Newborn Physical Examination PDF

APGAR SCORING KEY COMPONENTS: >Immediately at delivery assessment. >1 minute and 5 minutes after birth Appearance- Color Pulse- Heart rate Grimace- Cry...

APGAR SCORING KEY COMPONENTS: >Immediately at delivery assessment. >1 minute and 5 minutes after birth Appearance- Color Pulse- Heart rate Grimace- Cry Activity- Tone and reflex irritability Respiration- respiratory effort  Apgar scores between 8 and 10 indicates that the neonate is making a smooth transition to extrauterine life. Scores ≤ 7 at 5 minutes (particularly if sustained beyond 10 minutes) are linked to higher neonatal morbidity and mortality rates.  Cyanosis that does not clear may indicate congenital Many normal neonates have cardiopulmonary anomalies or cyanosis 1 minute after birth central nervous system (CNS) that clears by 5 minutes. depression.  Physical Examination of the Newborn A thorough physical examination should be done within 24 hours. Doing the examination with the mother and other family members present allows them to ask questions and the clinician to point out physical findings and provide anticipatory guidance. Basic measurements : includes LENGTH, WEIGHT, and HEAD CIRCUMFERENCE. Length is measured from crown to heel. Normal values are based on gestational age. When gestational age is uncertain or when the infant seems large for gestational age or small for gestational age, the gestational age can be more precisely determined using physical and neuromuscular findings. These methods are typically accurate to ± 2 weeks; however, in the sick neonate these methods are less reliable.  The physiologic adjustment to extra uterine life. All you NB appear to move through periods of irregular adjustment in the first six hours of life until at the point of their body system stabilize. This periods were first described by Desmond in 1963 as the three periods of reactivity. Always complete assessment quickly to prevent exposing a newborn to chilling yet not so swiftly that important findings are overlook.  About 20 hours after birth whaen the baby’s system have had time to stabilize, a more thorough and detailed examination is prepared. A NB is given preliminary physical examination as soon as parents have had an initial time to spend with their new child. In addition to height and weight determination to establish gestational age & to detect any observable condition such as difficulty of breathing, congenital heart anomaly or any birthmarks. ASSESSMENT OF THE NEONATE General Appearance POSTURE Flexion of head and extremities, which rest on chest and abdomen. They tend to follow their fetal position even after birth. General inspection of a NB skin includes:  ⬆concentration of RBC in ⬇in amount of subcutaneous their blood vessels. fats. Make blood vessels more visible NB with poor CNS control or respiratory difficulty may appear pale and cyanotic. Generalized mottling of the skin respiratory obstruction or cardiac disease mucus obstruction decrease oxygenation  Cyanosis of the trunk is always a cause for concern. * indicates decrease oxygenation that could be occurring as the result of temporary obstruction. * reflect a serious underlying respiratory obstruction or cardiac disease. *mucus obstructing a NB respiratory tract causes sudden cyanosis and apnea. Always suction from mouth before nose. The nose is the chief conduit Suctioning of nose first for air in the trigger a reflex gasp, NB. possibly leading to aspiration if there is a mucus in the posterior throat. malnutrition in utero , who metabolic Likedifficulty ave adult skin, sucking at birth. disorder. NB skin feel resilient if underlying tissue is well hydrated. Grasp a fold of skin it feels elastic, when release the skin should fall back to form a smoother surface. Always need to be reported as it suggest extremely poor hydration. If dehydrated, skin will not smooth out again, well remain as an elevated. Accumulation of excess bilirubin in the blood serum. In average NB, the skin & sclera of the eye begin to appear noticeably yellowish on the second to third day of life as a result of breakdown of fetal RBC. Increase RBC count built up in the utero. Reduced to Heme & Globin are released. NB can have difficulty with this process. Immature liver functions Prevents indirect bilirubin from being converted to direct bilirubin. Occur as a result of anemia. Caused by a number of circumstances such as: Fetal maternal transfusion. Blood incompatibility. Poor maternal nutrition. Internal bleeding. Early cutting of the cord. Fetal maternal transfusion (Blood loss F to M circulation) Blood incompatibility (Uterine RBC hemolysis) Poor maternal nutrition (low iron stored) Internal bleeding (signs of blood in stool or vomitus) Early cutting of the cord (inadequate blood flow)  Newborn identified with anemia need therapy such as supplemental iron or a packed RBC transfusion to restore their blood volume.  A newborn who has been lying on his side appears red on the dependent side of the body and pale on the upper side. As if line had been drawn down the center of the body.  