ASSESSMENT OF NEWBORN AND DAILY ASSESSMENT.pptx

A newborn baby is assessed in many ways including :- physical examination, apgar score, breathing, weight, reflexes, general danger signs , kangaroo mother care(KMC)

1. ASSESSMENT OF NEWBORN

2. NEWBORN EXAMINATION DEFINITION: It is a systematic examination i.e. both (physical and neurological) of newborn.

3. OBJECTIVE: To know infant’s state of development and wellbeing. To detect any deviation from normal To assess the progress of the child.

4. INDICATIONS: 1 st examination: in labor room within 2 hours of birth. 2 nd examination: before discharge. 3 rd examination: 6- 8 week

5. ARTICLES TPR tray. Stethoscope Measuring tape Torch Cotton wipe Weighing machine Mackintosh Kidney tray Paper bag Bowl with cotton

6. INITIAL ASSESSMENT 1. IDENTIFICATION Check and identify the sex of the infant and record with name, sex and regd. Number. 2. Identify gestational age, full term/pre term/post term.

7. VITAL SIGNS RESPIRATION: 40- 60breaths/min HEART RATE: 120-140 beats/min TEMPERATURE: 36.5 – 37.5 degree C Blood Pressure:60-80/40-60 mmhg

8. APGAR SCORE IN 1952,DR.Virginia Apgar developed the Apgar score. The Apgar score is done twice following the birth of new-born. It is done a 1 min and 5 minute after birth. A score of 8-10= normal A score of 5-7=mild neurological and respiratory distress. A score less than 5= indicate neonatal resuscitation.

9. APGAR SCORE

10. PHYSICAL EXAMINATION LENGTH (47- 50cm): crown to heel length with baby supine position with knee slightly pressed down to get maximum leg extension . HEAD CIRCUMFERENCE(33-35CM): it measured with a measuring tape across the center of the forehead and most prominent portion of the posterior head.

11. CHEST CIRCUMFERENCE (30-33CM): It is measured at the level of nipple and about 2cm less than head circumference. WEIGHT: 2.5kg -3.5kg

12. POSTURE: Supine position with partial flexion of arms, legs and hand commonly turned a little to one side.

13. 2. SKIN: The skin of a healthy newborn at birth has deep red. This is due to increased concentration of RBC and decreased amount of subcutaneous fat. This redness fades after one month.

14. Cyanosis: Peripheral cyanosis –This is normal in the 1 st 24 to 48 hours after birth. Central cyanosis – it indicates decreased oxygen. May cause due to respiratory distress.

15. Vernix caseosa : This is a soft, white, cheesy, yellowish cream on the infant's skin at birth .It is caused by the secretions of the sebaceous glands of the skin.

16. Lanugo This is a long, soft growth of fine hair on the infant's shoulders, back, and forehead. It disappears early in postnatal life.

17. Milia • These are tiny sebaceous retention cysts. They appear as small white or yellow dots and are common on the nose, forehead, and cheeks of the infant.

18. Erythema toxicum : It begins as papule, increasing in severity to become erythema by the 2 nd day and then disappearing by 4 th day onwards.

19. Mongolian Spots • These are blue-black colorations on the infant's lower back, buttocks, and anterior trunk. They disappear in early childhood.

20. 3. HEAD: Newborn’s head appears disproportionately large because it is one fourth of the total length. Fontanells : The anterior fontanel is diamond-shaped and strongly pulsatile. It normally closes at 9 to 18 months of age. The posterior fontanel is small, triangular shaped, and less pulsatile. It normally closes at 1 1/2 to 3 months of age.

21. Caput succedaneum: It is edematous swelling on the babies scalp due to infiltration of serous fluid by the pressure. It disappear in few days.

22. Cephal hematoma: It is collection of blood in between periosteum and flat bone of skull.

23. 4. EYES: When new born cries, tears may not be seen. Lacrimal ducts are not fully mature until 3 months. Eyes should appear clear without any redness or purulent discharge.

24. 5. EARS: The infant's ears tend to be folded .A line drawn through the inner and outer canthi of the eye should come to the top notch of the ear where it joins the scalp. The infant usually responds to sound at birth.

25. 6. MOUTH: The infant's lips should be pink and the tongue smooth and symmetrical. Mouth should be observed for cleft lip, cleft palate and tongue tie. Occasionally small round, glistering cysts ( Epstein pearls ) are present on palate due to extra calcium deposited in utero.

26. 7. NECK: The neck of newborn is short, and creased with skin fold. Head should rotate freely on it. 8. CHEST: Looks small because the infant’s head is large in proportion. Possible breast engorgement with secretion of thin watery fluid (witch’s milk)

27. 9. ABDOMEN: Bowel sound present. Stomach: The capacity of the infant's stomach is about 30-60ml at birth, but increases rapidly.

28. 10. UMBILICAL CORD: It has 2 arteries and 1 vein. After clamping it begin to dry and falls after 6-10 days.

