1. The Newborn

2. Leifer, G. (2011) Introduction to maternity and pediatric nursing
Leifer, G. (2011) Introduction to maternity and pediatric nursing. (6th edition. Philadelphia: Saunders.
Ministry of Health Tamariki Ora Health Book

3. The aims of the assessment of the newborn are to:
-ensure adaptation to the environment outside the uterus
-to identify any abnormalities early so intervention
may begin

5. At birth, the following is completed: -the time of birth is recorded -Apgar score completed -cord clamp -identification labels (if appropriate) -baby dried -baby’s weight is recorded ( kg) -a full top to toe and systems assessment Rationale / reason….why these assessments are performed…………

7. Assessment of the newborn is on going.
A “head to toe assessment”
follows a logical format
-allows the observation of
general appearance, normal
neonatal characteristics,
vital signs and reflexes

8. A combination of both assessments is very thorough
Systems approach
An assessment which focuses on body systems ensures the newborn has adapted to the new extra uterine environment.
A combination of both assessments is very thorough

9. -head circumference 34-35 cms
Head to toe assessment
General appearance: colour, activity…. prioritise
Head
-head circumference cms
-size and shape, symmetry
-fontanelles ( anterior, posterior)
soft and flat
-cephal hematoma
-caput succedaneum
-molding

11. Face
-symmetry, colour,
(pink,
jaundiced)
-eyes clear
-nose clear (infants nose
breathers)

12. -mouth (sucking reflex)
-milia

13. Chest -chest is symmetrical, (32-33cm) skin, colour -respiratory and cardiac assessments are done -heart rate beats, (apical heart rate) -respirations breaths per minute, -temperature 36.5 – 37.2 C.

14. Abdomen
-soft, cylindrical, skin colour
-umbilical cord (check)
-Moro reflex

15. Extremities (arms and legs) -symmetrical, full range of motion -colour of hands and feet -palmer (grasp) reflex -babinski reflex -hips (assess for hip dysplasia) -skin, colour

16. Back -spine straight, flat and intact -mongolian spots -anus patent, passed meconium, stools

17. Genitals
-assess for normal
appearance
-? passing urine
-? passing meconium,
stools.

18. Reflexes -assess an intact neurological system Moro reflex (startle) Grasp reflex -

19. Babinski reflex

20. Care of the cord.
-assess any ooze or bleeding, redness….
-there is debate as to whether the cord should be left alone or cleaned with an alcohol base solution
-the clamp is usually removed after 48+ hours

22. http://t3. gstatic. com/images

23. Weight
-normal variation kilograms
-when weighing babies important aspects include:
-warmth of the area
-consistency of the scales
(scales vary)
-clothing eg. singlet or not
-documentation
-involvement of the family

24. http://cache2. asset-cache. net/xc/50655191. jpg

25. Physiological weight loss
Weight loss which is normal and expected in the newborn following birth.
-usually approximately 10% of the initial weight after birth.
-regained by 10 days to 2 weeks

26. Length
-crown to heel
-average 50cm (47-53 cm)
Head circumference
-normal cm
-taken from above the ears and eyes in the
occipito-frontal plain.
This may change due to molding (moulding) of the newborns head following birth

27. Head circumference

28. The measurements of weight, length and head circumference are plotted together on a standardised growth chart.
All 3 measurements should be within the same percentile
The first measurements = baseline

30. Newborn characteristics
-milia
-lanugo
-vernix caseosa
-mongolian spots
-physiological jaundice
-caput succedaneum
-cephalhematoma
-molding

31. Assessment of skin
-milia:
white spots, typically on the nose, sometimes the forehead.
-cause retention of secretions in sebacous glands.
-disappear usually by 2 weeks.

32. milia http://newborns.stanford.edu/images/milia1.jpg

33. Mongolian blue spots irregular dark pigmentation back and sacral area

35. Vernix caseosa

36. http://www. ehealthconnection. com/adam/doc/graphics/images/en/9696
molding

37.
Cephalhematoma
-subcutaneous swelling containing blood found on the head of an infant several days after birth.
-usually disappears
within a few weeks
to 2 months.

38.
Caput succedaneum
-swelling or edema occurring in or under the fetal scalp during labour.

39. Physiological jaundice
Physiological jaundice. -a harmless condition in the new born caused by the normal reduction of red blood cells following birth. -occurring 48 hours after birth, peaking at day 5 and then disappearing by the 10th day -the newborn has a “yellowish” appearance to its skin colour. -the newborn may be sleepy and lethargic, but feeding must be regular -lying the baby in the sunshine helps.

41. Examination of the hips
(-refer to the picture in the book of readings)
Abduction maybe limited in congenital dislocation of the hips. One hand stabilises the pelvis.
With the other hand, the flexed thigh is gently pushed posteriorly and then abducted. During abduction a displaced hip relocates with a “clunk”
“Hip click test”

42. Newborn screening for several inborn errors of metabolism is done through a small blood test usually after 48 hours of feeding.
The Guthrie test uses a small amount of blood (obtained through a heel prick) to saturate a piece of filter paper.

43. The metabolic conditions tested for include:
PKU (phenylketonuria), Cystic Fibrosis, Galactosaemia, hypothyroidism, Maple syrup Urine Disease (MSUD), Biotinidase deficiency and congenital hyperplasia (CAH)

44. Priority assessments / on going and for the days and weeks following birth :
-general appearance
-respirations and heart rate
-colour, skin, cord, eyes
-temperature
-passing urine
-passing meconium / stools
-presence of sucking and swallowing /
-feeding patterns
-top to toe and systems assessment know the rationale
reason why?

45. At each ongoing assessment of the newborn / baby the child health nurse (plunket nurse) will assess -general appearance, skin, colour, cord, eyes, -feeding patterns, -patterns of elimination urine, bowel actions -sleeping patterns -general wellbeing, patterns of crying -hearing and vision -developmental milestones

46. -work with the mother and family to assist in providing a safe and stimulating environment for the baby, infant. -provide education regarding the introduction of solid foods, immunisations, dental health , vision and hearing assessments, availability of support services in the area…..type of car seat,