2. INTRODUCTION
Assessment of the newborn, as soon as possible after &
subsequent assessment in the postnatal period are vital
responsibility of the nurses working in hospital or in the
community.
The assessment include the details history of
ďPrenatal
ďIntranatal
ďGenetic & family history
ďWith head to foot examination & review of maternal
investigation
3. Purpose of assessment
ď To Assess The Need For
Resuscitation
ď To Ascertain Gestational Age
ď To detect presence of any congenital
anomalies or any disorders
4. Assessment of newborn
Physical assessment of newborn following
delivery can be
divided into four phases:
1. The initial assessment using the Apgar score
system.
2. Transitional assessment during the period of
reactivity.
3. Assessment of gestational age.
4. Systematic physical assessment.
5. 1.Initial assessment
The initial assessment of newborn is important activity
immediately after birth. By using of apgar score
The most frequently used method to assess the newborn's
immediate adjustment to extra uterine life.
The score is based on observation of :
1. Heart rate.
2. Respiratory effort.
3. Muscle tone.
4. Reflex irritability.
5. Color.
Each item is given a score of 0, 1,or 2
Evaluation of all five categories are made at 1 and 5 minutes
after birth and repeated until the infant's condition stabilized.
9. The Apgar score is affected by the degree of :
ďPhysiologic immaturity.
ďInfection.
ďCongenital malformations.
ďMaternal sedation or analgesia.
ďNeuromuscular disorders.
10. 2.Transitional assessment
Periods for reactivity:
1.First period of reactivity: For 6-8 hours after
birth.
Initial stage of alertness and activity:
ďDuring the first 30 minutes.
ďThe infant is very alert, cries vigorously, very
interest in the environment.
ďNeonate's eyes are usually open
ďThe newborn has a vigorous suck; this is an
opportune time to begin breast-feeding.
11. ďphysiologically, the resp rate is high as 80
breath/min, crackles may be heard, heart rate
reach 180 beat/min, bowel sound are active ,
mucus secretions are increased, and temp
may decrease.
12. ďSecond stage:
ďśLasts to 2-4 hours,
ďśHeart and resp rate decrease, temp continues
to fall, mucus production decreases ,and urine
or stool is usually not passed.
ďśThe infant is in state of sleep and relative
calm.
ďśUndressing or bathing is avoided during this
time
13. The second period of reactivity: begins when the
infant
awakes from this deep sleep.
ďIt lasts about 2-5 hours and
ďThe infant is again alert and responsive,
ďHeart and resp rates increase.
14. ďThe gag reflex is active gastric and respiratory
secretions are increased,
ďPassage of meconium frequently occurs.
ďThis period is usually over when the amount of
respiratory mucus has decreased.
ďAfter this stage is a period of stabilization of
physiologic systems and a vacillating pattern of sleep
and activity.
15. 3.Clinical assessment of gestational age
ďA frequently used method of determining
gestational age is the simplifies Assessment
of Gestational Age by Ballard(1979)
ďIt assess six external physical and six
neuromuscular signs.
ďEach sign has a number score, and the
cumulative score correlate with a maturity
rating of from 20 to 44 weeks of gestation.
16.
17. Classification of infants gestational age at birth by birth
weight , provides more satisfactory method for
predicting mortality risks & management of the neonate .
ďAppropriate for gestational age (AGA) :the infant
whose weight is between 10th and 90th percentiles. Can
be presumed to have grown at a normal rate regardless
of the time of birth preterm, term, or post term.
ďLarge for gestational age (LGA): above 90th percentile
can be presumed to have grown at an accelerated rate
during fetal life .
ďSmall-for-gestational-age (SGA): infant below 10th
percentile can be assumed to have intrauterine growth
retardation or delay.
18. 4. Physical assessment of the newborn
ď Vital signs: temp, resp, heart rate, bld pressure
19. ďGeneral behavior: Posture, position, general
alertness, activity, movements of limbs, crying,
response to stimulation, sleeping pattern etc.
ď Feeding behavior: Sucking & swallowing reflex,
vomiting, regurgitation, chocking, frothiness.
ď Pattern of elimination: Passage of meconium &
urine
20. ďmeasurements: Ht, wt, head circumference, chest
circumference, abdomen circumference
ďSkin: Color, Texture , Vernix Caseosa, Other
Abnormalities
ďHead: Size, Shape Other Abnormalities.
ďFace: Symmetry, paralysis, shape, swelling,&
abnormal movements.
21. ď Eyes: Edema, conjunctivitis, or discharge,
sub conjunctival hemorrhage, color of the
sclera, brush field spots, strabismus,
congenital cataract, pupillary size, & reflex,
abnormal placement of eyes, abnormal
distance b/w 2 eyes.
ď Nose: Nose is examines foe patency, low
nasal bridge, nasal discharge, nasal flaring.
22. ďEars: Size, shape, position, skin tags,
ď Mouth: Cleft palate, size of tongue, presence
of nasal teeth, Epstein's pearls, frenulum of
tongue ( tongue tie) blisters, oral infections
23. ď Neck: mobility, fracture, stiffness or rigidity,
hyperextension, torticollies, any cyst or mass, webbing.
ď Chest: shape, size, breast engorgement, rate & rhythm
of respiration, chest retraction, & abnormal respiratory
sound.
ď Abdomen: shape, size, umbilical cord infection, hernia,
& other congenital anomalies. all the 4 method shulod
be used to detect anomalies.
24. ďGenitalia:
ď female child: whether the labia majora covered the labia
minora & clitoris. Hymenal tag or imperforate hymen may
present. Vaginal white mucoid discharge
ďFor male child: whether the both tests in the scrotal sac,
penis should be examined for the hypospadias, epispadias,
phimosis, ambiguous genitalia, hydrocele, inguinal hernia,
25. ďBACK: Checked for abnormal spinal curvature, tufts of hair of
skin, meningocele, meningomyocele, meningoencephalocele,
anencephaly.
ď Buttocks: it should observed mass( sacrocoyygeal tertoma),
perianal should be examined for anal fissures or any
abnormalities.
ď Hips: congenital hip dislocation
ď Extremities: for fracture, paralysis, range of motion & irregular
position, fingers & toes missing for digits,
26. Summary
⢠Newborn assessment is the easiest and
simplest assessment through which we can
anticipate congenital or impending diseases or
disorders of the child.
27. References
ďAssuma Beevi (2009). Concise Textbook of Pediatric
Nursing. 2nd Edition. Elsevier Publication
ďOP Ghai (2013) Essentials of Pediatrics. 8th Edition.
CBS Publishers and distributors.
ďDatta Parul (2010). Paediatric Nursing. 3rd Edition.
JAYPEE publication