1_Newborn Assessment best lecture for nurses

It is important for assessment of new born .

1. BY HINA HUSSAIN NEWBORN ASSESSMENT

2. Objective To provide an assessment of infant’s state of development of wellbeing. 2. To detect any deviation from normal. 3. To assess the progress of the child. New Born Assessment/Examination   Definition: it is systematic examination (physical and neurological) of newborn.

3. INDICATIONS • First examination: a detailed one in labor room within 2 hours of birth. • Second examination; Before discharge. • Third examination: After 6-8 weeks of neonatal life. Purpose To perform an assessment of a newborn, using history, physical exam and routine screening procedures To identify normal parameters assessment of: RR, HR, BP, temperature To recognize the physical findings seen in a sick infant: poor perfusion, lethargy, hypotonic, cyanosis, plethora, poor feeding, weak cry.

4. TERMONOLOGIES • Small for gestational age (SGA)is less than 10% for weight at the time of birth Large for gestational age (LGA) is more than 90% for weight at the time of birth Appropriate for gestational age( AGA) is the birth weight between 10-90% FULL TERM : 37 to 42 weeks or 259 to 294 days. PRE-TERM : after 28 weeks and before 37 weeks. POST- TERM : after 42 weeks

5.   ARTICLES REQUIRED TPR Tray A tray containing: 1. Hand washing articles 2. Apron 3. Stethoscope 4. Inch tape 5. Torch 6. Bowl containing cotton wisp 7. Weighing machine 8. Bowl with extra cotton 9. Mackintosh 10. Kidney tray 11. Paper bag

6. INITIAL ASSESSMENT OF NEWBORN 1. IDENTIFICATION Check and identify the sex of the infant and verify the records with the correct name, sex and registration number. 2. GESTATIONAL AGE FULL TERM/ PRE-TERM/ POST- TERM   VITAL SIGNS Check the vital signs in the following order: a) RESPIRATION: normal value of respiration is 40-60 breaths/min. b) HEART RATE: normal value of heart rate is 120-140 beats/min. c) TEMPERATURE: normal value of temperature is 36.5-37.5 degree Celsius.

7. PHYSICAL EXAMINATION LENGTH Crown to heel length with infant supine/ upside down/ with the knees slightly pressed down to obtain maximum leg extension. (47-50 cm) HEAD CIRCUMFERENCE: It is measured with a tape measure drawn across the center of the forehead and the most prominent portion of the posterior head. ( 33-35 cm )   CHEST CIRCUMFERENCE: It is measured at the level of nipples and is about 2 cm less than head circumference. 30-33 cm WEIGHT: Average birth weight 2.5 -3.5 kg

8. Procedure Before starting the exam, always wash your Hands Tell the mother that you will be examining the baby and take the baby to the examination area Rationales Prevent cross infection It will reduce the anxiety level of the mother and her involvement

9. General Appearance Briefly describe baby’s appearance (hair, color, and posture) Some of the measurements will be recorded onto the‘Newborn examination sheet’, such as: Date and time of examination Weight (grams) Head Circumference (HC) (cm) Length (cm) Rationales To identify any abnormalities To observe Small for gestation, Large for gestation & Appropriate for gestation

10. Assess the skin for discoloration , Texture, Turgor , Pigmentation, jaundice and normal variations example rashes, Mongolian spots, birth marks, bruises, and patechiae . Rationales To identify any congenial skin anomalies) Head to Toe Assessment Head Assessment (General appearance, Size, Common Variations (Caput Succedaneum and Cephalhematoma ),Fontanels (Pulsation, Bulging, Sunken), Hairs (Texture, Distribution)

11. Face (Symmetry, Spacing of features, movement) Eyes (General placement. color, any tears, pupils react to light, sub Conjunctival hemorrhage) Nose (General appearance, Any sneezing, Occlude one nostril,Coanal Atresia ) Mouth (Symmetry, cleft palate, cleft lip, Tongue) Ears (Position, symmetry preauricular skin tag )

12. Neck (appearance and mobility) Clavicles (appearance and size, expansion and retraction, breast tissues, auscultate breath sounds, breathing movement, RR ) Heart (palpate, auscultate , any murmur, thrill, HR) Abdomen (appearance, palpate) Umbilicus (protrusions and herniation , number of vessels, auscultate bowel sounds, voiding) Rationale To identify any congenital abnormality/ anomaly

13. Genitals Male : General appearance ,Penis (placement of urinary meatus , scrotum, testis, Female :General appearance, vaginal tag, discharge) Rationale To identify any congenital abnormality/ anomaly Buttocks (symmetry , pattern of stool, pilonidal dimple,) To identify any congenital abnormality/ anomaly Meconium;First fecal material , sticky,odorless,greenish black to brownish green which is passed from 8-24 hours after birth. URINE:First urine is diluted because of immaturity of the kidneys and lack of ability to concentrate uriine .

