Week 6: Assessment of the Normal Newborn

The chapter discusses the assessment techniques used to ensure the health of a normal newborn.

Cardiorespiratory Status
- Assessment of the newborn’s breathing and heart function.
- Nurse determines if resuscitation or other immediate interventions are necessary.
Thermoregulation
- Importance of maintaining an appropriate body temperature immediately after birth.
Presence of Anomalies
- Check for any visible physical anomalies that may require attention.

Review Data
  - Review details about pregnancy, labor, and delivery.
  - Maternal factors to consider include:
    - Maternal age
    - Health problems
    - Complications during pregnancy or delivery.
Effects of Medications
- Narcotic analgesics given late in labor may affect the newborn’s respiration.
- Preterm infants may have inadequate amounts of surfactant, impacting lung function.

Airway: Proper airway management is crucial.
Indicators to Assess:
  - Respiratory Rate: Monitor the rate of breathing.
  - Breath Sounds: Listen for abnormalities.
  - Signs of Respiratory Distress:
    - Tachypnea: Increased breathing rate.
    - Retractions: Inward movement of the chest wall during breathing.
    - Nasal Flaring: Widening of the nostrils with breathing.
    - Cyanosis: Blue coloration indicating lack of oxygen.
    - Grunting: Sound made during expiration, indicating difficulty.
  - Choanal Atresia: A condition where the nasal passage is blocked which needs immediate attention.
  - Color Assessment:
    - Pallor: Pale skin indicating potential issues.
    - Ruddy Color: May indicate polycythemia or other conditions.
  - Heart Sounds: Listen for normal heartbeats and rhythms.
  - Pulses: Assess brachial and femoral pulses for circulation.
  - Blood Pressure: Monitor to ensure it is within normal range.
  - Capillary Refill: Assess perfusion time of less than 2 seconds.

Temperature Measurement: Take the newborn's temperature immediately after birth.
Setting Warmer Controls: Adjust incubator or warmer settings to manage heat production appropriately.
Reassessment: Conduct temperature assessments every 30 minutes until the newborn is stabilized.

Head Assessment:
  - Molding: Observe for head shape due to birth canal passage.
  - Fontanels: Check the anterior and posterior fontanels for bulging or depression.
  - Caput Succedaneum: Swelling of the soft tissues of the head.
  - Cephalohematoma: Blood accumulation between the skull and periosteum.
Face, Neck, and Clavicles: Examined for abnormalities.
Umbilical Cord: Assessment of the cord for any abnormalities.
Extremities: Inspect hands, feet, and hips for proper development.
Vertebral Column: Check for any deformities.
Measurements:
- Record weight, length, head circumference, and chest circumference.

Reflexes: Assess normal newborn reflexes.
Sensory Assessment:
- Check ears, eyes, and the sense of smell and taste.
Other Neurologic Signs:
  - Jitteriness (Tremors): Indicate possible neurological issues.
  - Seizures: Any signs of seizure activity must be addressed.
  - Irritability: Monitor for excessive fussiness or inability to be consoled.

Blood Glucose:
  - Check levels, especially in at-risk newborns.
  - Be aware of signs of hypoglycemia.
  - Routine screening for at-risk infants.
Bilirubin Levels:
  - Monitor levels to prevent jaundice.
  - Jaundice can indicate liver issues.
  - Phototherapy: Treatment for elevated bilirubin levels to prevent complications.

Kidney Palpation: Check for any abnormalities.
Urine Output:
- Track the average number of wet diapers in newborns.
- Look for uric acid crystals which can indicate dehydration.
Genitalia: Assess both female and male genitalia for proper development and abnormalities.

Skin Assessment:
  - Check for color variations, including normal tones.
  - Harlequin Color Change: A condition where the baby’s skin on one side is red and the other side is pale.
  - Mottling: Irregular spotting or blotching of skin.
  - Vernix Caseosa: A protective cream that covers the skin of the fetus.
  - Lanugo: Fine hair covering the fetus, which may still be present.
  - Milia: Small white cysts often seen on the face of the newborn.
  - Erythema Toxicum: A benign rash seen in many newborns.
  - Birthmarks: Presence of any birthmarks from delivery.
  - Other Skin Assessments: General condition of the skin examined.
  - Documentation: Important to document all findings systematically.
Breasts: Check for breast development in both sexes.
Hair and Nails: Assess for normal growth and absence of abnormalities.

Neuromuscular Assessment:
  - Posture: Note the normal resting position of the newborn.
  - Square Window: Assess the flexibility of the wrist.
  - Arm Recoil: Observe for spontaneous return after flexion.
  - Popliteal Angle: Measure angle of flexed knee during assessment.
  - Scarf Sign: Check how far the arm can be pulled across the chest.
  - Heel to Ear: Measure the flexibility of the leg.
Physical Characteristics Assessment:
  - Skin: Condition and appearance indicating gestational age.
  - Lanugo: Amount of lanugo present is indicative of age.
  - Plantar Surface: Examine creases in the foot which can indicate maturation.
  - Breasts: Presence and development assist in estimating age.
  - Eyes and Ears: Check for their firmness and position.
  - Genitals: Male and female genitalia development for age.

Scoring: The Ballard score is used to evaluate gestational age and infant size.
Gestational Age and Infant Size Categories:
  - Small for Gestational Age (SGA): Below the expected growth parameters.
  - Large for Gestational Age (LGA): Above the expected growth parameters.
  - Appropriate for Gestational Age (AGA): Within expected growth parameters.
Monitoring for Complications: Infants must be monitored for common complications associated with their age and size.

Periods of Reactivity: Understanding behavioral phases in a newborn.
Behavioral Changes to Observe:
  - Orientation: Newborn’s ability to attend to stimuli.
  - Habituation: Ability to become accustomed to repeated stimuli.
  - Self-consoling Activities: Ability to initiate comfort for themselves.
Parents' Response: Assess how parents react to the infant's behaviors.

Reason to Evaluate Plantar Creases:
  - Evaluate within a few hours of birth because:
    - The newborn has to be footprinted.
    - As the skin dries, the creases will become more prominent.
    - Heel sticks may be required.
    - Creases will be less prominent after 24 hours.