NEWBORN EXAMINATION for nursing students

1. NEWBORN
EXAMINATION
PRESENTED BY:
Ms. Satnam Kaur Mand

2. INTRODUCTION
• Head to toe physical examination of a
newborn to look for any abnormalities or
pathology.

3. PURPOSES
• Gives detailed information regarding the
problems of babies during the 1st four
weeks of life.
• To identify the abnormalities of the
newborn.
• To improve neonatal care and it leads to
better and intact infant survival.

4. PURPOSES
• To detect any complication occurs during
delivery.
• To identify and record evidence of birth
injury , congenital malformation and
diseases.

5. ARTICLES REQUIRED
• Radiant warmer
• Tape measure
• Stethoscope
• Watch with seconds
• Weighing scale
• Thermometer

6. • Growth Chart
• Ophthalmoscope
• Tongue depressor
• Scale, Pencil, Fresh clean sheet/ Clothes
• Infantometer
• Pen Torch

7. APGAR Scoring
• The APGAR score is determined by
evaluating the newborn baby on five simple
criteria on a scale from zero to two and
summing up the five values. The resulting
APGAR score ranges from zero to 10.

8. • Activity/ Muscle Tone
• Pulse/ Heart Rate
• Grimace/ Reflex Irritability/
Responsiveness
• Appearance/ Skin Color
• Respiration/ Breathing

10. • Healthy newborn: 7-10 at both 1 and 5
minutes .
• Moderately depressed newborn : 3-6 (
Need resuscitation )
• Severely depressed newborn : 1-2 (
Intensive resuscitation )

11. PHYSICAL
EXAMINATION

12. VITAL SIGNS
• Temperature
• Pulse
• Respiration
• Blood Pressure

13. TEMPERATURE
• It can be recorded at three sites: rectal, oral
or axillary. Most common site is axilla.
– After birth the baby should be kept in skin to
skin contact with the mother immediately.
– Hands and feet should be checked for warmth
with back of the hand to see if the baby is in
cold stress.

14. –If the baby feet and hand are cold but the baby
is warm when seen over the chest, it means that
the baby is in cold stress.
– Each time use a fresh clean thermometer. The
temperature of a baby is seen with the
thermometer held vertically in the axilla for 3
minutes.
• Normal temperature is 36.5 ° C – 37.5 ° C.
If it is between 36° C- 36.5 ° C , the baby is
in cold stress.

15. RESPIRATION
• Observe the chest rise and fall in full 60
seconds. Most often, the breathing of a
newborn is diaphragmatic, so during
inspiration the anterior thorax usually
draws inward while the abdomen protudes.
• Newborn respiratory rate is 30 to 60/ min.
• Grunting or labored breathing usually
suggests respiratory distress syndrome.

16. PULSE
• The heart rate is taken apically with a
stethoscope and the brachial, femoral
arteries are palpated for equality of
strength. Both are counted for a full 60
seconds.
• Normal heart rate 100-160 bpm
• Absence of femoral pulses or brachial
femoral delay is suggestive of left sided
heart lesions and coarctation of the aorta.

17. BLOOD PRESSURE
• Blood pressure measurement can be
difficult to perform on the neonate and
normal values vary depending on
gestational age and weight.
• Blood pressure should always be measured
with the infant in a quiet state and with the
correct sized blood pressure cuff.

18. • The preffered site for BP is right arm;
however other sites such as the forearm,
calf or thigh may be used as long as the cuff
width is 40 % of the circumference of the
limb on which the cuff is placed.
• Newborn BP (systolic) 60-80 mmHg.

19. ANTHROPOMETRIC
ASSESSMENT
• Weight
• Length
• Head Circumference
• Chest Circumference
• Waist Circumference

20. WEIGHT
• The scale should be taken to the baby. Then
the pan of the weighing scale is covered
with a fresh cloth.
• After this, the baby is placed naked over
the weighing scale.
• Normal weight is 2500- 4000 gm (2.5 to 4.5
kg)

21. WEIGHT

22. LENGTH
• Length is most accurately recorded using a
neonatal measurement board in which the
baby’s crown is placed at one end and the
examiner deflexes the hip and knees and
measures a maximum length to the sole of
the feet.
• Infant lies on back with legs extended;
measure the distance from vertex to heel of
right foot.

23. LENGTH
• Newborn length range is 46- 56 cm.

24. HEAD CIRCUMFERENCE
• The occipito frontal head circumference is
measured by placing a tape measure around
the head to encircle the occiput, the parietal
bones and the forehead (1cm above the
nasal bridge)
• Newborn head circumference is 32-37cm
(12.5- 14.5 inches)

25. HEAD CIRCUMFERENCE

26. CHEST CIRCUMFERENCE
• An assistant is required to assure that the
infant is in the correct position.
• The infant lies on back. With an automated
tape device, measure the circumference of
the chest at the level of the nipples during
normal breathing.

