on the sole of the foot

starts from toes to the heel.• W 30: anterior part (1/2 the sole)• W 34: 2/3 of the sole.• Term: entire sole of the foot.

Classification of Neonates according to GA

• After determining GA and Weight:

• 10th – 90th percentile: AGA• < 10th percentile: SGA• > 90th percentile: LGA

Physical Assessment of Neonates

See Study Guide

Silverman/Anderson Score to Evaluate degree of Respiratory Distress