New born assessment.pptx77777777777777777777777777777777777777

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1. SCHOOL OF CLINICAL SCIENCES Paediatrics New-born Assessment Lecturer: Dr. Jalloh Prepared By: Amadu Wurie Timbo ID No.: 22079

2. NEWBORN EXAMINATION It is a comprehensive clinical assessment conducted shortly after birth to evaluate the overall health, development, and immediate needs of a newborn

3. WHY? To identify Immediate Health Issues To assess Vital Functions To detect Congenital Anomalies To screen for Metabolic and Genetic Disorders To monitor Growth and Development To evaluate Neurological Function Parental Reassurance

4. INDICATIONS 1 st Examination Detailed one within 2 hrs of birth 2 nd Examination Before Discharge 3 rd Examination After 6-8 weeks of Neonatal Life

5. REQUIREMENTS Thermometer Watch/Timer Alcohol swabs Pen and Paper/Chart Gloves Hand Washing materials Apron Stethoscope Inch tape Torch Weighing Machine Bowl with cotton Kidney Tray

6. INITIAL ASSESSMENT OF NEWBORN Identification- sex of Infant, Name of Mother, Registration Number Gestational Age - Full-Term/Pre-Term/Post-Term

7. VITAL SIGNS (Normal) Respiration 40-60 breath/min Heart Rate 120-160 breath/min Temperature 36.5-37.5

8. PHYSICAL EXAMINATION LENGTH Supine, press down to obtain Max Leg extension (47-50 cm) HEAD CIRCUMFERENCE Glabella, external occipital  protuberance (33-35 cm)

9. CHEST CIRCUMFERENCE Level of nipples, about 2cm < Head Circumference, 30-33 cm WEIGHT 2.5-3.5

10. POSTURE AND MOVEMENT Supine Position Partial flexion of hands, legs and head slightly turned to one side Hip Joint partially abducted Movement mostly evident in face and limbs Report unusual or lack of movement

11. 2 . SKIN Colour Term newborns - ruddy complexion Cyanosi s- Periferial Cyanosis, Central cyanosis b) Vernix Caseosa - White, Cream Cheese-like c) Lanugo- fine, downy hair, covers newborn’s shoulder, back, upper arm and sometime forehead. Pre-term>Post-term

12. d ) Desquamtion - Skin peeling, head and feet Milia - pinpoint white papule. Disappears 2-4 weeks f) Erythema toxicum - Begins as papule, 2 nd day becomes erythema, 3 rd day Disappears

13. g) Forceps mark- Circular or linear contusion matching the rim of the blade. Disappears in two days along with the edema h ) Skin Turgor- Skin Feels elastic when grasped. Forms smooth surface when released Remains in elevated ridge in severe dehydration Mongolia spot Slate- gray – blue-black lesions over lumbo -sacral and buttocks Fades off by age 7

14. 3. HEAD Disproportionally Larger Forms 1/4 th of the total length Anterior Fontanel- soft spot Posterior Fontanel- readily palpable Sutures not be widely separated And not fused

15. CAPUT SUCCEDANEUM Suture lines swelling Appears as a soft and puffy CEPHALHEMATOMA Blood collection between the periosteum and the skull Limited to one cranial bone Appears hours after birth Firmer and more localized

16. 4. EYE Tearless and clear Observe for subconjuctival hemorrhage , opthalmi a , neonatorum , etc

17. EAR External top part should be on a line drawn from the inner canthus to the outer canthus of the eye and back across the side of the head Ear Cartilage- felt along with the edge Pinna firm

18. MOUTH Lips & Oral Cavity- shape, colour, etc Tongue- Size and Movement, Tongue-tie ( Ankyloglossia ) Hard and Soft Palate Gums and Teeth- Gingival, Natal Teeth Mucous Membranes- Mosture , Thrush (Oral Candidiasis) Chin and Jaw- Size and Alignment

19. NECK Neck Mobility- Range of Motion and head lag Neck Symmetry- Positioning, Muscle Tone and Symmetry Masses and Swellings Trachea Skin Folds and Redundancy Clavicles Neck Skin

20. CHEST Chest Shape and Symmetry Breathing Patterns Auscultation Palpation Cyanosis and Skin Color Nipple and Breast Examination Cardiac Function Signs of Respiratory Distress

21. ABDOMEN Inspection Umbilical Cord Auscultation Palpation Percussion Genitalia and Groin Signs of Abdominal Distress Abdominal Wall Defects Meconium and Stool Patterns

22. BACK Spinal Alignment Spinal Defects Symmetry of the Back Skin of the Back Gluteal Fold Symmetry Signs of Neural Tube Defects Palpation of the Sacrum Range of Motion in the Spine Neurocutaneous Markers

23. ANOGENETAL AREA (Male) Penis- penis straight and well-formed (2.5 to 3.5 cm ) Urethral opening- Hypospadias and Epispadias Scrotum and Testes- Scrotal appearance, Testicular descent/Cryptorchidism, Hydrocele

24. ANOGENETAL AREA (Female) labia majora , labia minora Clitoris prominent but not excessively large; congenital adrenal hyperplasia Vaginal Discharge- (milky or blood-tinged discharge/ pseudomenstruation ) Hymen- Imperforate hymen

25. ANOGENETAL AREA ( Male & Female) Anus - Patency, meconium (within the first 24-48 hours), Position

26. EXTREMITIES Digits (Fingers and Toes)- polydactyly , syndactyly , nail deformities or cyanosis Hands- palmar creases (simian crease) Arms- arms move equally, Palpate the clavicles, brachial plexus injury (e.g., Erb's palsy)

27. Legs - Barlow and Ortolani maneuvers , abnormal curvature Feet - clubfoot, positional foot deformities Skin and Joints- bruising, edema , or birthmarks, crepitus or dislocation . Skeletal Abnormalities- skeletal dysplasia or limb length discrepancies, scoliosis or spina bifida Sole - soft and smooth

28. MECONIUM Timing of Passage- Normal, Delayed passage, Early passage Characteristics of Meconium- thick, tar-like, and dark green or black . sterile and odorless .

29. NEONATAL REFLEXES Moro Reflex (Startle Reflex ) Sudden movement, loud noise, or sensation of falling . Baby throw arms out, spread fingers , and then bring arms back to the body while crying . Present at birth, Disappear s Around 4–6 months . Moro reflex absent or asymmetric may indicate neurological issues or brachial plexus injury.

30. Rooting Reflex Stroke the side of the baby’s cheek or mouth. Baby turn head toward the stimulus and open the mouth Present at birth, disappears around 4 months. Initiate breastfeeding .

31. Sucking Reflex Touch the roof of the baby’s mouth. B aby begins to suck. Present at birth, disappears round 4 months Essential for feeding

32. Palmar Grasp Reflex Place an object in the baby’s palm. B aby will grasp object tightly . Present at birth, disappears round 5–6 months. Demonstrates normal neurological development

33. Plantar Grasp Reflex Press on the sole of the baby’s foot, near the toes. B aby’s toes curl down as if trying to grasp. Present at birth, disappears around 9–12 months. Absence could suggest neurological impairment.

34. Babinski Reflex Strike the sole of the foot from heel to toes. B ig toe extends upward, and the other toes will fan out. Present at birth, disappears around 12-24 months. Normal in infants, beyond 2 years may indicate neurological problems

35. Stepping Reflex (Walking Reflex) Hold baby upright with the feet touching a flat surface. B aby makes stepping movements, trying to walk. Present at birth, disappears around 2 months Prepares for future walking.

36. Tonic Neck Reflex (Fencing Reflex) Turn baby’s head to one side while on their back A rm on the side, head turned extends, while the opposite arm bends at the elbow Present at birth, disappears around 4–6 months. Helps with hand-eye coordination and prepares baby for voluntary reaching .

37. Galant Reflex Stroke one side of the baby’s spine, baby face down. B aby curves body toward the side that is stroked. Present at birth disappears around 4–6 months. Absence indicates spinal cord issues.

38. Swimming Reflex Place the baby face down in water. B aby make coordinated swimming movements. Present at birth, disappearance around 4–6 months. Prepares the baby for swimming-like motions later on.

39. Blinking/Corneal Reflex Use bright light, or bright light, or lightly touching the cornea Baby rapidly closes both eyelids P resent at birth and persists throughout life I ndicator cranial nerve function Absence- Neurological impairment or brain damage, or coma or severe brain injury in severe cases. Delay May suggest a central nervous system issue or decreased sensitivity of the cornea.

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