Newborn Appraisal Benita
Newborn Appraisal Benita
Newborn Appraisal Benita
BY:
Benita David
Objectives:
• To detect congenital anomalies which are not identified at
neonate.
At discharge
On follow up
precaution.
Significant history for neonatal
assessment
The mother’s medical and obstetrical history
Risk factors:
• Chorioamnitis
Mode of delivery
Need of resuscitation
Assessment of newborn
I. Apgar scoring
Head circumference:
• 33-35cms
Chest Circumference:
• 2 cm less than head
circumference
Weight :
• Average weight- 2.5 kg
• Second born children weight more than the first
born
• Exceeding 4.7 kg is unusual
• 5-10% weight loss in the first few days
• 75-90% weight is due to fluid
• 2lb/month during 1st 6 months
Length:
Radiation
Evaporation
Conduction
Blood pressure:
• It is a localized softening
of then cranial bones
caused by pressure of fetal
skull against the mothers
pelvic bone in utero.
Craniosynostosis
Slight substernal
retraction evident
during inspiration,
which needs to be
tackled.
Xiphesternal
process evident:
Contd….
• Respiration is chiefly abdominal-chest is ‘Bell-shaped’ at birth.
Cough reflex is absent at birth, present by 1-2 days postnatal.
Possible signs of RDS are:
- Cyanosis other than hands & feet.
- Flaring of nostrils.
-Intercostal retractions.
- Expiratory grunt-heard with or without stethoscope.
• A high crowing sound on inspiration suggests stridor or
immature tracheal development.
Cardiovascular Examination:
• Heart murmurs are very common in newborns
as their cardiopulmonary systems adjust to
extrauterine life. These benign murmurs in
newborns are usually transient in nature and
caused by the foramen ovale not being closed
completely. Murmurs are usually benign and not
necessarily indicative of heart disease. They
generally resolve spontaneously.
•.
• CHD-Feeding difficulties are often a first sign, and they may
be evident as early as 6 to 12 hours prior to symptoms of
heart failure. Because feeding difficulty may be attributed
to many different causes, it should exceed 30 minutes and
be accompanied by tachypnea, sweating, and subcostal
retraction to be considered related to a CHD or heart
failure.
• Assess for capillary refill time
Abdomen:
• Cylindrical shape and protruberant.
• The umbilical stump initially is white and gelatinous in
appearance and begins to dry within the first few hours.
• The umbilical stump should be inspected for the presence
of two umbilical arteries and one vein.
• They make the appearance of a "smiley face," as the
musculature in the arteries makes them appear round, like
the eyes of a face, and the vein tends to collapse due to lack
of musculature.
Normal shape Normal Cord
.
Meconium stained
umbilical cord
Abdomen contd…
• A scaphoid or sunken appearance may indicate missing
abdominal contents or diaphragmatic hernia.
• Inspect cord clamp to be certain it is secure. It begins to
dry in 1st hr, turns black by 2-3days. It falls by 6-10days.
• The base of the cord should appear dry.
• Bowel sound should be present within an hour after birth.
• Bruits heard on auscultation may reveal AV fistula, renal
artery stenosis.
Abdomen…
• Palpate and percuss beginning below the umbilicus and
proceeding upward. The abdomen should feel soft.
• Infants may draw their legs up or cry if in pain during
palpation of the abdomen. The liver is palpable 1–3 cm
below the right costal margin.
• The kidneys are moderately firm and lobulated. The bladder
can be assessed for distension by palpating for a firm dome
shape midline, in the lower portion of the abdomen
• GIT:
– Capacity: 90 ml, with rapid intestinal
peristalsis ( 2 ½ to 3 hrs)
– Bowels sounds; (+) within 1-2 hrs after
birth
– Presence of mass, distention depression
or protrusion
– (+) Scaphoid = diaphragmatic hernia
– (+) Distended = LGIT obstruction/ mass
19+17=36
36 39
• The Ballard Maturational Score was refined and expanded to achieve greater accuracy
and to include extremely premature neonates. To test validity, accuracy, interrater
reliability, and optimal postnatal age at examination, the resulting New Ballard Score
(NBS) was assessed for 578 newly born infants and the results were analyzed.
Gestational ages ranged from 20 to 44 weeks and postnatal ages at examination ranged
from birth to 96 hours. In 530 infants, gestational age by last menstrual period was
confirmed by agreement within 2 weeks with gestational age by prenatal
ultrasonography (C-GLMP). For these infants, correlation between gestational age by
NBS and C-GLMP was 0.97. Mean differences between gestational age by NBS and C-
GLMP were 0.32 +/- 1.58 weeks and 0.15 +/- 1.46 weeks among the extremely premature
infants (less than 26 weeks) and among the total population, respectively. Correlations
between the individual criteria and C-GLMP ranged from 0.72 to 0.82. Interrater
reliability of NBS, as determined by correlation between raters who rated the same
subgroup of infants, ws 0.95. For infants less than 26 weeks of gestational age, the
greatest validity (97% within 2 weeks of C-GLMP) was seen when the examination was
performed before 12 hours of postnatal age. For infants at least 26 weeks of gestational
age, percentages of agreement with C-GLMP remained constant, averaging 92% for all
postnatal age categories up to 96 hours. The NBS is a valid and accurate gestational
assessment tool for extremely premature infants and remains valid for the entire
newborn infant population.
1.A method of transmission
of heat by circulation of
warmed molecules of liquid
or a gas?
• Evaporation
• Conduction
• Convection
• Radiation
2.Head circumference of a
new born in cms
• 33-34
• 31-32
• 33-35
• 35-40
3.Which is the principle of
heat loss here?
4.Harlequin sign is due to
an infection
• True
• False
5. Retractions are inward
movement of the chest
• True
• False
6.Which the method of
thermoregulation?
7. Infantometer is used to
check
• Weight
• length
• Chest circumference
• Head circumference
8.Which is the principle of
thermoregulation ?
9. Witch’s Milk is due to
withdrawal of maternal
Estrogen
Progestron
Testosterone
Growth hormone
10.Which is the principle of
thermoregulation?
Congratulations……
Conclusion: