NEWBORN EXAMINATION.pptx

NEWBORN EXAMINATION for nursing students

1. NEWBORN EXAMINATION PRESENTED BY: Ms. Satnam Kaur Mand

2. INTRODUCTION Head to toe physical examination of a newborn to look for any abnormalities or pathology.

3. PURPOSES Gives detailed information regarding the problems of babies during the 1 st four weeks of life. To identify the abnormalities of the newborn. To improve neonatal care and it leads to better and intact infant survival.

4. PURPOSES To detect any complication occurs during delivery. To identify and record evidence of birth injury , congenital malformation and diseases.

5. ARTICLES REQUIRED Radiant warmer Tape measure Stethoscope Watch with seconds Weighing scale Thermometer

6. Growth Chart Ophthalmoscope Tongue depressor Scale, Pencil, Fresh clean sheet/ Clothes Infantometer Pen Torch

7. APGAR Scoring The APGAR score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two and summing up the five values . The resulting APGAR score ranges from zero to 10 .

8. A ctivity / Muscle Tone P ulse / Heart Rate G rimace / Reflex Irritability/ Responsiveness A ppearance / Skin Color R espiration / Breathing

9. Healthy newborn : 7-10 at both 1 and 5 minutes . Moderately depressed newborn : 3-6 ( Need resuscitation ) Severely depressed newborn : 1-2 ( Intensive resuscitation )

10. PHYSICAL EXAMINATION

11. VITAL SIGNS Temperature Pulse Respiration Blood Pressure

12. TEMPERATURE It can be recorded at three sites: rectal, oral or axillary . Most common site is axilla . After birth the baby should be kept in skin to skin contact with the mother immediately. Hands and feet should be checked for warmth with back of the hand to see if the baby is in cold stress.

13. If the baby feet and hand are cold but the baby is warm when seen over the chest, it means that the baby is in cold stress. Each time use a fresh clean thermometer. The temperature of a baby is seen with the thermometer held vertically in the axilla for 3 minutes. Normal temperature is 36.5 ° C – 37.5 ° C. If it is between 36° C- 36.5 ° C , the baby is in cold stress .

14. RESPIRATION Observe the chest rise and fall in full 60 seconds. Most often, the breathing of a newborn is diaphragmatic, so during inspiration the anterior thorax usually draws inward while the abdomen protudes . Newborn respiratory rate is 30 to 60/ min. Grunting or labored breathing usually suggests respiratory distress syndrome.

15. PULSE The heart rate is taken apically with a stethoscope and the brachial, femoral arteries are palpated for equality of strength. Both are counted for a full 60 seconds. Normal heart rate 100-160 bpm Absence of femoral pulses or brachial femoral delay is suggestive of left sided heart lesions and coarctation of the aorta.

16. BLOOD PRESSURE Blood pressure measurement can be difficult to perform on the neonate and normal values vary depending on gestational age and weight. Blood pressure should always be measured with the infant in a quiet state and with the correct sized blood pressure cuff.

17. The preffered site for BP is right arm; however other sites such as the forearm, calf or thigh may be used as long as the cuff width is 40 % of the circumference of the limb on which the cuff is placed. Newborn BP (systolic) 60-80 mmHg.

18. ANTHROPOMETRIC ASSESSMENT Weight Length Head Circumference Chest Circumference Waist Circumference

19. WEIGHT The scale should be taken to the baby. Then the pan of the weighing scale is covered with a fresh cloth. After this, the baby is placed naked over the weighing scale. Normal weight is 2500- 4000 gm (2.5 to 4.5 kg)

20. WEIGHT

21. LENGTH Length is most accurately recorded using a neonatal measurement board in which the baby’s crown is placed at one end and the examiner deflexes the hip and knees and measures a maximum length to the sole of the feet. Infant lies on back with legs extended; measure the distance from vertex to heel of right foot.

22. LENGTH Newborn length range is 46- 56 cm.

23. HEAD CIRCUMFERENCE The occipito frontal head circumference is measured by placing a tape measure around the head to encircle the occiput , the parietal bones and the forehead (1cm above the nasal bridge) Newborn head circumference is 32-37cm (12.5- 14.5 inches)

24. HEAD CIRCUMFERENCE

25. CHEST CIRCUMFERENCE An assistant is required to assure that the infant is in the correct position. The infant lies on back. With an automated tape device, measure the circumference of the chest at the level of the nipples during normal breathing.

26. CHEST CIRCUMFERENCE

27. WAIST CIRCUMFERENCE An assistant is required to assure that the infant is in the correct position. The infant lies on back with legs fully extended. With an automated tape device, measure the circumference just below the level of the iliac crest and above the level of the greater trochanter in a plane perpendicular to the torso.

28. WAIST CIRCUMFERENCE

29. GENERAL APPEARANCE

30. POSTURE In the full term neonate, the posture is one of complete flexion. Infant’s behavior is carefully noted. Normal flexion of the extremities indicates good muscle tone. Lack of flexion is associated with hypotonicity , whereas excessive flexion usually suggests hypertonicity .

31. SKIN Color: Most babies are pink, although some babies exhibit ACROCYANOSIS (cyanosis of the peripheries) without significance. Fingers and toes appear bluish is normal for a new born infant. If there is generalized cyanosis, observe the response to oxygen administration as well as cry.

32. VERNIX : This is a white substance often present on the skin at birth. Its role in the fetus is to prevent overhydration of fetal skin

33. LANUGO : Fine downy hair covers the skin of the shoulder, upper arms and thigh.

34. PETECHIA : The presences of the small hemorrhagic skin lesions may be begin and occur on the face due to birth injuries or trauma

35. MILIA : They occur particularly over the nose and are small sebaceous cyst.

36. MONGOLIAN SPOT : Acres of bluish colored pigmentation may occur extensively on the back especially over the sacro coccygeal region.

37. SCALP The scalp is most commonly the presenting part at delivery. It is relatively easily traumatised and swelling with or without bruising in relatively common. A cranial meningocele (neural tube defect that develops due to inadequate development of upper end of neural tube)or encephalocele may also poduce a swelling.

38. HEAD FONTANELLES : Fontanelles are areas where at least three bony plates of the skull meet. They can be felt as soft spots on the head. The posterior fontanelle normally measures less than 0.5cm at birth and closes shortly after it.

39. The anterior fontanelle normally measures 1-5cm in diameter at birth and doesnot close until 18months of age. The anterior fontanelle at rest should neither bulge nor be sunken. It will bulge as the baby cries.

40. SUTURES Sutures are the gaps between two bony plates of the skull. At birth the sutures may be easily palpable, but the bone edges are not widely separated. Premature fusion of a suture may be palpable as a prominent edge, but beware because over riding sutures can often be felt following delivery, but they will resolve with time.

41. Examine head for: Asymmetry/ abonrmal shape Size Premature closing of suture and fontanelles . Large fontanel is associated with hypothyroidism, osteogenesis , chromosomal abnormalities. Bulging fonatenelles due to increased ICP, meningitis or hydrocephalus. Decreased fonatenelles are seen with dehydration. Small fonatenelle may be due to hyper thyroidism , microcephaly .

42. CAPUT SUCCEDANEUM : It is formation of swelling due to stagnation of fluid in the layers of scalp. MOLDING : Over riding of parietal bones. CEPHALOHEMATOMA : It is the collection of blood in between the periosteum usually unilaterally over the parietal bone.

43. FACE The skin of the face should be uniformly pink in color and free from swellings, abrasions and lesions to detect asymmetry; hemihypertrophy , cleft clip. Look at the symmetry of the face. Asymmetry may result from abnormalities of development of individual components, postural deformities or syndromes.

44. EYES Examination of the eyes by observing the lids for edema. Eyes are observed to find out asymmetry, corneal opacity, coloboma (hole in one of the structures of the eye) and to asses for jaundice. Sclera should be white and clear. The iris of a baby is normally blue. It should be perfectly circular with a round opening (pupil) in the center.

45. COLOBOMA

46. EARS Examine for position, structure and auditory function to identify skin creases, deformity, perauricular skin tags. The top of the pinna should lie in a horizontal plane to the outer canthus of the eye.

47. NOSE Babies are nasal breathers. The nose is usually flattened after birth. Patency of the nasal canal is assessed by holding a handover the infants mouth and one canal and noting the passage of air through the unobstructed opening.

48. MOUTH AND THROAT Assures for cleft lip and palate. Epstein pearl small white epithelial cyst both sides of the hard palate.

49. NECK Observe for range of motion, shape and any abnormal masses and palpate each clavicle for possible fractures especially if there us any history of shoulder dystocia or any suggestion of an Erb’s palsy (paralysis of arm)

50. CHEST Chest is examined for asymmetry. Moving down to the chest look for any asymmetry of the rib cage. The newborn’s breast may be enlarged due to maternal estrogen. The white discharge from nipple is commonly known as “Witch’s milk”

51. HEART One of the most difficult and important systems to examine is the heart, so the baby must be calm and content. It is the ideal to examine the heart first before examining other parts. Check heart rate, rhythm and also presence of any abnormal heart sound.

52. ABDOMEN The examiner’s fingertips must be gently placed and hel d on the abdomen without exerting any downward pressure. Deep palpation should then proceed gradually. Examine for distention, shape, tenderness and organomegaly , hepatomegaly , spleenomegaly .

53. UMBILICUS Umbilical cord is inspected for determining for 2 arteries and one vein, any discharge, color and redness. The normal umbilicus is bluish white in color on first day. Later over the next few days, it begins to dry and shrink and falls off after 7-10 days

54. GENITALIA FEMALE: The labia majora are not well developed and therefore the clitoris and labia minora are prominent. Vaginal discharge and some vaginal bleeding may be present during 1 st week is pseudo menstruation. It is due to withdrawal of maternal hormones.

55. MALE: Examine for testis within the stratum and hydrocele , hypospadias etc. Check for testis, size and shape of penis, position of meatus , urine stream.

56. REFLEXES

57. EYES BLINKING OR CORNEAL REFLEX : Infant blinks at sudden appearance of a bright light or at approach of an object toward the cornea, persist throughout the life.

58. PUPILLARY: Pupil constrict when a bright light shines towards it persists throughout the life. DOLL’s EYE: As head is moved slowly to right or left, eyes tag behind and donot immediately adjust to new position of head .

59. NOSE SNEEZE: Spontaneous response of nasal passages to irritation or obstruction. GLABELLA: Tapping briskly on glabella causes eyes to close tighly .

60. MOUTH, THROAT & NECK ROOTING : Touching or striking the cheek along the side and begin to suck. SUCKING : Infant begins strong sucking movements of circumoral areas in response to stimulation. SWALLOWING : Movement of throat muscle to push food from mouth to esophagus.

61. EXTRUSION : When tongue is touched or depressed infants respond to by forcing it outward. YAWN: Spontaneous response to decreased oxygen by increasing amount of inspired air.

62. COUGH : Irritation of mucus membrane of larynx or trachea bronchial tree carries coughing. TONIC AND NECK REFELX: When head is turned to one side, arm and leg of same side are extended in a fencing posture .

63. EXTREMITIES GRASP: Touching palms of hands or soles of feet near base of digits causes flexion of hands and toes. BABINSKI: Stroking outer sole of foot outward from head and across ball of foot causes the big toes to dorsi flex and the other toes to hyperextend or fanning of finger occurs.

64. MORO : When startled, arms and legs swing quickly out, then immediately back and neonate curls up into a ball.

65. SUMMARIZATION Today we have discussed about: Newborn examination Introduction Purposes Articles required for examination Vital Signs Anthropometric assessment Physical Examination Neonatal Reflexes

66. RECAPTUALIZATION What is Newborn examination? What is Acrocyanosis ? What is lanugo ? What is Rooting reflex? What is Babinski reflex?

67. ASSIGNMENT Define Newborn examination. Write about Anthropometric assessment. Explain neonatal reflexes.

68. REFERENCES Swain Dharitri , Obstetrics Nursing Procedure Manual, First Edition, Jaypee Brothers Medical Publishers(P) Ltd, 2017. Pp: 164-176. Jacob Annamma , A Comprehensive Textbook of Midwifery & Gynecological Nursing, 4 th Edition, Jaypee Brothers Medical Publishers(P) Ltd; 2015. pp 270-276.