Newborn assessment

Newborn BP normal at birth is 70-50/45-30 mmHg

Newborn normal pulse ranges from 120 to 140 to 160 bpm when awake

Newborn normal pulse ranges from 80-90 bpm when asleep

Newborn normal pulse ranges from up to or equal to 170 bpm when crying

Apical pulse is counted for 1 full minute

Low BP indicates hypovolemia or shock

Weak pulse indicates decreased cardiac output

Bradycardia indicates severe asphyxia

Asphyxia is when the body does not get enough oxygen or there is too much carbon dioxide

Tachycardia indicates infection, CNA problems, arrhythmia, stress, or hypovolemia

Normal newborn respirations ranges from 30 to 60 breaths/min

Normal newborn respiration shows visible synchronous chest and abdominal movements

Normal newborns breathing are diaphragmatic and abdominal

Normal newborn respirations are characterized as transient tachypnea

Tachypnea indicates pneumonia or RDS

Rapid and shallow breathing indicates hypermagnesemia caused by large mg doses given to mothers w/ preeclampsia

Preeclampsia is characterized by high blood pressure and organ damage

Respirations below 30 breaths/min indicate use of maternal anesthesia or analgesia

Transient tachypnea occurs when there is fluid in the newborn’s lungs

Cry of a newborn is strong and lusty

Cry of newborn has a moderate tone and pitch

Cries of newborn vary from 3-7 minutes after consoling measures are used

High-pitched and shrill cry indicate a neurologic disorder or hypoglycemia

Weak or absent cry indicate a CNS disorder or laryngeal problem

Laryngeal relates to larynx

Inconsolable cry indicates Gi discomfort or feeding intolerance

Normal newborn temp axilla is 36.5-37.2 Celsius or 97.7 to 99 Fahrenheit

Elevated newborn temp indicates room is too warm, too much clothing or covers, dehydration, sepsis, or brain damage

Lower than normal newborn temp indicates brainstem involvement, cold, or sepsis

Heavier newborns tend to have higher body temperatures

Swings of more than 2 Fahrenheit from one reading to the next or subnormal temperature indicate infection

Newborns typically weight 2500 to 4000 g or 5 lb, 8 oz to 8 lb, 13 oz

Underweight newborns indicate SGA or preterm newborn

SGA means small for gestational age

Overweight newborns indicate LGA or mother is diabetic

LGA means large for gestational age

IDM means infant of a diabetic mother

Within first 3–4 days, normal weight loss of 5–10% for term newborns, up to 15% for preterms

Large babies tend to lose more because of greater fluid loss in proportion to birth weight except infants of diabetic mothers

Loss greater than 15% (low fluid intake, loss of meconium and urine, feeding difficulties, diabetes insipidus)

Newborn length ranges from 46 to 56 cm or 18 to 22 in

Newborns grow 10 cm or 3 in within the first 3 months

Less than 45 cm (17.7 in.) (congenital dwarf)

Short/long bones proximally (achondroplasia)

Short/long bones distally (Ellis–van Creveld syndrome)

Newborn’s body usually flexed, hands may be tightly clenched, neck appears short as chin rests on chest

In breech presentations, newborn’s feet are usually dorsiflexed

Abnormal if only extension noted, inability to move from midline (trauma, hypoxia, immaturity)

Abnormal if newborn is in constant motion (maternal caffeine intake or drug withdrawal)

Color consistent with genetic background

Newborns of European descent: Pink-tinged or ruddy color over face, trunk, extremities

Newborns of African descent or Native American: Reddish brown to pale pink with yellow or red tinge

Newborns of Asian descent: Pink or rosy red to yellow, olive tinge

Common variations: Acrocyanosis, circumoral cyanosis, Mongolian spots, or harlequin color change

Abnormal if pallor of face, conjunctiva (anemia, hypothermia, anoxia)

Abnormal if beefy red (hypoglycemia, immature vasomotor reflexes, polycythemia)

Abnormal if meconium staining (nonreassuring fetal status)

Abnormal if jaundice (hemolytic reaction from blood incompatibility within first 24 hr, sepsis)

