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Newborn Assessment

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TEMP: NORMAL 97.7-99.1
DECREASED: INSTITUTE WARMINGMEASURE AND CHECK IN 30 MIN. CHECK BLOOD GLUCOSE
INCREASED: REMOVE EXCESSIVE CLOTHING AND CHECK FOR DEHYDRATIONS
CHECK FOR SIGNS OF INFECTION WITH INCREASED AND DECREASED TEMP. MAKE SURE RADIANT WARMER OR INCUBATOR TEMP IS ACCURATE, AS WELL AS THEMOMETOR IF SKIN IS WARM OR COOL TO THE TOUCH.

HEART RATE: 120-160 ( 180 IF CRYING ) REGULAR RHYTHM. PMI AT THIRD OR FOURTH INTERCOSTAL SPACE, SLIGHTLY TO LEFT MIDCLAVICULAR LINE.
IF ANY MURMURS, NOTE LOCATION, REFER ABNORMAL RATES, RHYTHM AND SOUNDS, PULSES.
RESPIRATIONS: RATE 30-60 BREATHS PER MIN. RESPIRATIONS IRREGULAR, SHALLOW UNLABORED. CHEST MOVEMENT IS SYMMETRIC. BREATH SOUNDS PRESENT AND CLEAR BILATTLERLLY.
MILD VARRIATIONS REQUIRE CONTINUED MONITORING AND USUALLY CLEAR IN EARLY HOURS AFTER BIRTH. IF PERSISTENT OR MORE THAN MILD, SUCTION, GIVE 02, CALL PHYSCIAN AND INTITATE MORE INTENSIVE CARE.
BIRTH WIEGHT: A baby's birthweight is an important indicator of health. The average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs. (3.2 kg). In general, small babies and very large babies are at greater risk for problems. Babies are weighed daily in the nursery to assess growth, fluid, and nutrition needs.
PERCENT OF WIEGHT LOSS: Newborn babies may lose as much as 10 percent of their birthweight. This means that a baby weighing 7 pounds 3 ounces at birth might lose as much as 10 ounces in the first few days. Premature and sick babies may not begin to gain weight right away.
LENGTH - the measurement from crown of head to the heel
HEAD CIRCUMFERENCE: NORMAL, 32-38CM (the distance around the baby's head) - is normally about one-half the baby's body length plus 10 cm
CHEST CIRCUMFERENCE: NORMAL: 30-36CM -2-3CM LESS THAN THE HEAD MORO REFLEX: A reflex is a type of involuntary (without trying) response to stimulation. The Moro reflex is one of many reflexes that are seen at birth. It normally disappears after 3 or 4 months.
ROOTING REFLEX: occurs when you stroke the baby's cheek. The infant will turn toward the side that was stroked and begin to make sucking motions with the mouth.
SUCKING REFLEX: sucks when area around mouth is touched.
GAG REFLEX: gagging when the throat or back of the mouth is stimulated.
GRASP REFLEX: occurs if you place a finger on the infant's open palm. The hand will close around the finger. Trying to remove the finger causes the grip to tighten. Newborn infants have strong grasps and can almost be lifted with one finger.
Babinski's reflex: occurs when the big toe moves toward the top surface of the foot and the other toes fan out after the sole of the foot has been firmly stroked.
Tonic Neck Reflex: also known as the “fencing reflex" because of the characteristic position of the infant's arms and head, which resembles that of a classically trained fencer. When the face is turned to one side, the arm and leg on the side to which the face is turned extend and the arm and leg on the opposite side flex. * MUSCLE TONE: * posture - how does the baby hold his/her arms and legs. * square window - how far the baby's hands can be flexed toward the wrist. * arm recoil - how far the baby's arms "spring back" to a flexed position. * popliteal angle - how far the baby's knees extend. * scarf sign - how far the elbows can be moved across the baby's chest. * heel to ear - how close the baby's feet can be moved to the ears.

SKIN :
COLOR:
TURGOR
MILIA: Pinpoint white papules on nose and cheeks
LANUGO: Fine hair on shoulders and back VERNIX CASEOSA: Cheesy white skin covering present at birth ERYTHEMA TOXICUM: Yellow papules on trunk, disappear within days. MONOGOLIAN SPOTS: These are pigmented birthmarks that appear commonly in babies born with darker skin. They most often appear on the lower back or buttocks and look like a flat bruise . These birthmarks usually fade with time
Plantar surface creases: Term infants have numerous creases on plantar surface of foot. Pre-term infant have much fewer creases.

1. Anterior Fontanelle 1. Junction of coronal suture and sagittal suture 2. Mean newborn size: 2.1 cm (larger in black infants) 3. Often enlarges in first few months of life 4. Closes between 4 to 26 months (median 13.8 months) 2. Posterior Fontanelle 5. Junction of lambdoidal suture and sagittal suture 6. Mean newborn size: 0.5 to 0.7 cm 7. Closes by 2 months 1. Exam: Anterior Fontanelle 3. Palpate Fontanelle with infant sitting upright quietly 8. Fontanelle should feel soft 9. Fontanelle should not be sunken or bulging 4. Other examination features 10. Auscultate for bruit (suggests AV malformation) 11. Macewen's Sign (percussion of Fontanelle) 1. Dull cracked-pot sound suggests increased ICP 2. Causes of abnormal Anterior Fontanelle 5. Bulging Fontanelle causes
Crying, coughing or vomiting increased icp
Hydrocephalus
meningitis or encephalitis
Trauma
Dermoid tumors of the scalp 6. Sunken Fontanelle causes
Decreased ICP (dehydration) 7. Large Fontanelle or delayed closure
Congenital hypothyroidism
Trysomy 21
NEW BORN HEAD MOLDING: is an abnormal head shape that results from pressure on the baby's head during childbirth.
CAPUT SUCCEDANEUM: is swelling of the scalp in a newborn. It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery.
CHIGNON: is a temporary swelling left on an infants head after a ventouse suction cap has been used to deliver him or her. It is not a sign of serious injury and may take as little as two hours or as long as two weeks to disappear.
EYES: SYMMETRIC, EYES CLEAR, SCANT OR ABSENT TEARS. PUPILD EQUAL, REACT TO LIGHT. ALERTS TO INTERESTING SIGHTS. FOLLOWS OBJECTS ACROSS MIDLINE. IMPORTANT TO CLEAN AND MONITOR ANY DRAINAGE AND SEEK CAUSE.
OPTHALMIA NEONATORUM: a purulent conjunctivitis and keratitis of the newborn resulting from exposure of the eyes to chemical, chlamydial, bacterial, or viral agents. Chemical conjunctivitis usually occurs as a result of the instillation of silver nitrate in the eyes of a newborn to prevent a gonococcal infection.
SUBCONJUNCTIVAL HEMORRHAGE: is one cause of a red eye. It is caused by a small bleed behind the conjunctiva. It can look alarming, but it usually causes no symptoms and is usually harmless. The redness usually clears within two weeks.
EARS: WELL FORMED AND COMPLETE, AREA WHERE UPPER EARS MEET HEAD EVEN WITH IMAGINARY LINE DRAWN FROM OUTER CANTHUS OF THE EYE. STARTLES TO LOUD NOISES, ALERTS TO HIGH PITCHED SOUNDS. IF THE EARS ARE ABNORMALLY POSITIONED, LOOK FOR SIGN OF CHROMOSOMAL ABNORMALITY. REFER FOR REEVALUATION IF NO RESPONSE TO SOUND.
BREAST: It's normal for babies (boys and girls) to have mild or even swollen, enlarged breasts and/or lumps under the nipple. They are almost always benign and due to exposure to maternal hormones in the womb. The same hormones that cause the mother's breasts to swell and milk glands to be stimulated can do the same to the baby's breasts.These lumps and enlarged breasts in the baby may be quite noticeable at birth. They might even continue to grow after birth for a while. If you were to pinch them, some real breast milk may be expressed. In a preterm infant, breast buds are typically flush and unpalpable when using hand to rub across chest

UPPER AND LOWER EXTREMITY DIGITS: COUNT ALL FINGERS AND TOES, MAKE SURE NO WEBBING OR ABNORALITIES ARE PRESENT.
GENITALIA: FEMALES, SMALL AMOUNT OF WHITE MUCUS VAGINAL DISCHARGE, URINARY MEATUS AND VAGINA PRESENT.
MALES: TESTES WITHIN SCROTAL SAC, ROGAE SCROTUM. CHECK TIP OF PENIS FOR ANY SIGNS AND SYMPTOMS OF INFECTION IF CIRCUMCISED. Pre-term infants frequently have very little rogae in the scrotum and testes may or may not have completely descended.

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