Newborn Assessment

Apgar Scoring

• A quick system review of newborn systems at 1 and 5 minutes post-birth
• Determines extrauterine adaptation, guiding interventions
• Scores range 0-3 (severe distress), 4-6 (moderate difficulty), 7-10 (minimal/no difficulty)
• Five criteria: heart rate, respiratory rate, muscle tone, reflex irritability, and color
• Each criterion rated 0-2, with a total score indicating newborn condition
• Example: heart rate 120, good cry, pink skin, would score 10
• Consider genetic background for accurate color assessment

Newborn Assessment Overview

• Understanding newborn physiologic response to birth essential for nursing care
• Key elements include Apgar score, physical exam, Ballard Score, vital signs, and complications
• Transition to extrauterine life requires respiratory and circulatory system adjustments
• Respiratory function establishment marked by first breath and umbilical cord clamping
• Circulatory adaptation involves closure of ductus arteriosus, ductus venosus, and foramen ovale
• Immediate post-birth assessment critical to identify abnormalities or complications

Equipment for Newborn Assessment

• Bulb syringe for suctioning mucus
• Pediatric stethoscope for heart rate, breath sounds, bowel sounds
• Axillary thermometer for monitoring temperature
• Blood pressure cuff for measuring blood pressure
• Scale for weighing newborns
• Tape measure for length (crown-to-heel) and head circumference

Initial Assessment Procedures

• Quick initial assessment for critical abnormalities
• Skin color, peeling, birthmarks, nasal patency observation
• Chest assessment: breathing, heart and lung sounds auscultation
• Abdominal assessment: umbilical cord, abdomen inspection
• Neurologic assessment: muscle tone, reflexes, fontanel size evaluation
• Document gross structural malformations

Expected Reference Ranges

• Weight: 2,500 to 4,000 grams (5.5 to 8.8 lbs)
• Length: 45 to 55 cm (18 to 22 in)
• Head Circumference: 32 to 36.8 cm (12.6 to 14.5 in)
• Chest Circumference: 30 to 33 cm (12 to 13 in)

Gestational Age Assessment

• Performed within first 48 hours after birth
• Crucial for predicting neonatal morbidity and mortality
• Physical measurements and New Ballard Score used

New Ballard Score

• Assesses neuromuscular and physical maturity
• Each parameter (e.g., neuromuscular, physical) rated -1 to 5
• Total score indicates gestational age in weeks
• Score of 35 indicates approx. 38 weeks gestation
• Helps identify preterm and post-term infants

Classification of Newborns

• Classified by gestational age and birth weight
• Appropriate for Gestational Age (AGA): 10th-90th percentile birth weight
• Small for Gestational Age (SGA): Below 10th percentile birth weight
• Large for Gestational Age (LGA): Above 90th percentile birth weight

Normal Deviations in Skin

• Milia: Small pearly spots on face, usually vanish on their own
• Mongolian Spots: Blue-gray or brown pigmentation, common in darker-skinned infants, typically harmless
• Telangiectatic Nevi (Nevus Flammeus): Flat pink/red marks, typically on the neck or face, usually fade with age
• Capillary Flammeus: Pink marks that do not blanch, often seen on the face, and are permanent unless treated

Vital Signs Assessment

• Sequence: respirations, heart rate, blood pressure, temperature
• Normal respiratory rate: 30-60 breaths/min
• Normal heart rate: 110-160 beats/min
• Normal temperature: 36.5°C to 37.5°C (97.7°F to 99.5°F)
• Abnormal findings like crackles, wheezing, grunting, or nasal flaring indicate respiratory distress

Physical Examination from Head to Toe

• Newborn posture typically curled up with moderate flexion.
• Skin color transitions from deep red to purple (acrocyanosis), especially in first few hours
• Jaundice may appear by day 3 due to increased bilirubin levels (usually resolves spontaneously)

Head Assessment

• Head circumference should be 2-3 cm larger than chest circumference
• Head circumference greater than or equal to 4cm larger than chest circumference may indicate hydrocephalus
• Regular monitoring crucial for neurological development

Caput Succedaneum and Cephalohematoma

• Caput Succedaneum: Localized soft tissue swelling due to birth pressure, resolves in 3-4 days without treatment
• Cephalohematoma: Blood collection between periosteum and skull bone, does not cross suture lines, resolves in 2-8 weeks

Sensory Assessment

• Eye Examination: Symmetry in size, shape, distance between inner/outer canthus, assess for tears, pupillary and red reflexes
• Ear and Nose Assessment: Ear positioning, nasal patency, possible abnormalities
• Oral and Neck Assessment: Palate closure, symmetry, tongue protrusions, presence of neck webbing

Reflexes and Neurological Assessment

• Sucking/Rooting, Palmar/Plantar grasp, Moro, Symmetrical Tonic Neck, Babinski, Stepping reflexes documented
• All reflexes should be present at birth unless there is a developmental delay

Extremities Assessment

• Assessing for full range of motion, symmetrical extremities, evaluating bowed legs, flat feet, and pink nail beds. Absence of extra digits noted

Pain Assessment in Newborns

• CRIES scale and NIPS used to assess pain.
• Behavioral changes like alterations in sleep, feeding, or activity are noted indicators.
• Physiological responses (e.g., increased heart rate, shallow respirations) also evaluated for pain.

Newborn Laboratory Values

• Hgb: 14-24 g/dL
• Platelets: 150,000-300,000/mm³
• Hct: 44-64%
• Glucose: >40-45 mg/dL
• Other laboratory (RBC count, bilirubin) values based on time after birth