ASSESSMENT AND CARE
OF NEWBORN
B Y : MA DA M ROHIMA H B T ISMA IL
PPSK , UNISZA
LEARNING OUTCOME
•Demonstrate the physical assessment of
newborn
•Describe the care of normal/healthy of
newborn
• Clinical assesment
❑ Physical examination for newborn baby.
❑ Essential newborn care begins with a
thorough general clinical assessment.
❑ Hand hygiene and keep warm.
❑ Baby should be naked in a warm and safe
CLINICAL environment.
ASSESSMENT ❑ Good light.
❑ Performed orderly from crown to heel
HEALTHY NEWBORN
Normal general appearance for
healthy newborn
• well-flexed,
• full range of motion,
• spontaneous movement.
• crying well
• color pink.
Clinical
Assessment
INSPECTION
General appearance
• General feature.
✓Well-flexed posture.
✓Alertness.
✓Spontaneous activity.
✓Newborn reflexes.
Reflexes help identify normal
brain and nerve activity
SKIN
• Thin, delicate, easily damaged
by friction or pressure
• Vernix caseosa
➢A cream / white cheesy
substances presents on the
baby’s skin at birth.
➢Clean off easily with oil.
LANUGO
A fine, soft, downy hairs seen on
the back and shoulders especially
in preterm infants
Milia
• PINPOINT WHITISH PAPULES
ON NOSE AND CHEEKS DUE
TO BLOCKAGE OF
SEBACEOUS GLANDS
•MONGOLIAN BLUE SPOT
• GREY / BLUISH PIGMENT
PATCHES SEEN IN THE
LUMBAR / SACRAL AREA,
BUTTOCKS AND
EXTREMITIES.
CAPILLARY HAEMANGIOMAS
Red flat patches which blanch with gentle
pressure.
Commonly found on upper eyelids, forehead and
nape.
ERYTHEMA TOXICUM
• Small white / yellow papules or
pustules on a red base seen on
face, trunk, and limbs.
• Develop 1 – 3 days after birth
and usually disappear by one
week.
HEAD
• 1. Observe the size and shape of the head (micro / macrocephaly;
cephalhaematoma)
• Normal findings:
• moulding – overlapping of the bones of head.
• resolve within 2 -3 days.
• caput succedaneum – localized swelling of soft tissues of scalp due
the pressure on the head during labor.
ABNORMAL FINDINGS
Cephalohematoma
• •a collection of blood between the periosteum and bone of the skull that it
covers.
• •either unilateral or bilateral and does not cross the suture line.
• •disappearance may take as long as 3 weeks.
• 2. examine the infant with palpate the vault of skull.
• 3. check the anterior and posterior fontanelle, and sutures.
• •to understand the status of health of the newborn and development of the
brain.
ANTERIOR SUTURE
Normal finding:
• at the level with cranial bones.
• abnormal:
• -bulging – if newborn cries, cough or vomit.
• •bulging mean increase intracranial pressure (icp)
• •sunken mean dehydration.
• •large fontanelle / delayed closure (down syndrome, syphilis)
• •early closure - abnormal brain development due to chromosomal
anomalies, fetal hypoxia or fetal alcohol syndrome
Down
Syndrome
Baby
POSTERIOR SUTURE
• Abnormal finding:
• •delayed closure
• •may indicate
HYDROCEPHALY
FACE – EYE, NOSE & MOUTH
Face – eye, nose & mouth
• general observation of the face
• •facial movements should be symmetry.
• Eye
• •placement, space between for symmetry
• •blinking reflex,
• •open spontaneously
• •vision
✓myopia – best length of 8- 12 inches.
✓visual tracking – 10 second.
✓equality, pupil size
EAR
• General observation of the face
• •upper notch of pinna should be level with the canthus of the eye.
• •patency of external auditory meatus is verified.
• •small tags of tissue noted lying in front of the ear.
• ear abnormalities associated with chromosomal anomalies and
syndrome – report to pediatrician
•FORM AND POSITION OF EARS
• •Low set ears – shown chromosome abnormalities
Nose
• •nasal patency
• •flaring of nose – fetal distress.
Mouth
• •can be open easily by gentle pressing against the angle of the jaw.
• •to allow visual inspection of tongue, gums and palate.
• •palate: high arched, intact.