27. CHEST CIRCUMFERENCE

28. WAIST CIRCUMFERENCE
• An assistant is required to assure that the
infant is in the correct position.
• The infant lies on back with legs fully
extended. With an automated tape device,
measure the circumference just below the
level of the iliac crest and above the level of
the greater trochanter in a plane
perpendicular to the torso.

29. WAIST CIRCUMFERENCE

30. GENERAL
APPEARANCE

31. POSTURE
• In the full term neonate, the posture is one
of complete flexion. Infant’s behavior is
carefully noted.
• Normal flexion of the extremities indicates
good muscle tone. Lack of flexion is
associated with hypotonicity, whereas
excessive flexion usually suggests
hypertonicity.

32. SKIN
• Color: Most babies are pink, although
some babies exhibit ACROCYANOSIS
(cyanosis of the peripheries) without
significance.
• Fingers and toes appear bluish is normal
for a new born infant. If there is generalized
cyanosis, observe the response to oxygen
administration as well as cry.

34. • VERNIX : This is a white substance
often present on the skin at birth. Its role in
the fetus is to prevent overhydration of fetal
skin

35. • LANUGO : Fine downy hair covers the
skin of the shoulder, upper arms and
thigh.

36. • PETECHIA: The presences of the small
hemorrhagic skin lesions may be begin and
occur on the face due to birth injuries or
trauma

37. • MILIA : They occur particularly over the
nose and are small sebaceous cyst.

38. • MONGOLIAN SPOT : Acres of bluish
colored pigmentation may occur extensively
on the back especially over the sacro
coccygeal region.

39. SCALP
• The scalp is most commonly the presenting
part at delivery. It is relatively easily
traumatised and swelling with or without
bruising in relatively common. A cranial
meningocele (neural tube defect that
develops due to inadequate development of
upper end of neural tube)or encephalocele
may also poduce a swelling.

40. HEAD
• FONTANELLES:
Fontanelles are areas where at least three
bony plates of the skull meet. They can be
felt as soft spots on the head. The posterior
fontanelle normally measures less than
0.5cm at birth and closes shortly after it.

41. • The anterior fontanelle normally measures
1-5cm in diameter at birth and doesnot
close until 18months of age.
• The anterior fontanelle at rest should
neither bulge nor be sunken. It will bulge as
the baby cries.

43. SUTURES
• Sutures are the gaps between two bony
plates of the skull. At birth the sutures may
be easily palpable, but the bone edges are
not widely separated.
• Premature fusion of a suture may be
palpable as a prominent edge, but beware
because over riding sutures can often be felt
following delivery, but they will resolve with
time.

45. • Examine head for:
– Asymmetry/ abonrmal shape
– Size
– Premature closing of suture and fontanelles.
– Large fontanel is associated with
hypothyroidism, osteogenesis, chromosomal
abnormalities.
– Bulging fonatenelles due to increased ICP,
meningitis or hydrocephalus.
– Decreased fonatenelles are seen with
dehydration.
– Small fonatenelle may be due to hyper
thyroidism, microcephaly.

46. • CAPUT SUCCEDANEUM: It is formation
of swelling due to stagnation of fluid in the
layers of scalp.
• MOLDING: Over riding of parietal bones.
• CEPHALOHEMATOMA: It is the
collection of blood in between the
periosteum usually unilaterally over the
parietal bone.

49. FACE
• The skin of the face should be uniformly
pink in color and free from swellings,
abrasions and lesions to detect asymmetry;
hemihypertrophy, cleft clip.
• Look at the symmetry of the face.
Asymmetry may result from abnormalities
of development of individual components,
postural deformities or syndromes.

50. EYES
• Examination of the eyes by observing the lids for
edema.
• Eyes are observed to find out asymmetry,
corneal opacity, coloboma (hole in one of the
structures of the eye) and to asses for jaundice.
• Sclera should be white and clear. The iris of a
baby is normally blue. It should be perfectly
circular with a round opening (pupil) in the
center.

51. COLOBOMA

52. EARS
• Examine for position, structure and
auditory function to identify skin creases,
deformity, perauricular skin tags.
• The top of the pinna should lie in a
horizontal plane to the outer canthus of the
eye.