14. Extremity and trunk General appearance , symmetry, ROM, polydactyl, syndactyly , simian crease, spine, hip, legs and feet) Rationale To identify any congenital abnormality/ anomaly.

15. Reflexes are also known as developmental, primary and primitive reflex It provide info regarding lower motor neuronand muscle tone.( Moro, Rooting , Sucking, Palmer grasp, Planter grasp, Stepping, Babinski , Tonic neck, Trunk incurvation ) Rationale: To observe the motor responses Activity ( cry (check for pitch) Rationale: Weak cry indicate abnormal brain development Sensory (vision, auditory, tactile, olfactory, gustatory) Rationale:To observe the sensory responses Remember to properly wrap the baby after the exam Rationale:To regulate the body temperature and prevent from hypothermia Document all the findings according to the institution policy Rationale:To report any alteration and findings

16. Soles Full Term Neoborn : Creases covering the entire soles.of the foot. Post mature Infant: Deep creases over the foot Premature Infant: Absent or partially upper two third cover the infant sole.

17. Important Requirements : Tape Measure Digital Scale Examination Form Stethoscope for auscultation (listening) to the heart and lungs Small Mattress

18. Reflexes in the Neonate Root Reflex. This reflex begins when the corner of the baby's mouth is stroked or touched. ... Suck  Reflex. Rooting helps the baby become ready to  suck . ... Tonic Neck Reflex . ... Moro Reflex . ... Grasp Reflex . ... Babinski Reflex. ... Step Reflex.

19. Reflex​ Age When Reflex Appears Age W​hen Reflex Disappears Stepping Birth 2 months Rooting Birth 4 months Palmar grasp Birth 5–6 months Moro reflex Birth 5–7 months Tonic neck reflex Birth 5–7 months Plantar grasp Birth 9–12 months

20. Reflex Stimulation Response Duration SOURCE :  Table after Child Development, 6th ed. Wm. C. Brown Communications, Inc., 1994. Babinski Sole of foot stroked Fans out toes and twists foot in Disappears at nine months to a year Blinking Flash of light or puff of air Closes eyes Permanent Grasping Palms touched Grasps tightly Weakens at three months; disappears at a year Moro Sudden move; loud noise Startles; throws out arms and legs and then pulls them toward body Disappears at three to four months

21. Rooting Cheek stroked or side of mouth touched Turns toward source, opens mouth and sucks Disappears at three to four months Stepping Infant held upright with feet touching ground Moves feet as if to walk Disappears at three to four months Sucking Mouth touched by object Sucks on object Disappears at three to four months Swimming Placed face down in water Makes coordinated swimming movements Disappears at six to seven months Tonic neck Placed on back Makes fists and turns head to the right Disappears at two months

22. Glossary : HR (Heart rate) RR (respiratory rate ) Moro reflex (response to sudden movement or loud noise) Rooting reflex (turn in different direction of stimulus ) Sucking reflex (sucking is adequate on nutritional intake) Palmer grasp ( when palm is stimulated and held momentarily lessens baby grasps the finger) Planter grasp ( toe turned downward when stimulate the feet ) Stepping reflex ( when held upright and one foot touching the flat surface will step alternately disappear) Babinski reflex (fanning and extension of all toes ) Tonic neck (fencer position when head is turned to one side ) Trunk incurvation (in prone position stroking of spine causes pelvis to turn to stimulated side )

23. Head to toe examination of newborn The optimal way to perform the  newborn  check is by examining from  head to toe  sequentially. In reality, it's an opportunistic  examination  – if the  baby  is settled listen to their heart first, if they open their eyes check the fundal reflexes and if they're crying look at the palate.

24. The APGAR Scoring System was developed by Dr. Virginia APGAR as a method of assessing the newborn’s adjustment to extrauterine life. It is taken at one minute and five minutes after birth. With depressed infants, repeat scoring every five minutes as needed. The one minute score indicates the necessity for resuscitation.