• •uvula: central
• •sucking reflex: sucking the nurse finger.
CHEST & ABDOMEN
• Observation;
• •Respiratory movement
• •chest and abdominal movements
• •chest - the space between the nipples should be noted.
• •Abdomen
• •shape – rounded
• •scaphoid (boat-shaped) abdomen
• •any protrusion, particularly at the base of the umbilical cord.
•UMBILICAL CORD
• •Cord clamp must be applied
approximately 2cm from the
umbilicus
• •no bleeding seen from stump
of umbilical cord.
• blood loss 30ml from uc =
almost ½ litre of blood from an
adult.
Genitilia & Anus
Genitalia should be examined carefully.
• •if sex is uncertain, pediatrician will initiate investigation.
Male.
• •testes should be descent and placed inside the scrotum.
• •if no, it mean undescended testes – report to pediatrician.
Female.
• •shape of external genitalia.
• •labia majora cover the labia minora.
• •clitoris.
• •anus: insert rectal thermometer to confirm patency of the anus and taking body
temperature.
• - based on hospital policy
Limb & digits
• •symmetry
• •length and movement of the limbs
• •extra digit.
• •counting the digits.
• •separate the digits- to ensure webbing not present.
• •the hands must open fully - to ensure no extra digit.
Feet
• Examine for any deformity such as talipes equinovarus, as well as
extra digits.
• axillae, elbow, groins and popliteal space should be examined for
abnormalities.
• normal flexion and rotation of the wrist and ankle joints should be
confirmed.
Spine
The baby lying prone
• •inspect and palpate the baby’s back.
• •any swellings, dimples or hairy patches may signify an occult spinal
defect - report to pediatrician.
Measurement
Purpose:
•to provide parameters against for future growth monitoring.
Head circumference
• •32 – 37cm
Chest circumstance
• •30 – 35cm
Length
• •48 – 56cm ( average = 50 - 52cm )
Weight.
• •2.5kg – 3.5kg (5lb 5oz – 7lb 7oz)
NURSING CARE
NORMAL NEWBORN
• •Prevent heat loss (keep warm)
• •Bonding
• •Baby hygiene
• •Feeding
• •Immunization
• •Prevent infection
• •Prevent injury
• •Keep baby safe
PREVENT HEAT LOSS
• Dry the baby immediately after birth
• -remove the wet towel
• -wrap the baby with a dry prewarmed towel
• -cover the baby’s head
• -put under radiant warmer
• At home
• -wrap the baby
• - change pampers prn
PROMOTION OF PARENT-BABY
RELATIONSHIP
• BONDING
• -establishment of parent – baby relationship in the early neonatal
period
• -keep baby warm
• ( by attached baby to mother body temperature)
BABY HYGIENE
• Top & tail
• - after birth (within 24 hrs)
• ( to prevent hypothermia)
• eye care
• to prevent ophthalmia neonatorum
• clean with sterile water
• umbilical cord care
• to prevent cord infection.
• clean with 70% alcohol + 4% chlorhexidine-
BATHING BABY
Hospital
• -after 24hrs childbirth
At home
• -after discharge from hospital
• - daily bath
Breast feeding
• •start immediately after birth
• •mother-infant relationship (bonding)
• •sterile & fresh – breast milk straight from the alveoli (milk gland)
• •antibodies- help to protect infant for fighting the off the infection
and disease
• •exclusive breast feeding for 6 months continue until 2 years old
IMMUNIZATION
Hepatitis B
• to prevent hepatitis b
•
BCG
• to prevent tuberculosis
Vitamin k
• prophylaxis against bleeding disorders
PREVENTION OF INFECTION
• 1. hand washing before touching the baby
• 2. using their own equipment for the baby and don't share
• 3. reduce the number of people handling the baby
• 4. people with infection don't handle the baby
• 5. cleaning the baby by giving regular bath
• 6. cleaning the eyes if there is any discharge
• 7. keep the umbilical cord clean
PREVENTION OF INJURY
• handle baby gently
• used baby basinet to prevent baby from fall
• always pull up baby cot after procedure
• ensure mother always stay with baby
• At home
• Parent always assist to keep an eye to prevent any unexpected injury
to the baby
KEEP BABY SAFE
• always check baby tag similar
with mother tag
• ensure nurse always in nursery
• At home
• baby should not be left
unattended