29. 11. BACK: The spine of newborn typically appears flat in lumber and sacral areas. 12. GENITAL: Anus must be inspected for patent and not covered by a membrane. In male baby both testes are present in scrotum. In female labia majora fully cover labia minora .

30. 13. EXTRIMITIES: Observe for syndactyly or polydactyly . A full term baby have creases covering the entire sole.

31. NEONATAL REFLEXES BLINKING/CORNEAL REFLEXES: Infant blinks at sudden appearance of light. 2. PUPILLARY REFLEX: Pupil constricts when bright light shines towards it.

32. 3. DOLL’S EYE REFLEX : As head move slightly to left or right, eyes lag behind and do not immediately adjust to new position of head.

33. GLABELLAR REFLEX Tapping briskly on glabella causes eyes to close tightly. Disappears as brain mature.

34. SUCKING REFLEX: Rooting helps the baby become ready to suck. When the roof of the baby’s mouth is touched, the baby will begin to suck.

35. ROOTING REFLEX: The infant turns his head and open his mouth to the side when the side of his face is touched. Disappears at 3-4 months.

36. GAG REFLEX: Stimulation of posterior pharynx by food, suction or passage of tube causes infant to gag.

37. MORO REFLEX: Hold the baby so that one hand support head and another supports buttocks. The reflex is elicited by sudden dropping of the head in her hand. The baby responds with series of movements i.e. hands open and there is extension and abduction of the upper extremities. This is followed by anterior flexion of upper arm and audible cry. This disappears at 6 months.

38. TONIC NECK REFLEX: This elicited by rotating the infant’s head from midline to one side. The baby should respond by extending the arm on the side to which the head is turned and flexing the opposite arm. The lower extremities responds similarly. It disappears at 7 months.

39. PALMAR GRASP REFLEX: Elicited by examiner placing her finger on the palmar surface of the infant’s hand and baby will grasp the finger. Disappears in 2-3 months.

40. EXTRUSION REFLEX: When tongue is touched or depressed the baby responds by forcing it outwards. Disappears by age of 4-5 months.

41. YAWN: Spontaneous response to decreased oxygen by increasing amount of inspired air.

42. STEPPING REFLEX: Elicited by touching the top of the baby’s foot to the edge of a table while the baby is held upright. The baby makes movements that resemble stepping. Disappear in 3-4 months.

43. SNEEZING REFLEXES Spontaneous response of nasal passage to irritation or obstruction persists throughout the life .

44. GALANT REFLEX: It is named after neurologist Johann Susmann Galant. It is elicited by holding the newborn in ventral suspension (face down) and stroking along the one side of the spine. The normal reaction is for the newborn to laterally flex toward the stimulated side.

45. BABINSKI REFLEX: Elicited by stimulating the edge of the sole of the foot. The baby will respond by planter flexion and either flexion or extension of toes.

46. TORTICOLLIS (WRY NECK) The head held to one side with chin pointing to the opposite side due to positioning in the womb. Exercise the neck gently on opposite direction.

47. HARLEQUIN COLOR CHANGE The color changes as the baby lies on the side, lower half of the body becomes pink or red and upper half is pale. It is harmless and never been associated with permanent problem.

48. DAILY ASSESSMENT

49. Obtain Vital Sign Temperature In neonate the temperature can be taken from groin, axilla from mouth. Normal temperture:36.5-37.5 degree C Hypothermia: <36 degree C Hyperthermia: >41degree C Respiration : count by observing the abdominal movement in infant. Normal rate is : 40-60 breath/min

50. Conti…….. PULSE : Apical pulse are more reliable for infants (between 4 th and 5 th intercostal space. Blood pressure : Manual blood pressure monitoring is not routinely done in neonatal nursery but in certain circumstances with Oscillometry . The average systolic /diastolic pressure is 65/44 mmhg at 1 to 3 days of age

51. Head to toe examination

52. Assessment of Breast feeding pattern Weight pattern – consistent weight gain(20-30g/day). Voiding –wet diaper/dry, soaked? Feeding demand –every 2-3 hour Duration of feeding-generally 10-20min/side Activity of infant. Sleeps 16-18 hours per day

53. Check skin condition Skin color Skin lesion

54. Help in bedding in / rooming -in

55. Assess bathing and hygiene and grooming.

56. Elimination Pattern 6-8 times pale/colorless voides /day. 3-4 times loose ,yellow ,curd like stool per day. Note For any abnormalities: e.g Cleft palate,cleft lip,hydrocephalus .

57. Neurological assessment: Useful information can be gained simply by observation of the baby’s posture, alertness and level of activity. Cranial nerves may quickly tested by reflexes. Blood volume 80ml /kg of body weight RBC: 6 to 8 million/ cmm Hb%: 18 g% Platelets: 350000/ cmm WBC: 10000 to 17000/ cmm

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