53. NOSE
• Babies are nasal breathers.
• The nose is usually flattened after birth.
• Patency of the nasal canal is assessed by
holding a handover the infants mouth and
one canal and noting the passage of air
through the unobstructed opening.

54. MOUTH AND THROAT
• Assures for cleft lip and palate.
• Epstein pearl small white epithelial cyst
both sides of the hard palate.

56. NECK
• Observe for range of motion, shape and any
abnormal masses and palpate each clavicle
for possible fractures especially if there us
any history of shoulder dystocia or any
suggestion of an Erb’s palsy (paralysis of
arm)

57. CHEST
• Chest is examined for asymmetry.
• Moving down to the chest look for any
asymmetry of the rib cage.
• The newborn’s breast may be enlarged due
to maternal estrogen.
• The white discharge from nipple is
commonly known as “Witch’s milk”

58. HEART
• One of the most difficult and important
systems to examine is the heart, so the baby
must be calm and content. It is the ideal to
examine the heart first before examining
other parts.
• Check heart rate, rhythm and also
presence of any abnormal heart sound.

59. ABDOMEN
• The examiner’s fingertips must be gently
placed and held on the abdomen without
exerting any downward pressure. Deep
palpation should then proceed gradually.
• Examine for distention, shape, tenderness
and organomegaly, hepatomegaly,
spleenomegaly.

60. UMBILICUS
• Umbilical cord is inspected for determining
for 2 arteries and one vein, any discharge,
color and redness.
• The normal umbilicus is bluish white in
color on first day. Later over the next few
days, it begins to dry and shrink and falls
off after 7-10 days

61. GENITALIA
FEMALE:
• The labia majora are not well developed
and therefore the clitoris and labia minora
are prominent.
• Vaginal discharge and some vaginal
bleeding may be present during 1st week is
pseudo menstruation. It is due to
withdrawal of maternal hormones.

62. MALE:
• Examine for testis within the stratum and
hydrocele, hypospadias etc.
• Check for testis, size and shape of penis,
position of meatus, urine stream.

63. REFLEXES

64. EYES
• BLINKING OR CORNEAL REFLEX:
Infant blinks at sudden appearance of a
bright light or at approach of an object
toward the cornea, persist throughout the
life.

65. PUPILLARY:
Pupil constrict when a bright light shines
towards it persists throughout the life.
DOLL’s EYE:
As head is moved slowly to right or left, eyes
tag behind and donot immediately adjust
to new position of head.

67. NOSE
SNEEZE:
Spontaneous response of nasal passages to
irritation or obstruction.
GLABELLA:
Tapping briskly on glabella causes eyes to
close tighly.

68. MOUTH, THROAT & NECK
• ROOTING: Touching or striking the cheek
along the side and begin to suck.
• SUCKING: Infant begins strong sucking
movements of circumoral areas in response
to stimulation.
• SWALLOWING: Movement of throat
muscle to push food from mouth to
esophagus.

70. • EXTRUSION: When tongue is touched or
depressed infants respond to by forcing it
outward.
• YAWN: Spontaneous response to decreased
oxygen by increasing amount of inspired
air.

71. • COUGH: Irritation of mucus membrane of
larynx or trachea bronchial tree carries
coughing.
• TONIC AND NECK REFELX: When
head is turned to one side, arm and leg of
same side are extended in a fencing posture.

73. EXTREMITIES
• GRASP: Touching palms of hands or soles
of feet near base of digits causes flexion of
hands and toes.
• BABINSKI: Stroking outer sole of foot
outward from head and across ball of foot
causes the big toes to dorsi flex and the
other toes to hyperextend or fanning of
finger occurs.

75. • MORO: When startled, arms and legs
swing quickly out, then immediately back
and neonate curls up into a ball.

76. SUMMARIZATION
Today we have discussed about:
• Newborn examination
• Introduction
• Purposes
• Articles required for examination
• Vital Signs
• Anthropometric assessment
• Physical Examination
• Neonatal Reflexes

77. RECAPTUALIZATION
• What is Newborn examination?
• What is Acrocyanosis?
• What is lanugo?
• What is Rooting reflex?
• What is Babinski reflex?

78. ASSIGNMENT
• Define Newborn examination.
• Write about Anthropometric assessment.
• Explain neonatal reflexes.

79. REFERENCES
• Swain Dharitri, Obstetrics Nursing Procedure
Manual, First Edition, Jaypee Brothers Medical
Publishers(P) Ltd, 2017. Pp: 164-176.
• Jacob Annamma, A Comprehensive Textbook of
Midwifery & Gynecological Nursing, 4th Edition,
Jaypee Brothers Medical Publishers(P) Ltd;
2015. pp 270-276.