Newborn assessment
This can be a great way for teaching and assessing parent-newborn interaction. Remember to keep infant warm!
| General Appearance: | |
| Posture: flexed, symmetry (think birth trauma), no retractions, jittery | |
| Color: pale pink to warm brown (darker skinned kids get darker), plethora (>RBC: HCT: 44-64%, Hgb: 14-24), circumoral cyanosis, acrocyanosis, jaundice (physiologic vs pathophysiologic), | |
| Irregularities in color: eccymoses, petechiae (birth trauma), vernix, milia, lanugo, erythema toxicum, pigmented nevi (melanin), vascular nevi ((blood vessels), mongolian spots, harlequin sign, nevus flammeus: port wine staining (capillary angioma & stays same size), nevus flammeus: strawberry mark (gets bigger, then fades), stork bites, Cafe Au Lait spots (> 5 ? neurofibromatosis), mottling (cardiac?), rashes (infection?) | |
| Skin: peeling, lanugo, diaper rash | |
| Vital signs: | Respirations (30-60, but can have transient tacypnea) do first, HR: 120-160 (listen through back for mummers), both R and HR are usually irregular, Auxiliary T: 36.5-37.2 (97.7-98.9). Weight: may drop 10% in 1st week |
| Head: | Shape: round, molding, hematoma (doesn't cross sutures, may increase), caput succedaneum (fluid, does cross, usually decreases). Circumference: 33-35 cm |
| Fontanels: anterior, posterior, bulging, sunken, will pulse) Sutures: overriding | |
| Eyes: Color, subconjuntival hemorrhages, strabismus, nystagmus (immature neuro) | |
| Nose: Patent (check each nostril, look for flaring, sneeze ok) | |
| Mouth: jittery (may with cry), palate (cleft: finger in mouth), thrush, Epstein pearls (inclusion cyst: nl), teeth | |
| Ears: Position, symmetry | |
| Neck: short, skin folds, head control | |
| Chest | Clavicles (feel), retractions, breast engorgement & discharge (nl: witch's milk). Circumference: 30-33 cm. (2 cm<head) |
| Abdomen | Skin: smooth, peeling, blood vessels visible (maybe a few), not loose |
| Umbilical cord: color, smell, cord clamp off or on, cord falls off 7-10 days, erythema, hernia, innies and outies, do cord care | |
| Genitalia | Female: Introitus patent, vaginal discharge (bloody or much nl). |
| Male: Urethral meatus (hypospadias, episapdius), Scrotum: testes descended (90% at term), hydrocele | |
| GU: urination, # of wet diapers, can have orange crystals | |
| Back & Buttocks | Spine: Straight, pilonidal dimple (?incomplete closure of spinal tract) |
| Anus: Patent | |
| Extremities | Count digits (polydactyly), webbing (syndactyly) |
| Pulses: femoral | |
| Muscle tone: symmetrical movement, feet turn in (if can bring to midline: not club foot) | |
| Reflexes | Especially: Moro, sucking, grasp P. 546 |
Ballard Scale for Gestational Age Assessment: p. 567.
Gestational age assessment: by weight p. 568.
Bulb suction: Compress first, then in side of mouth
Heel stick: outside surface of sole.
Injections: vastus lateralis, stabilize leg
Pain scales:
CRIES: page 59. Goal: < 4.
Neonatal Infant Pain Scale (NIPS)
| Categories | 0 | 1 | 2 |
| Face | Relaxed muscles | Grimace | |
| Cry | No Cry Quiet | Whimper Mild moaning | Vigorous Cry Note: silent cry if baby intubated (mouth, facial movement) |
| Breathing Patterns | Relaxed | Change in breathing irregular, faster than usual, gagging, breath holding | |
| Arms | Relaxed (Not rigid) flexed is nl | Flexed/Extension tense, rapid extension and flexion | |
| Legs | Relaxed (Not rigid) flexed is nl | Flexed/Extension tense, rapid extension and flexion | |
| State of Arousal | Sleeping/Awake quiet, peaceful or alert and settled | Fussy Alert, restless |
Goal: 2 or less