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Questions and Answers
What is indicated by the absence of the red reflex in an eye examination?
What is indicated by the absence of the red reflex in an eye examination?
Which condition is represented by 'doll's eyes' beyond 10 days of age?
Which condition is represented by 'doll's eyes' beyond 10 days of age?
What can be a sign of chemical conjunctivitis?
What can be a sign of chemical conjunctivitis?
What does the presence of epicanthal folds indicate in newborns not of Oriental descent?
What does the presence of epicanthal folds indicate in newborns not of Oriental descent?
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What is the significance of opaque lenses during an eye examination?
What is the significance of opaque lenses during an eye examination?
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Which reflex indicates an infant's ability to feed by sucking?
Which reflex indicates an infant's ability to feed by sucking?
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What is a common variation that appears as white, shiny spots on the hard palate?
What is a common variation that appears as white, shiny spots on the hard palate?
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Which feature indicates proper development in an infant's mouth regarding tongue movement?
Which feature indicates proper development in an infant's mouth regarding tongue movement?
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What physical characteristic is associated with well-developed fat pads in infants' cheeks?
What physical characteristic is associated with well-developed fat pads in infants' cheeks?
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What is the significance of the uvula being situated midline in an infant?
What is the significance of the uvula being situated midline in an infant?
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What is the duration of the condition mentioned?
What is the duration of the condition mentioned?
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On which day does the condition appear?
On which day does the condition appear?
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What should not be done to the breasts during this condition?
What should not be done to the breasts during this condition?
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How does the condition progress over time?
How does the condition progress over time?
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What is a possible consequence of expressing the breasts?
What is a possible consequence of expressing the breasts?
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At what age do fontanels typically close?
At what age do fontanels typically close?
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What characterizes caput succedaneum?
What characterizes caput succedaneum?
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What is the purpose of the APGAR scoring system?
What is the purpose of the APGAR scoring system?
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What is a common result of caput succedaneum?
What is a common result of caput succedaneum?
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Which of the following describes a sign of potential distress in a newborn?
Which of the following describes a sign of potential distress in a newborn?
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Which characteristic describes normal sutures in infants?
Which characteristic describes normal sutures in infants?
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What is the normal temperature range for a newborn measured axillary?
What is the normal temperature range for a newborn measured axillary?
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Which of the following best describes molding of fontanels and suture spaces?
Which of the following best describes molding of fontanels and suture spaces?
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What is a common variation of newborn posture associated with breech delivery?
What is a common variation of newborn posture associated with breech delivery?
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What heart rate range is considered normal for newborns?
What heart rate range is considered normal for newborns?
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What is an example of a sign indicating a possible oral anomaly?
What is an example of a sign indicating a possible oral anomaly?
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What condition is characterized by incomplete fusion of oral structures?
What condition is characterized by incomplete fusion of oral structures?
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What is circumoral pallor a potential sign of?
What is circumoral pallor a potential sign of?
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Which condition is specifically identified as a congenital oral anomaly?
Which condition is specifically identified as a congenital oral anomaly?
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Which symptom might suggest a problem with tongue mobility?
Which symptom might suggest a problem with tongue mobility?
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Study Notes
Physical Assessment of the Newborn
- The presentation addresses the physical assessment of newborns, including initial observations, classifications, and the roles of nurses and physicians.
- Initial observation determines if immediate intervention is needed for neonatal conditions. If so, the infant is sent to the normal newborn nursery or maternity floor for follow-up and stabilization.
- Gestational age classification includes early-term (37 to < 39 weeks), full-term (39 to < 41 weeks), late-term (41 to < 42 weeks), and post-term (42 weeks and beyond).
- The role of neonatal nurses and physicians is crucial within the normal newborn nursery or maternity floor.
- The presentation includes a mnemonic (SUGAR) for stabilizing transitioning newborns encompassing sugar, temperature, artificial breathing, blood pressure, labs, and emotional support for the family.
- Admission care involves good communication, a thorough maternal and neonatal history, ensuring identification bands, complete physical assessment, prevention of hemorrhage (vitamin K, if not given during delivery), and documentation.
Assessment: APGAR Scoring System
- The initial assessment of a newborn utilizes the APGAR scoring system.
- The APGAR system assesses the newborn's immediate adjustment to extrauterine life.
- The scoring system rates different factors like appearance (color), pulse, grimace (reflex irritability), activity (muscle tone), and respiration.
- The APGAR score is a tool that helps evaluate the newborn's status immediately after birth with a score of 0 to 10.
- The evaluation determines the degree of depression.
- No depression : Score 7-10
- Mild depression : Score 4-6
- Severe depression : Score 0-3
General Measurements
- Head circumference ranges from 33 to 35 cm.
- The head should be 2 to 3 cm larger than the chest.