Collections of pigment cells (MELANOCYTES) Appear as slate gray patches across sacrum of the buttocks and possibly in the arms and legs. Mostly into Asian, Southern European of African ethnicity. Disappear by school age without treatment. White cheesy Vernix “varnish” coating, covering Caseosa“cheese” skin. White cream cheese like substance Noticeably serves as skin lubricant in skin folds. in utero. Stained by excessive Meconium stained bilirubin or blood dyscrysia. First bath, handle newborn with gloves. to protect self from exposure to body fluids. Skin is tender Never rub away harshly. Entry of bacteria. Skin breakdown. Newborn infants Water (81%) undergo a progressive Proteins (10%) adaptation immediately after birth, Lipid (9%) including a slow During transition from intra reduction in surface Vernix performs an epiderm hydration, decrease in epidermal growth under skin PH, and stratum. hydrophobic barrier aga and loss of fluids and electr Antioxida Anti- Moisturizin Wound healing nt infective g Properties Properties Property Properties Presence of mechanical barrier Because of its contains antimicrobial antioxidants properties with high water peptides and has a vitamin-E and respect to bacterial content, vernix direct role in defense melanin in it. invasion. acts as an agent against bacteria. Vernix has also to moisturize the been shown to stratum corneum. effectively block penetration of exogenous chymotrypsin present in the amniotic fluid from meconium Rarely with Is fine downy hair that 42 weeks. 32 to 39 covers a term NB’s weeks have shoulder, back, upper generous arms and possibly also supply. the forehead and ears. 2 weeks of age usually disappear. Rubbed away by friction of beddings and cloth against NB skin.  transient skin disorder in which the skin has a bluish red marbling pattern when exposed to cold temperatures. Temporary reaction to suddenly living in an air filled rather than a liquid filled environment. 24 hours after birth the skin of most NB begins to dry. Evident on the palms of the hands or soles of the feet. Peelings resemble those brought on by sunburn.  Cracks in the skin folds. NB who are post term and have suffered intra uterine malnutrition may have such extremely dry skin. This should be differentiated from normal desquamation because it helps to diagnose the NB as post term.  Parents may No treatment. apply hand lotion to prevent excessive dryness. Appear as tiny bumps or papules on the nose, chin, and cheeks. Due to immature sebaceous glands. Disappear by 2 to 4 weeks - sebaceous glands mature and plugged ones drain. Caution parents to avoid scratching or squeezing the papules. - prevent secondary infection.  Baby Koo has milia on his nose. What teaching would constitute as safety risk? A. This will disappear on their own so you don’t need to take any action. B. Wash the same way that the nurse first taught you. C. Try to gently scratch off these spots in a few days. D. Make sure that you keep the Baby bundled warmly.  Found almost in all NB Also called flea bite rash because lesions are so minuscule.  Appear 1st to 4th day or at late 2 weeks of age. Begins with small papules. 2nd day -⬆severity and becomes erythematous. 3rd day- disappearance.  No treatment needed. Cause by NB eosinophils reacting to rough environment of sheets and clothing rather than smooth liquid against the skin. Occurs sporadically and unpredictably. Should be differentiated from lesions of herpes ( clustered vesicles ) as this is a serious findings.  Miliaria rubra Miliaria cristallina or prickly heat Occlusion is superficial, Slightly deeper occlusions sweat results collects forming in red papules andclear, thin- pustules. walled blisters. Most affected newborns No treatment do not have symptoms but occasionally is needed except have a : to give A condition in which there are fluids. Deep rosy too many red blood cells in red color. the blood circulation. Ruddy or dusky color. Very rarely have seizures. Lethargy (sluggish). Feed poorly.  Chin appears to be receding it quivers easily if the infant is startled or Usually appear cries. disproportionately large it is about 1/4 of the total body length. (1/8 of total body height If with hair looks full for adults.) bodied. (Poorly nourished and preterm have thin lifeless hair.) forehead appears larger and prominent. Head circumference reflects brain size and is routinely measured up to 36 months.  by byage age73the Over years nextthe years the 2 years brain is 90% brain head is 80%of of circumference adult size. size. adult increases 3.5 cm 12 months the brain has completed half its postnatal growth First 8 months and is 75% of adult growth is size. more rapid. At birth, the brain is 25% of adult size, and head circumference averages 35 cm. During the first year head circumference increases an average 1 cm per month.  are the spaces or openings where the skull bones joints. soft spot in the skull of an infant.  Dia mo cm s ha nd pe o4 located at the 2t o3 3t junction of the two cm parietal bones and that to fuse frontal Normally closes at 12 to 18 months of age. bone. Measures 2 to 3 in width 3 to 4 cm in length.  Measures about 1-2 cm in length. 1-2cm Triangular Shape Located at the junction of the parietal bones and occipital bone. Closes at the end of So small, cannot be 2nd month palpated. FONTANELS SHAPE CHARACTERISTIC CLOSURE LOCATION Anterior junction of the two closes at parietal Can be felt as so Diamon 12 to 18 bones soft. d months and that of age to fuse frontal bone. junction of the end of parietal Triangula So small, cannot 2nd bones r be palpated month and occipital Skull sutures the separating lines of the skull. Four major at birth May override Overriding becausesubsides of the extreme sutures: pressure exerted on in the head 24 to 48 during hours. passage thru the birth canal. Wide separation suggest ↑ ICP and accumulation of CSF.