Normal newborn is mottled when undressed

Normal newborn has Minor bruising: Over buttocks in breech presentation and over eyes and fore-head in facial presentations

Abnormal newborn with cyanosis (choanal atresia, CNS damage or trauma, respiratory or cardiac problem, cold stress)

Normal newborn texture is smooth, soft, flexible, may have dry, peeling hands and feet

Abnormal newborn texture if generalized cracked or peeling skin (SGA or post-term; blood incompatibility; metabolic, kidney dysfunction)

Abnormal newborn texture if Seborrheic dermatitis (cradle cap)

Abnormal newborn texture if Absence of vernix (postmature)

Abnormal newborn texture if Yellow vernix (meconium staining)

Normal newborn turgor is Elastic, returns to normal shape after pinching

Abnormal newborn turgor maintains tent shape (dehydration)

Normal newborn pigmentation is clear; milia across bridge of nose, forehead, or chin will disappear within a few weeks

Normal newborn pigmentation may have Café-au-lait spots (one or two)

Abnormal newborn pigmentation if Six or more Café-au-lait spots (neurologic disorder such as von Recklinghausen disease, cutaneous neurofibromatosis)

Normal newborn pigmentation may have Congenital dermal melanocytosis (Mongolian blue spots) common over dorsal area and buttocks in dark skinned newborns

Normal newborn pigmentation may have Erythema toxicum

Normal newborn pigmentation may have Telangiectatic nevi

Normal newborn may have rashes, but may also indicate infection

Abnormal newborn pigmentation is Impetigo (group A β-hemolytic streptococcus or Staphylococcus aureus infection)

Abnormal newborn pigmentation is Hemangiomas: Nevus flammeus (port-wine stain)

Abnormal newborn pigmentation is Nevus vascularis (strawberry hemangioma)

Abnormal newborn pigmentation is Cavernous hemangiomas

Normal newborn pigmentation may have Petechiae of head or neck (breech presentation, cord around neck)

Abnormal newborn pigmentation may have Generalized petechiae (clotting abnormalities)

Normal newborn head should have a General appearance, size, movement

Normal newborn head should have a Round, symmetric, and moves easily from left to right and up and down; soft and pliable

Abnormal newborn head is Asymmetric, flattened occiput on either side of the head (plagiocephaly)

Abnormal newborn head is Head held at angle (torticollis)

Abnormal newborn head is Unable to move head side to side (neurologic trauma)

Normal circumference of newborn head is 32 to 37 cm or 12.6 to 14.6 in

Normal circumference of newborn head is 2 cm or 0.8 in greater than chest circumference

Normal circumference of newborn head is one-fourth of body size

Abnormal newborn head may have Extreme differences in size may be microencephaly (Cornelia de Lange syndrome, cytomegalic inclusion disease [CID], rubella, toxoplasmosis, chromosomal abnormalities), hydrocephalus (meningomyelocele, achondroplasia), anencephaly (neural tube defect)

Abnormal newborn head is 3 cm or 1.2 in or more larger than chest circumference (preterm, hydrocephalus)

A common variation of normal newborn heads is molding

A common variation of normal newborn heads are Breech and cesarean newborns’ heads are round and well shaped

Abnormal newborn head may have Cephalohematoma (trauma during birth, may persist up to 3 months)

Abnormal newborn head may have Caput succedaneum (long labor and birth; disappears in 1 week)

Normal newborn fontanelles should be palpated at juncture of cranial bones

Normal Anterior fontanelle: 3–4 cm (1.2–1.6 in.) long by 2–3 cm (0.8–1.2 in.) wide, diamond shaped

Normal Posterior fontanelle: 0.5–1.0 cm (0.2–0.4 in.) at birth, triangle shaped

Normal newborn fontanelles should have Slight pulsation

Normal newborn fontanelles have Moderate bulging noted with crying, stooling, or pulsations with heartbeat

Abnormal newborn fontanelles may have Overlapping of anterior fontanelle (malnourished or preterm newborn)

Abnormal newborn fontanelles may Prematurely close sutures (craniosynostosis)

Abnormal newborn fontanelles may have a Late closure (hydrocephalus)

Abnormal newborn fontanelles may have Moderate to severe pulsation (vascular problems)

Abnormal newborn fontanelles may bulge (increased intracranial pressure, meningitis)

Abnormal newborn fontanelles may sink (dehydration)

Normal newborn hair texture is Smooth with fine texture variations (Note: Variations depend on ethnic background.)

Normal newborn hair distribution has Scalp hair high over eyebrows (Spanish, Mexican hairline begins mid-forehead and extends down back of neck.)

Abnormal newborn hair may be Coarse, brittle, dry hair (hypothyroidism) White forelock (Waardenburg syndrome)

Abnormal newborn hair distribution may have Low forehead and posterior hairlines may indicate chromosomal disorders

Normal newborn face is Symmetric movement of all facial features, normal hairline, eyebrows and eyelashes present

Normal newborn face has Eyes at same level, nostrils equal size, cheeks full, and sucking pads present

Normal newborn Lips equal on both sides of midline

Abnormal newborn face may have Eyes wide apart—ocular hypertelorism (Apert syndrome, cri du chat, Turner syndrome)

Abnormal newborn face (trisomy 21, cretinism, gargoylism)

Normal newborn Chin recedes when compared with other bones of face

Abnormal newborn may have abnormally small jaw—micrognathia (Pierre Robin syndrome, Treacher Collins syndrome)

Normal newborns can make facial grimaces

Abnormal newborns may be unable to suck, grimace, and close eyelids (cranial nerve injury)

Normal newborns are faces are Symmetric when resting and crying

Abnormal newborns may have asymmetrical faces (paralysis of facial cranial nerve)

Normal newborn eyes are Bright and clear; even placement; slight nystagmus (involuntary cyclic eye movements)

Normal newborn eyes may have Concomitant strabismus

Normal newborn eyes Move in all directions

Normal newborn eyes may be Blue, slate blue gray, or Brown at birth in darker-skinned newborns

Normal newborn eyelids are positioned above pupils but within iris, no drooping

Normal newborn eyes are on parallel plane

Normal newborn may have Epicanthal folds in newborns of Asian heritage and 20% of newborns of northern European descent

Abnormal newborn eyes may have Gross nystagmus (damage to third, fourth, and sixth cranial nerves)

Abnormal newborn eyes may have Constant and fixed strabismus

Abnormal newborn eyes may lack pigmentation (albinism)

Abnormal newborn eyes may have Brushfield spots (a light or white speckling of the outer two-thirds of the iris) may indicate trisomy 21

Abnormal newborn eyelids may have Elevation of (hydrocephalus) or retraction of upper lid (hyperthyroidism)

Abnormal newborn eyelids may have “Sunset sign” lid elevation and downward gaze (hydrocephalus), ptosis (congenital or paralysis of oculomotor muscle)

Abnormal newborn eyes are Almond-shaped with upward slant on the lateral sides in newborns of non-Asian heritage (trisomy 21)

Abnormal newborn eyes have Epicanthal folds but are not Asian or northern European descent (trisomy 21, cri du chat syndrome)

Normal newborn eyes have Blink reflex in response to light stimulus

Abnormal newborns have Blink absent (CNS injury, cranial nerve damage)

Normal newborns have Eyes open wide in dimly lighted room

Normal newborn eyes may be Edematous for first few days of life, resulting from birth; no lumps or redness

Abnormal newborn eyes may have Purulent drainage (infection); infectious conjunctivitis (gonococcus, chlamydia, staphylococcus, or gram-negative organisms)

Abnormal newborn eyes may have Marginal blepharitis (lid edges red, crusted, scaly)

Normal newborn cornea is clear and corneal reflex present

Abnormal newborn cornea may have Ulceration (herpes infection); large cornea or corneas of unequal size (congenital glaucoma)

Abnormal newborn cornea may have Clouding, opacity of lens (cataract)

Normal newborn sclera may appear bluish in newborn, then white; slightly brownish color frequent in newborns of African descent

Abnormal newborn may have True blue sclera (osteogenesis imperfect)

Normal newborn pupils are equal in size, round, and react to light by accommodation

Abnormal newborn eyes may have Anisocoria—unequal pupils (CNS damage)

Abnormal newborn eyes may have Dilation or constriction (intracranial) damage, retinoblastoma, glaucoma; pupils nonreactive to light or accommodation (brain injury)

Normal newborn eyes may have Slight nystagmus in newborn who has not learned to focus

Normal newborn has Pupil light reflex demonstrated at birth or by 3 weeks of age

Abnormal newborn eyes may have Nystagmus (labyrinthine disturbance, CNS disorder)

Normal newborn conjunctiva may have Chemical conjunctivitis or Subconjunctival hemorrhage

Abnormal newborn conjunctiva may have Pale color (anemia)

Normal newborn may have Palpebral conjunctiva (red but not hyperemic)

Abnormal newborn conjunctiva is Inflammated or has edema (infection, blocked tear duct)

Normal newborn has 20/200 vision

Normal newborn can Track moving objects to midline

Normal newborns have Fixed focus on objects at a distance of about 10–20 in. (3.8–6.7 cm); may be difficult to evaluate in newborn

Normal newborn Prefers faces, geometric designs, and black and white to colors

Abnormal newborns may have Cataracts (congenital infection)

Normal newborn has Presence of lashes (lashes may be absent in preterm newborns)

Normal newborn lacrimal ducts cause newborn to Cry commonly tearless

Abnormal newborn lashes may Not be present on inner two-thirds of lid (Treacher Collins syndrome);

Abnormal newborn lashes may be bushy (Hurler syndrome)

Abnormal newborn lashes may be long (Cornelia de Lange syndrome)

Abnormal newborn lacrimal glands may have Excessive tearing (plugged lacrimal duct, natal narcotic withdrawal), glaucoma

Normal newborn nose May appear flattened as a result of birth process

Normal newborn nose is Small and narrow in midline, even placement in relationship to eyes and mouth

Normal newborn nose has Patent nares bilaterally (nose breathers)

Normal newborn sneezes common to clear nasal passages

Normal newborn Responds to odors, may smell breast milk

Abnormal newborn nose may be Continued flat or broad bridge of nose (trisomy 21)

Abnormal newborn nose may have a Low bridge of nose, beaklike nose (Apert syndrome, Treacher Collins syndrome), upturned (Cornelia de Lange syndrome)

Abnormal newborn nose may have Blockage of nares (mucus and/or secretions), choanal atresia

Abnormal newborn nose may have Flaring nares (respiratory distress)

Abnormal newborn nose may have No response to stimulating odors

Normal newborn mouth should be symmetrical in movement and strength

Normal newborn has Presence of gag, swallowing, coordinated with sucking reflexes; Adequate salivation

Abnormal newborn may have Mouth draws to one side (transient seventh cranial nerve paralysis due to pressure in utero or trauma during birth, congenital paralysis)

Abnormal newborn mouth may have Fishlike shape (Treacher Collins syndrome)

Abnormal newborn mouth may have Suppressed or absent reflexes

Normal newborn palate is a hard palate dome-shaped

Normal newborn palate has Uvula midline with symmetric movement of soft palate

Abnormal newborn palate may be high-steepled (Treacher Collins syndrome), bifid uvula (congenital anomaly)

Normal newborn palate is intact, sucks well when stimulated

Normal newborn palate has Epithelial (Epstein) pearls appear on mucosa

Normal newborn has Esophagus patent, some drooling common in newborn

Abnormal newborn has Clefts in either hard or soft palate (polygenic disorder)

Abnormal newborn has Excessive drooling or bubbling (esophageal atresia)

Normal newborn tongue is Free moving in all directions, midline

Abnormal newborn may be tongue-tied

Abnormal newborn tongue may Lack of movement or asymmetric movement (neurologic damage)

Abroaml newborn tongue may have Fasciculations (fine tremors)

Abnormal newborn tongue may have Spinal muscular atrophy

Normal newborn tongue is pink, smooth to rough texture, noncoated

Abnormal newborn tongue may deviate from midline (cranial nerve damage).

Abnormal newborn tongue may have White cheesy coating (thrush)

Abnormal newborn tongue may have deep ridges

Normal newborn tongue is proportional to mouth

Abnormal newborn tongue is large with short frenulum (cretinism, trisomy 21, other syndromes)

Normal newborn external ear is Without lesions, cysts, or nodules

Abnormal newborn external ears may have Nodules, cysts, or sinus tracts in front of ear

Abnormal newborn external ears may have Adherent earlobes

Abnormal newborn external ears may be low-set (genetic anomaly or syndrome)

Abnormal newborn external ears may have Preauricular skin tags

Normal newborn hearing includes Eustachian tubes are cleared with first cry

Normal newborns Attend to sounds; sudden or loud noise elicits Moro reflex

Abnormal newborn hearing may have Presence of one or more risk factors

Abnormal newborn hearing may includes No response to sound stimuli (deafness)

Normal newborn neck is Short, straight, creased with skinfolds

Normal newborn Posterior neck lacks loose extra folds of skin

Abnormal newborn neck may be Abnormally short (Turner syndrome)

Abnormal newborn may Arch or inable to flex neck (meningitis, congenital anomaly)

Abnormal newborn neck may have webbing (Turner syndrome, trisomy 21, trisomy 18)

Normal newborn clavicles are straight and intact

Normal newborn has Moro reflex elicitable

Normal newborn has Symmetric shoulders

Abnormal newborn may have Knot or lump on clavicle (fracture during difficult birth)

Abnormal newborn clavicles may have Unilateral Moro reflex response on unaffected side (fracture of clavicle, brachial palsy, Erb–Duchenne paralysis)

Abnormal newborn clavicles may have Hypoplasia

Normal newborn chest has a Circumference (average) of 32 cm (12.6 in.), 1–2 cm (0.4–0.8 in.) less than head

Normal newborn chest is Wider than it is long

Normal newborn chest has a Normal shape without depressed or prominent sternum

Normal newborn’s Lower end of sternum (xiphoid cartilage) may be protruding; is less apparent after several weeks

Normal newborn has a Sternum 8 cm (3.1 in.) long

Abnormal newborn may have Funnel chest (congenital or associated with Marfan syndrome)

Abnormal newborn may have Continued protrusion of xiphoid cartilage (Marfan syndrome, “pigeon chest”)

Abnormal newborn may have barrel chest

Normal newborn chest has Bilateral expansion

Abnormal newborn chest may have Unequal chest expansion (pneumonia, pneumothorax, respiratory distress)

Normal newborn chest has No intercostal, subcostal, or supracostal retractions

Abnormal newborn chest may have Retractions (respiratory distress)

Abnormal newborn chest may have Seesaw respirations (respiratory distress)

Normal newborn Breath sounds are louder than adults because there is less subcutaneous tissue to muffle transmission

Normal newborns’ Chest and axillae clear on crying

Abnormal newborn breath sounds may be decreased (decreased

respiratory activity, atelectasis, pneumothorax)

Abnormal newborn breath sounds may be increased (resolving pneumonia or in cesarean births)

Normal newborn Bronchial breath sounds (heard where trachea and bronchi closest to chest wall, above sternum and between scapulae): Bronchial sounds bilaterally, Air entry clear, Rales may indicate normal newborn atelectasis, Cough reflex absent at birth that appears in 2 or more days

Abnormal newborn breath sounds may be Adventitious or abnormal sounds (respiratory disease or distress)

Normal newborn breasts are Flat with symmetric nipples

Normal newborn have Breast tissue diameter 5 cm (2 in.) or more at term

Normal newborn has Distance between nipples 8 cm (3.1 in.)

Normal newborn has Breast engorgement occurs on third day of life; liquid discharge may be expressed in term newborns

Abnormal newborn nipples may be Supernumerary

Abnormal newborn nipples may be Dark-colored

Abnormal newborn breast may have Lack of tissue (preterm or SGA)

Abnormal newborn breast may have discharge

Abnormal newborn breast may have abscesses

Abnormal newborn breast may experience engorgement