newborn-notes

Assessment of the Newborn

Skin Assessment

  • Ruddy Complexion: Due to increased concentration of RBCs and less fat, making blood vessels more visible.

  • Cyanosis: Generalized mottling of skin is common.

  • Acrocyanosis: Blueness of hands and feet, normal in the first 24-48 hours of life.

  • Hyperbilirubinemia: Can lead to jaundice; occurs on the 2nd or 3rd day of life due to breakdown of fetal RBCs -> physiologic jaundice.

Physical Changes in Jaundice

  • Physiologic Jaundice: Occurs on the 3rd day of life.

  • Pathologic Jaundice: Occurs within the first 2 hours after birth. Bilirubin level is more than 12 mg/dL.

  • Kernicterus: Increased bilirubin levels may lead to brain damage.

Interventions for Increased Bilirubin Levels

  • Examine skin color.

  • Facilitate frequent feeding to hasten meconium passage and bilirubin excretion.

  • Maintain hydration.

  • Prepare for phototherapy.

Phototherapy

  • Purpose: Treats newborns for jaundice by using light to break down bilirubin in the blood, facilitating excretion.

  • Procedure:

    • Use of intense fluorescent lights.

    • Expose as much skin as possible, but cover the genital area and eyes.

    • Remove patches to check for irritation/infection once per shift.

    • Monitor skin temperature.

Interventions During Phototherapy

  • Increase feeds (breast milk or IV fluids).

  • Expect loose green stools and darker urine.

  • Monitor skin color after lights are off.

  • Reposition every 2 hours.

  • Provide stimulation.

Harlequin Sign

  • Appears red on the dependent side of the body and pale on the upper side; it is transient and fades with position change or crying.

  • Caused by immature circulation.

Birthmarks

  • Hemangiomas: Vascular tumors of the skin.

  • Nevus Flammeus (Portwine Stain): Capillary malformation, presenting as pink or dark red lesions.

  • Mongolian Spots: Pigmentation across the sacrum or buttocks, disappearing by school age without treatment.

Common Newborn Skin Features

Vernix Caseosa

  • White, cream cheese-like substance that serves as skin lubricant.

Lanugo

  • Fine hair covering newborn's shoulders, back, and upper arms; disappears by 2 weeks of age.

Desquamation

  • Peeling, evident on palms and soles; more common in post-term infants.

Milia

  • Pinpoint white papules found on cheeks or bridge of the nose; due to immature sebaceous glands, disappearing by 2-4 weeks of age.

Head Assessment

  • Fontanelles & Sutures:

    • Anterior Fontanelle: Diamond-shaped, closes at 12-18 months of age.

    • Posterior Fontanelle: Triangular, closes by the end of the second month.

  • Molding: Head molds into an oblong shape due to birth canal pressure.

Caput Succedaneum

  • Edema of the scalp at the presenting part, disappearing around the 3rd day of life; requires no treatment.

Cephalhematoma

  • Collection of blood between the periosteum and skull bone, caused by ruptured capillaries from pressure; confined to one bone and may take weeks to absorb.

Anogenital Area

  • Inspect anus for patency; can insert a gloved, lubricated little finger to check for imperforate anus.

Male Genitalia

  • Check for presence of testicles (cryptorchidism).

Female Genitalia

  • Swollen vulva may present; blood-tinged secretion may occur (pseudomenstruation).