Normal newborn - WordPress.com · 2014-10-13 · Normal newborn. objectives Quickly ... Newborn examination indications ... Part of general examination.

Normal newborn

objectives

Quickly identify any danger signs

Assess the normal adaptations of a

newborn after birth

Identify conditions requiring special care or

follow-up observation.

Identify any birth defect or birth trauma;

Monitor growth

Counsel the mother

TERMS:

Neonatal Period:

Birth --> 28 days of life

Term Infant:

38 - 42 weeks of gestation

Transition Period: Phases of instability

during the first 6-8 hours after birth

(?????)

Gestational Age & Birth Weights

Gestational Age:– Pre-term: < 37 weeks

– Term: 37-41 6/7 weeks

– Post-term: 42 or more weeks

Term Infant (weight classification)– LGA: >4000 g

– AGA: 2500-3999 g

– SGA: <2500 g

Gestational

Age

Classification

Pre-term, term, and

post term infants

must all be plotted to

determine if they are

SGA, AGA, and LGA

with regards to

weight, length, and

head circumference.

LGA

AGA

SGA

X X X

danger signs for newborn

not feeding well

Fast breathing, difficult breathing with severe

chest in drawing ,grunting ,cyanosis

Convulsions

hypothermia, fever

Reduced movement, and jaundice appearing

anywhere on the first day or palmer or sole

jaundice at any age

Newborn examination indications

Immediately after birth

Before discharge from maternity unit

Whenever there is any concern about the

infant's progress

Examination precaution

Hand washing,hand washing ,hand

washing

Thermal environment

Light and noise

Brief examination time

General examination

Attention : at initial ex

Congenital anomalies

Infant has successful transition from fetal

life to air breathing

Gestational age ,delivery medication

Any sign of infection or metabolic disease

APGAR Score

Score 0 1 2

Heart Rate Absent <100bpm >100bpm

Respiratory effort Absent, irregular Slow, crying Good

Muscle tone(activity) Limp Some flexion of

extremities

Active motion

Reflex irritability (nose

suction)

No response Grimace Cough or sneeze

Color Blue, pale Acrocyanosis Completely pink

Newborn first exam

Postnatal assessment of gestational

age

New Ballard Score

Accuracy within 1-2 weeks

2 parts– Neurologic characteristic

– Physical characteristic

Part of general examination

General(Growth parameters)

Weight (Naked) N:( 2.5-˂4 kg) full term

,loss of weight is expected by 5-10% in the

first few days

Length(straight) N:(48-53cm ) full term

Head circumference(3 measurements)

N:(33-38 cm) full term

Vital Sign

Heart RateHR 120-160

Respiratory Rate

RR 40-60 periodic rather than regular

Temperature skin: 36-36.5 C

rectal :36.5-37.5 C

Blood Pressure

General

Well, Distress or not?

skin

– Pink is normal

– Acro cyanosis is normal

– Cyanosis

-- pallor

– Jaundice

– Common variants skin rash

• Erythema toxicum, mongolian spot

Vigorous cry is assuring

Weak cry

– sepsis, asphyxia, metabolic, narcotic use

High pitch cry

– CNS causes, kernicterus

16

s

Erythema Toxicum Erythematous

macules and firm 1-3

mm yellow or white

papules

Etiology obscure

Papule contain

eosinophils and are

sterile

Appear in the first 3-

4 days of life

– Range: Birth to 14

days

Benign and self

limited

Mongolian Spots

Slate-gray to blue-

black lesions

Usually over

lumbosacral area and

buttocks

Accumulation of

melanocytes within

the dermis

Generally fade by age

1year

Head and Face

Shape of the head

Fontanels?

Sutures?

Eyes?

Nose?

Mouth,lips,palate?

Ears?

Neck?

20

Eye

Head Forceps and vacuum

marks

Caput succedaneum

– Boggy edema in presenting part of head

– Cross suture lines

– Disappear in few days

Cephalhematoma

– Subperiosteal

– Weeks to resolve

– Dose not cross sutures

Newborn Scalp Hematomata

Chest

Distress signs(,Tachypnea,Nasal flaring,asymetric chest

rise,supra-sternal, intercostal, sub costal retraction

Grunting ).

Deformities(Pectus excavatum, carinatum)

Auscultate

– Air entry, symmetry

– crepitation

Breast hypertrophy

– Milk production

– No redness

Heart

HR 120-160 beats/min

Color, perfusion, Central cyanosis

Murmur

Abdomen

Inspection– Scaphoid

– Distention

– Abdominal wall defect (gastroschisis)

Palpation; baby sucking and use warm hands

– Liver 2.5 cm

– Spleen may palpable

– Umbilical vessels• 2 artery, one vein

– Hernias ; umbilical and inguinal

The umbilicus: Which one is

normal? Normal vs. Abnormal

Genitalia

Penile size

Hypospadias, epispadias

Testes– 2% crypoorchid

– Hydrocele

Female:– Prominent clitoris and majora

– Vaginal skin tag

– Vaginal discharge /blood

– Labial fusion

Anus : Patency and location

Hip and Extremities

Erb’s palsy: extended arm and internal rotation with limited

movement

Humorus fracture ,clavicle fracture

Digital abnormality

– Syndactaly, brachdactaly, polydactaly

Single palmar crease

Hip dislocation

Feet deformities

Back and spine

– abnormal curvature

– Sinus tract, tuft of hair

Hip Exam

Neonatal reflexes

Also known as developmental, primary,

or primitive reflexes.

They consist of autonomic behaviors

that do not require higher level brain

functioning. They can provide

information about lower motor neurons

and muscle tone.

They are often protective and disappear

as higher level motor functions emerge.

Newborn Reflexes

Moro reflexwww.nlm.nih.gov

Stepping reflexwww.imi.org.uk

Newborn Reflexes

Palmar and plantar graspwww.winfssi.com

Rooting reflexwww.winfssi.com

Moro

Onset: 28-32 weeks GA

Well-established: 37 weeks GA

Disappearance: 4-6 months

How to elicit and what is the response?

An absent or inadequate Moro response on

one side : hemiplegia, brachial plexus palsy,

or a fractured clavicle

Persistence beyond 6 months of age is :

indicate severe neurological defects

Please contact me with any questions or

concerns.

[email protected]