- Chest circumference ranges from 30.5 to 33 cm.
- Head and chest circumference may be equal during the first 24-48 hours of life.
- Weight range is 2500 to 4000 gms.
Weight
- Average daily weight gain for healthy term infants is about 30 gms for the first month, then 20 gms in the second month, and 10 gms daily afterwards in the first year.
Skin
- Skin is reddish, smooth, and puffy at birth.
- At 24-36 hours, skin can be flaky, dry, and pink.
- Edema can be present around eyes, feet, and genitals.
- Vernix caseosa (white, cheesy substance) is present; often in skin folds.
- Lanugo (fine downy hair) is also present, typically on shoulders, sacrum, and back, and usually disappears in the first weeks of life.
- Turgor (skin elasticity) is good with quick recoil.
- Hair is silky and soft with individual strands.
- Nipples are present in expected locations.
- Umbilical cord should have one vein and two arteries, cord clamped tight.
- Nails are to the end of the fingers and extend slightly beyond.
- Common variations include acrocyanosis (sluggish peripheral circulation) , Mongolian spots (dark spots on the lower back), physiologic jaundice (yellowing of the skin), milia (tiny white or yellow papules on areas such as cheeks), erythema toxicum (pink rash with vesicles), petechiae/bruises over presenting part, Harlequin color change (half of the body appearing red and half pale), Desquamation(Peeling of skin over bony prominence), Jaundice within 24 hours of birth, and General cyanosis (blueish coloration).
Head
- Anterior fontanel is diamond-shaped at the junction of the parietal and frontal bones and is 2–3 cm wide and 3–4 cm long, closing between the ages of 12 and 18 months.
- Posterior fontanel is triangular, about 0.5–1 cm in diameter, located between the parietal and occipital bones and closes by the second month of life.
- Fontanels should be soft, firm, and flat.
- Sutures should be palpable with small separations.
- Common variations include molding of fontanels and sutures.
- Caput succedaneum is a soft area on the scalp, usually resulting from labor or vacuum extraction. It extends across the midline over suture lines from pressure on the cervix; venous return is slowed, causing edema and possible bleeding, It typically resolves within a few days.
- Signs of potential distress can include bulging or depressed fontanels, hydrocephalus (excess fluid in the brain), macrocephaly (enlarged head), cephalhematoma (blood collection between the skull bone and periosteum), closed sutures, and craniosynostosis (early closure of skull sutures).
Eyes
- Expected findings: Slate gray or blue eye color (true color not determined until 3-6 months of age), no tears, fixation and ability to follow objects, red reflex, blink reflex, visible and distinct eyebrows, shiny cornea, and pupils that are equal and reactive to light.
- Common variations include edematous eyelids, myopia (nearsightedness), uncoordinated eye movements, limited focus duration, limited vision (high-contrast colors like black and white), discharges (chemical conjunctivitis), and subconjunctival hemorrhage.
- Signs of potential distress could include opaque lenses, absence of red reflex, epicanthal folds present in non-Asian newborns, “doll's eyes” beyond 10 days, absent reflexes, congenital cataracts, and congenital glaucoma.
Ears
- Expected findings include pinna positioned on a horizontal line with the outer canthus of the eye, ability to hear shortly after first sneeze, startle reflex elicited by loud noises, and presence of flexible pinna with cartilage.
- Common variations include skin tags around the ears, low set ears may indicate possible chromosomal or kidney issues, preauricular sinus, malformations, and cartilage absence.
Nose
- Expected findings: patent nostrils, obligate nose breathers (primary nose breathers), no nasal discharge.
- Common variations include sneezing to clear nostrils, and an absent nasal bridge, or thin, white nasal mucus discharge.
- Signs of potential distress include choanal atresia, nasal discharge, and malformations.
Mouth and Throat
- Expected findings: moist mucosa, high-arched palate, midline uvula, minimal/absent salivation, tongue that moves freely, well-developed fat pads on cheeks, and present reflexes—sucking, rooting, gag, and extrusion.
- Common variations include Epstein's pearls (small, white, brittle spots on hard palate, near midline of the gums, often disappearing), cleft lip/cleft palate, circumoral pallor, asymmetrical lip movement, absent reflexes, protruding tongue, reduced tongue movement, and candidiasis/thrush.
Neck
- Expected findings include short and thick neck, readily turning side to side, intact clavicles, presence of tonic neck reflex, neck-righting reflex, and some head control.
- Common variations include torticollis (stiff neck, limited neck movement), large fat pad on back of neck, palpable crepitus during neck palpation, which might indicate difficulty during movement.
Chest
- Expected findings: visible and intact xiphoid process, bilateral and synchronized chest movement, symmetrical nipples with approximately 8 cm distance between them, absent cough reflex immediately after birth, yet present within 1–2 days postnatally.
