Assessments of Newborn New

ASSESSMENT OF NEW-BORN
Aim: -
After assessing the new born we will be able to understand and identify the specific physical
and neurological characteristics of new-born.
Objectives: -
At the end of this assessment we will able to –
 List down the purposes of new-born examination
 Know the steps of examination of new-born
 Understand various aspects of history related to new-born health status.
 Describe physical characteristics of normal new-born.
 Recognise neurological characteristics of normal new-born.
 Identify any deviations in terms of congenital defects and neonatal infections.
 Identify the health needs of new-born and mother
 Educate mother about breast feeding and care of new-born

INTRODUCTION: -
Monitoring of new-born is the keynote of their successful outcome. Accurate nursing

observation is a vital factor in the survival and future development of the new-born. The
initial physical examination should be performed as soon as after birth of new-born. All new-
born should be thoroughly examined in first 24-48 hrs of the age. Assessment of new-born is
a very important aspect to recognise and identify any deviations in terms of congenital
defects and infections.
PURPOSES OF ASSESSMENT: -
 Identify the physical and neurological characteristics of new-born.
 Identify and record evidence of common new-born problems and congenital

anomalies and provide basis for identification of needs and plan nursing care of new-
born.
I. BIODATA OF THE BABY AND MOTHER: -
Name of baby: -
Age: -
Sex: -
Date of birth: -
Birth weight: -
Present weight: -
Mother’s name: -
Address: -
Period of gestation: -
Date of delivery: -
Identification band applied: -
Type of delivery: -
Place of delivery: -
Registration of Birth:-
Any problem during birth: -
If yes explain:-
Antenatal history :-
(Antenatal visits, Immunization.)
Mothers age :-
Height :-
Weight:-
Nutritional status of the mother: -
A socioeconomic background: -
I.ASSESSMENT
a) Vital parameters
Parameters Normal range Observed in child Remark
Weight 2.5-3.8kg
Length 50cm
Head circumference 33-35.5cm
Chest 31-33cm
circumference
Temperature 36.5-37.50C.
Heart rate 120-160 beats/min
Respiration 40.60breaths/min
b) General behaviour and observation

Observation Normal characteristics In child remark
Skin –
Colour Pink
Plethora Dark reddish to purple
Turgor Good – smooth and soft
Lanugos Fine hair seen on back

shoulder and chicks
Vernix caseosa Greasy grey white substances

with cheese like consistency
Pallor It may be due to anaemia, birth

asphyxia or shock
Cyanosis Central
Peripheral
Acrocyanosis
Birth marks-
Port wine stain Permanent birthmarks that
have cosmetic implications.
Normal
variation Yellowish
Jaundice discoloration/enteric, bilirubin
level >5mg/dl.
Mottling Red or blue lacy appearance of
the baby’s skin
Milia Small white spots on the

infant’s nose chin or cheeks.
These are due to sebaceous
glands and resolve in two to
three weeks.
Oedema Normally not present
Erythema nettle sting’ appearance,

-toxicum erythema with white papules. It
often begins on the face and
spreads to the trunk and limbs
but the palms and soles are not
affected. They resolve
spontaneously.
Mongolian spot Bluish, often large, commonly

seen on the back buttocks,
thighs
Infantile Initially blanching or red

haemangioma maculae of varying size
Head –
Anterior Diamond shaped, flat soft and
fontanelle firm
Posterior fontanel Triangular in shaped, 1-2 cm

wide, fontanel may budge
when new-born cries
Cephalo- Localise effusion (serum
hematoma blood) firmer to touch
thanoedematous area, appears
on 2nd or 3rd day, resulting from
a traumatic delivery, it never
extends the suture lines
Caput Localise oedema on the scalp
succedaneum crossing the suture lines, may
be present at birth
Sutures It may override during vaginal

delivery
Hair Silky separate strands
Eyes Eyes usually closed, lids

usually oedematous
sclera- white to bluish
white
Iris· dark grey or brown, no
discharge, eyes clean and
healthy
Glabellar tap brisk closure of eyes
Face cleft lip cleft palate
Ears top of the pinna of ear is in a

Location horizontal plane to the outer
canthus.
Cartilage Pinna firm, cartilage felt along

with edge.
Instant recoil
Nose Nasal passage is patent

Oral cavity Clean oral cavity intact. High
Cleanliness arched palate uvula in midline.
No precocious teeth, no
Epstein pearls and no oral
thrush.
Neck Neck is short symmetrical, no

glands palpable full range.
Chest Breast tissue more than 10 mm

Breast nodule diameter.
Areola raised May have
gynaecomastia, may have
milky white
discharge.
Abdomen
Bowl sound Are present
Initially it is white and

Umbilical cord gelatinous later it dries and
shrivels. Two
arteries and vein
Genitalia
Female Labia majora well developed
and cover labia minora.
Urethral
meatus is located above the
vaginal opening. Whitish
mucoid
discharge or bloody discharge.
(pseudo menstruation)
Testes descended in the

scrotum. Pendulous and deeply
pigmented urethra opening
Male located at the tip of glans.
Back Spinal curved round.

Spinal curve Patent
Anus
Extremities 10 fingers of hands and toes
No. of fingers and each
toes
Sole creases Deep creases over anterior

1/3rd to ½ of sole
Resistance to New-born offer resistance to

passive passive movements. Elbow
movements doesn’t cross the mid line of
the chest.
Joint mobility Joints are flexible.
Reflexes touching or stroking the

Rooting reflex cheek along the side of
mouth stimulates
the new-born to tum the
head towards that side.
Sucking reflex Sucking and swallowing

reflex is well developed
and coordinated.
Extrusion reflex When tongue is touched or

depressed new-born
respond by forcing it
outwards.
Tonic neck reflex The arm and leg on the side to
which head is tuned extend
while the
opposite arm and leg are
flexed.
Grasp reflex grasp fingers
Moros reflex sudden extension and

abduction of extremities and
fanning of fingers followed by
flexion and adduction of
extremities.
Babinski’s reflex The toes flare open
Step or dance New-born make stepping

reflex movement
Cry: Good / Weak:
APGAR Scoring at Birth:

Book picture
Sr Criteria 0 1 2
no.
1. Respiration Absent Slow Good crying
Irregular
2. Heart Rate Absent Slow More than
Below 100 100/min.
3. Muscle Tone Flaccid Some flexion of Active
extremities movements
No response Grimace Cry
In new born:
5. Skin Color Blue pale Body pink Completely pink
extremities blue
Sr Criteria 1 min after birth 5 min after birth
no.
1. Respiration
2. Heart Rate
3. Muscle Tone
4. Reflex Response
5. Skin Colour
Total
First feed given:
Type of feed given:
Total requirement of fluid and calories:
Amount of feed accepted:
Special observation made during feed:
Care of skin:
Care of eyes: -
Care of nose, ears, mouth:

Care of umbilicus and genitalia:
Meconium passed/Not passed:
Urine Passed/ Not passed:
IV) Identification of Health Needs in Baby & Mother :-

V) Health Education to mother :-
1. Brest feeding: -
2. Care of skin, eyes and umbilicus:-
3. Immunisation
4. Lactation Diet:-
5.Hygiene: -
6.Prevention of accidents: -
Bibliography
1. Mayoor K Chheda, practical aspects of paediatrics, CBS publishers and
distributors 7th edition.
2. O P Ghai, Essential paediatrics, CBS publishers and distributors, edition 9th
edition,2019.
3. Parul Datta, Pediatric Nursing, second edition, Jaypee.
4. Marlow’s, Text book of pediatric nursing, south asian edition, ELSEVIER
publisher.
5. Rimple Sharma’s Essentials of Pediatric Nursing, second edition

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ASSESSMENT OF NEW-BORN

At the end of this assessment we will able to –

 List down the purposes of new-born examination

 Know the steps of examination of new-born

 Understand various aspects of history related to new-born health status.

 Describe physical characteristics of normal new-born.

 Recognise neurological characteristics of normal new-born.

 Identify any deviations in terms of congenital defects and neonatal infections.

 Identify the health needs of new-born and mother

 Educate mother about breast feeding and care of new-born

Monitoring of new-born is the keynote of their successful outcome. Accurate nursing

 Identify and record evidence of common new-born problems and congenital

Head circumference 33-35.5cm

Heart rate 120-160 beats/min

b) General behaviour and observation

Plethora Dark reddish to purple

Turgor Good – smooth and soft

Lanugos Fine hair seen on back

Vernix caseosa Greasy grey white substances

Pallor It may be due to anaemia, birth

Milia Small white spots on the

Erythema nettle sting’ appearance,

Mongolian spot Bluish, often large, commonly

Infantile Initially blanching or red

Posterior fontanel Triangular in shaped, 1-2 cm

Sutures It may override during vaginal

Hair Silky separate strands

Eyes Eyes usually closed, lids

Glabellar tap brisk closure of eyes

Face cleft lip cleft palate

Ears top of the pinna of ear is in a

Cartilage Pinna firm, cartilage felt along

Nose Nasal passage is patent

Neck Neck is short symmetrical, no

Chest Breast tissue more than 10 mm

Initially it is white and

Testes descended in the

Back Spinal curved round.

Sole creases Deep creases over anterior

Resistance to New-born offer resistance to

Joint mobility Joints are flexible.

Reflexes touching or stroking the

Sucking reflex Sucking and swallowing

Extrusion reflex When tongue is touched or

Grasp reflex grasp fingers

Moros reflex sudden extension and

Babinski’s reflex The toes flare open

Step or dance New-born make stepping

Cry: Good / Weak:

APGAR Scoring at Birth:

First feed given:

Type of feed given:

Total requirement of fluid and calories:

Amount of feed accepted:

Special observation made during feed:

Care of nose, ears, mouth:

Meconium passed/Not passed:

Urine Passed/ Not passed: