Assessment of New Born.pptx

assessment pf newborn

1. Assessment of newborn Mrs. Malarkodi .S Assistant Professor CON, AIIMS, Rishikesh

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 Prenatal Intranatal Genetic & family history With head to foot examination & review of maternal investigation

3. Purpose of assessment To Assess The Need For Resuscitation To Ascertain Gestational Age 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: The initial assessment using the Apgar score system. Transitional assessment during the period of reactivity. Assessment of gestational age. 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 : Heart rate. Respiratory effort. Muscle tone. Reflex irritability. 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.

6. Virginia Apgar

7. The Apgar score is affected by the degree of : Physiologic immaturity. Infection. Congenital malformations. Maternal sedation or analgesia. Neuromuscular disorders.

8. 2.Transitional assessment Periods for reactivity : 1.First period of reactivity: For 6-8 hours after birth. Initial stage of alertness and activity: During the first 30 minutes. The infant is very alert, cries vigorously, very interest in the environment. Neonate's eyes are usually open The newborn has a vigorous suck; this is an opportune time to begin breast-feeding.

9. physiologically, 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.

10. Second stage: Lasts to 2-4 hours, Heart and resp rate decrease, temp continues to fall, mucus production decreases ,and urine or stool is usually not passed. The infant is in state of sleep and relative calm. Undressing or bathing is avoided during this time

11. The second period of reactivity: begins when the infant awakes from this deep sleep. It lasts about 2-5 hours and The infant is again alert and responsive, Heart and resp rates increase.

12. The gag reflex is active gastric and respiratory secretions are increased, Passage of meconium frequently occurs. This period is usually over when the amount of respiratory mucus has decreased. After this stage is a period of stabilization of physiologic systems and a vacillating pattern of sleep and activity .

13. 3.Clinical assessment of gestational age A frequently used method of determining gestational age is the simplifies Assessment of Gestational Age by Ballard(1979) It assess six external physical and six neuromuscular signs. Each sign has a number score, and the cumulative score correlate with a maturity rating of from 20 to 44 weeks of gestation.

14. Classification of infants gestational age at birth by birth weight , provides more satisfactory method for predicting mortality risks & management of the neonate . Appropriate for gestational age (AGA) :the infant whose weight is between 10 th and 90 th percentiles. Can be presumed to have grown at a normal rate regardless of the time of birth preterm, term, or post term. Large for gestational age (LGA): above 90 th percentile can be presumed to have grown at an accelerated rate during fetal life . Small-for-gestational-age (SGA): infant below 10 th percentile can be assumed to have intrauterine growth retardation or delay.

15. 4. Physical assessment of the newborn Vital signs: temp, resp, heart rate, bld pressure

16. General behavior : Posture, position, general alertness, activity, movements of limbs, crying, response to stimulation, sleeping pattern etc. Feeding behavior : Sucking & swallowing reflex, vomiting, regurgitation, chocking, frothiness. Pattern of elimination : Passage of meconium & urine

17. measurements: Ht , wt , head circumference, chest circumference, abdomen circumference Skin: Color, Texture , Vernix Caseosa , Other Abnormalities Head: Size, Shape Other Abnormalities. Face: Symmetry, paralysis, shape, swelling,& abnormal movements.

18. 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. Nose : Nose is examines foe patency, low nasal bridge, nasal discharge, nasal flaring.

19. Ears : Size, shape, position, skin tags, Mouth: Cleft palate, size of tongue, presence of nasal teeth, Epstein's pearls, frenulum of tongue ( tongue tie) blisters, oral infections

20. Neck: mobility, fracture, stiffness or rigidity, hyperextension, torticollies, any cyst or mass, webbing. Chest : shape, size, breast engorgement, rate & rhythm of respiration, chest retraction, & abnormal respiratory sound. Abdomen : shape, size, umbilical cord infection, hernia, & other congenital anomalies. all the 4 method shulod be used to detect anomalies.

21. Genitalia: female child : whether the labia majora covered the labia minora & clitoris. Hymenal tag or imperforate hymen may present. Vaginal white mucoid discharge For male child: whether the both tests in the scrotal sac, penis should be examined for the hypospadias, epispadias , phimosis, ambiguous genitalia, hydrocele, inguinal hernia,

22. BACK : Checked for abnormal spinal curvature, tufts of hair of skin, meningocele, meningomyocele, meningoencephalocele, anencephaly. Buttocks: it should observed mass( sacrocoyygeal tertoma), perianal should be examined for anal fissures or any abnormalities. Hips: congenital hip dislocation Extremities : for fracture, paralysis, range of motion & irregular position, fingers & toes missing for digits,

23. Summary Newborn assessment is the easiest and simplest assessment through which we can anticipate congenital or impending diseases or disorders of the child.

24. References Assuma Beevi (2009). Concise Textbook of Pediatric Nursing. 2 nd Edition. Elsevier Publication OP Ghai (2013) Essentials of Pediatrics. 8 th Edition. CBS Publishers and distributors. Datta Parul (2010). Paediatric Nursing. 3 rd Edition. JAYPEE publication