1. Neonatal Nursing Care: Part2 Neonatal Assessment
Developed by D. Ann Currie, RN, MSN

2. Neonatal Assessment

3. Gestational Age Assessment: Physical Characteristics
Resting posture
Preterm - extended
Term - flexed
Skin
Preterm - thin and transparent with veins prominent
Term - opaque and disappearance of the vernix caseosa

4. Newborn Assessments

5. Newborn Measurements

6. Cephalhematoma and Caput Succedaneum

7. Newborn Vital Signs

8. Common Reflexes of the Newborn

9. Potential Birth Injuries

10. Gestational Age Assessment: Physical Characteristics
Lanugo
Decreases as gestational age increases
Sole (plantar) creases
As gestation progresses, proceeds to the heel
Breast bud
Term: the tissue will measure between 0.5 and 1 cm

11. Gestational Age Assessment: Physical Characteristics
Ear form and cartilage distribution
Preterm - relatively shapeless and flat, no recoil
Term - some cartilage and slight incurving of the upper pinna, good recoil
Male genitals
Preterm - small scrotum, few rugae, testes are palpable in the inguinal canal
Term - testes are generally in the lower scrotum, which is pendulous and covered with rugae

12. Gestational Age Assessment: Physical Characteristics
Female genitals
Preterm - clitoris is prominent, labia majora are small and widely separated
Term - labia majora cover the labia minora and clitoris

13. Assessment of Neuromuscular Characteristics
Square window
Recoil
Popliteal angle
Scarf sign
Heel to ear
Ankle dorsiflexion
Head lag
Ventral suspension

14. Measurement and Appearance
Average weight of 3405 g at term
Average length is 50 cm (20 in)
Head circumference is cm
Chest circumference is cm
Skin – pink tinged

18. Head Proportionally larger than body Fontanelles Hair Face Anterior
Posterior
Hair
Face

19. Eyes Tearless crying Peripheral vision Can fixate on near objects
Can perceive faces, shapes and colors
Blink in response to bright light
Pupillary reflex is present

20. Ears and Neck Ears Neck Soft and pliable Ready recoil
Pinna parallel with inner and outer canthus
Neck
Short with skin folds

22. Nose and Mouth Nose Mouth Small and narrow Must breathe through nose
Lips pink
Taste buds present

23. Chest Chest – cylindrical Breasts – engorged, whitish secretion
Respirations
Diaphragmatic
30-60 per minute
Heart rate bpm

24. Abdomen Cylindrical and soft
Bowel sounds present by 1 hour after birth
Umbilical cord
Initially white and gelatinous
Two arteries, one vein

25. Genitalia and Extremities
Female – labia majora covers labia minora
Male – testes descended, pendulous scrotum
Extremities
Short, flexible, and move symmetrically
Legs are equal in length with symmetrical creases

26. Measurements Weight Length Head circumference Chest circumference
Abdominal girth
Temperature

27. Skin Variations Acrocyanosis Mottling Harlequin sign Jaundice
Erythema toxicum
Milia

28. Erythema toxicum.

29. Facial milia.

30. Skin Variations Vernix Caseosa Forceps marks Telangiectatic nevi
Mongolian spots
Nevus flammeus
Nevus vasculosus

31. Mongolian spots

33. Head Variations
Molding
Cephalohematoma
Caput succedaneum

38. Mouth Variations Cleft lip and palate Precocious teeth
Epstein’s Pearls
Thrush

39. Ear and Eye Variations Low set ears Edema of the eyelids
Normal variations
Subconjunctival hemorrhage
Transient strabismus
Doll’s Eye

40. Respiratory Variations
Signs of respiratory distress
Nasal flaring
Intercostal or xiphoid retractions
Expiratory grunting or sighing
Seesaw respirations
Tachypnea

43. Cardiac Variations Heart is large Low pitched murmur
Decreased strength or absence of femoral pulses

45. Female Genitalia Variations
Vaginal tag
Pseudomenstruation
Smegma

46. Male Genitalia Variations
Hypospadias
Phimosis
Hydrocele
Cryptorchidism

47. Variations in Extremities
Gross deformities
Extra digits or webbing
Clubfoot
Hip dislocation

49. The asymmetry of gluteal and thigh fat folds seen in infant with left developmental of the hip. B, Barlow (dislocation) maneuver. Baby’s thigh is grasped and adducted (placed together) with gentle downward pressure. C, Dislocation is palpable as femoral head slips out of acetabulum. D, Ortolani’s maneuver puts downward pressure on the hip and then inward rotation. If the hip is dislocated, this maneuver will force the femoral head back into the acetabular rim with a noticeable “clunk

53. Reflexes Tonic-neck Moro Grasping Rooting Sucking Babinski
Trunk incurvation

54. Protective reflexes
Blink
Yawn
Cough
Sneeze

55. Brazelton’s Neonatal Behavioral Assessment Scale
Habituation
Orientation to inanimate and animate visual and auditory assessment stimuli
Motor activity
Variations
Self-quieting activity
Cuddliness or social behaviors

56. The End of Part 2