- Common variations may include Witch's milk (swollen breasts), accessory nipples.
- Signs of potential distress include asymmetrical chest movement, a depressed sternum, marked retractions, absent breast tissue, and flattened chest, with possible supernumerary nipple.
Abdomen
- Expected findings: dome-shaped abdomen, soft to palpation, well-formed umbilical cord with three vessels, dry cord base, liver palpable 2-3cm beneath right costal margin, bilateral femoral pulses, bowel sounds (within 2 hrs of birth), voiding, and meconium within 24-48 hours.
- Common variations may include small umbilical hernia, absent bowel sounds, visible peristaltic waves, abdominal distension, palpable masses (e.g., omphalocele), base of the cord red or with drainage, presence of two vessels in the cord itself.
- Signs of potential distress include absent bowel sounds, visible peristalsis, abdominal distention, palpable masses, base of the cord with redness or drainage, and cord with two vessels, gastroschisis (abdominal wall defect with exposed intestines), omphalocele (abnormal protrusion of abdominal organs into the umbilical cord).
Female Genitalia
- Expected findings may include edematous labia and clitoris, labia majora larger than surrounding labia minora, urethral meatus located behind clitoris, vernix between labia.
- Common variations include hymenal tag, pseudomenstruation, increased pigmentation, ecchymosis and edema after breech birth, "red brick" urine due to uric acid crystals.
- Signs of potential distress can include fused labia, fecal discharge from vaginal opening, imperforate hymen, ambiguous genitalia, and widely separated labia
Male Genitalia
- Expected findings: urinary meatus located at the tip of the glans, large, edematous, pendulous scrotum, usually pigmented, palpable testicles in the scrotum, presence of smegma (thick, cheesy secretion), and an adequate stream on voiding.
- Common variations: prepuce covering urinary meatus, erections, increased pigmentation, edema and ecchymosis after breech birth.
- Signs of potential distress include non-palpable testicles, phimosis (stricture of foreskin), hypospadias (abnormal urethral opening), epispadias (abnormal urethral opening on upper surface), scrotum smooth, and ambiguous genitalia.
Back and Rectum
- Expected findings include intact spine without masses or openings, trunk incurvation reflex, and a patent (open) anal opening.
- Common variations include limitations in movement, fusion of vertebrae, spina bifida, tufts of hair, imperforate anus, anal fissures, and pilonidal cyst
Extremities
- Expected findings include newborn maintaining a flexed posture, equal and bilateral extremity movements and tone, full range of motion in all joints, ten fingers and ten toes with pink nail beds, bowed/straight legs, flat feet, present palmar and sole creases.
- Common variations may include unequal tone, asymmetrical extremity movements, polydactyly (extra digits), syndactyly (fused digits), unequal leg lengths, asymmetrical skin creases, persistent cyanosis of nail beds, clubfoot, and marked metatarsus varus (abnormal turning inward of the foot's metatarsal bones).
Neuromuscular System
- Expected findings include maintaining flexion posture, ability to turn head side-to-side when prone, and holding head and back horizontal when prone. Ability to momentarily hold head erect.
- Common variations may include hypotonia (low muscle tone), straightening of extremities, clonic jerking, and paralysis.
The Central Nervous System
- Reflexes are a strong indicator of normal central nervous system (CNS) function.
- Successful reflex mechanisms are a sign of normal CNS functioning.
Screening
- Screening is a procedure used to detect abnormal conditions before symptoms appear.
- Screening is not diagnostic, it enables early intervention.
- Most screening programs are state-funded.
- An example is screening for PKU (phenylketonuria).
- Screening can include tests for endocrine conditions, organic acid metabolism, fatty acid metabolism, amino acid metabolism, hearing, cystic fibrosis, and hip ultrasounds.
Behavioral Assessment
- Newborns pass through phases of reactivity during the first 6 to 8 hrs after birth.
Behavioral States
- Sleep states—quiet sleep, active sleep
- Transitional state—drowsiness
- Awake states—quiet alert, active alert, crying
Understanding Newborn Cues
- Newborns have distinct cues to communicate their needs.
- Desires for interaction are expressed with behaviors like focusing on the parent's face, ceasing random body movements, and reaching out.
- Newborns communicate their hunger cues by placing hand near mouth or exhibiting sucking and rooting reflexes and flexing arms and clenching fists. Newborn behaviors that indicate a desire to end interaction include turning their head away, displaying fussiness, yawning, and squirming.
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Description
This quiz covers the essential aspects of physical assessment of newborns, focusing on initial observations, gestational age classifications, and the roles of healthcare professionals. It also introduces a helpful mnemonic for stabilizing transitioning newborns and emphasizes the importance of effective communication in admission care. Test your knowledge on this critical area of neonatal care!
