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Physical Examination
A complete physical examination is an important part of newborn care. Each body system
is carefully examined for signs of health and normal function. The physician also looks
for any signs of illness or birth defects. Physical examination of a newborn often includes
assessment of the following:
vital signs:
o temperature - able to maintain stable body temperature 98.6° F (37° C) in
normal room environment
o pulse - normally 120 to160 beats per minute
o breathing rate - normally 30 to 60 breaths per minute
general appearance - physical activity, tone, posture, and level of consciousness
skin - color, texture, nails, presence of rashes
head and neck:
o appearance, shape, presence of moulding (shaping of the head from
passage through the birth canal)
o fontanels (the open "soft spots" between the bones of the baby's skull)
o clavicles (bones across the upper chest)
face - eyes, ears, nose, cheeks
mouth - palate, tongue, throat
lungs - breath sounds, breathing pattern
heart sounds and femoral (in the groin) pulses
abdomen - presence of masses or hernias
genitals and anus - for open passage of urine and stool
arms and legs - movement and development
120-160
NORMAL RESPIRATIONS ------
30-60
NORMAL TEMPERATURE ------
97.8-99
NORMAL B/P ------
80/46
MOLDING
MICROCEPHALY
CRANIOSTENOSIS
CHEST CIRCUMFERENCE ------
30-33 CM
12-13 IN
LENGTH ------
18-22 IN
WEIGHT ------
2500-4000 GM
5-9 LBS
VERNIX CASEOSA ------
LANUGO ------
ACROCYNOSIS ------
MILLIA ------
TELANGIECTATIC NEVI ------
STORK BITE. BLANCHES WITH PRESSURE. FOUND ON UPPER EYELIDS, BACK OF NECK. FADES AT
1-2 YEARS
NEVUS FLAMMEUS ------ PORT WINE STAIN- RED/PURPLE, DOES NOT BLANCH. HUGE. FOUND
ON FACE OR THIGH, FLAT BIRTH MARK
NEVUS VASCULOSUS ------
STRAWBERRY MARK, RAISED AREA CAUSED BY DILATED NEWLY FORMED CAPILLARIES, STAY
SCHOOL AGE OR OLDER
CAPET SUCCEDANEUM ------
EDEMATOUS SWELLING BENEATH THE SCALP, COVERS SUTURE LINES,MOST COMMON OVER
OCCIPUT,LAST 3-4 DAYS
PLAGIOCEPHALY ------
FLATTENED OCCIPUT ON ONE SIDE AND PROMINENCE OF FRONTAL REGION. CAUSED BY LYING
IN ONE POSITION
ANTERIOR FONTANELS ------
DIAMOND SHAPE, 1-6 CM, CLOSES @ 18 MONTHS, SAGITAL & CORONAL SUTURES
POSTERIOR FONTANELS ------
TRIANGLE SHAPE, 1-2 CM, CLOSES @2 MONTHS, SAGITAL & LONGITOIL SUTURE
EXTRA DIGITS ------ POLYDACTYLY
SYNDACTYLY ------ WEBBING OF DIGITS
PILONIDAL DIMPLE ------ CYSTS COVERED WITH A TUFT OF HAIR @ BASE OF SPINE, INDICATES
NEURAL DEFECTS
GALANT-4 WEEKS
6 months
Newborn babies - they are so small, yet they are the focus
of so much attention. Each year in the United States, more
than 4 million babies are born - about seven babies every
minute.
NTHS
Newborn Appearance
What does a newborn look like?
Parents often dream of what their new baby may look like, thinking about a pink, round,
chubby-cheeked and gurgling wonder. It may be surprising for many parents to see their
newborn the first time - wet and red, with a long head, and screaming - nothing at all like they
had imagined.
Newborns have many variations in normal appearance - from color to the shape of the
head. Some of these differences are just temporary, part of the physical adjustments a
baby goes through. Others, such as birthmarks, may be permanent. Understanding the
normal appearance of newborns can help you know that your baby is healthy. Some of
the normal variations in newborns include the following, and are explained below:
color
moulding
vernix
lanugo
milia
stork bites
mongolian spots
erythema toxicum
acne neonatorum "baby acne"
strawberry hemangioma
port wine stains
newborn breast swelling
swollen genitals/discharge
Milia Milia are tiny, white, hard spots that look like pimples on a
newborn's nose. They may also appear on the chin and
forehead. Milia form from oil glands and disappear on their
own. When these occur in a baby's mouth and gums, they are
called Epstein pearls.
Stork bites or salmon These are small pink or red patches often found on a baby's
patches eyelids, between the eyes, upper lip, and back of the neck.
The name comes from the marks on the back of the neck
where, as the myth goes, a stork may have picked up the
baby. They are caused by a concentration of immature blood
vessels and may be the most visible when the baby is crying.
Most of these fade and disappear completely.
Acne neonatorum (baby About one-fifth of newborns develop pimples in the first
acne) month. These usually appear on the cheeks and forehead. It is
thought that maternal hormones cause these, and they
usually disappear within a few months. Do not try to break
open or squeeze the pimples, as this can lead to infection.
Strawberry hemangioma This is a bright or dark red, raised or swollen, bumpy area that
looks like a strawberry. Hemangiomas are formed by a
concentration of tiny, immature blood vessels. Most of these
occur on the head. They may not appear at birth, but often
develop in the first two months. Strawberry hemangiomas are
more common in premature babies and in girls. These
birthmarks often grow in size for several months, and then
gradually begin to fade. Nearly all strawberry hemangiomas
completely disappear by nine years of age.
Port wine stain A port wine stain is a flat, pink, red, or purple colored
birthmark. These are caused by a concentration of dilated tiny
blood vessels called capillaries. They usually occur on the head
or neck. They may be small, or they may cover large areas of
the body. Port wine stains do not change color when gently
pressed and do not disappear over time. They may become
darker and may bleed when the child is older or as an adult.
Port wine stains on the face may be associated with more
serious problems. Skin-colored cosmetics may be used to
cover small port wine stains. The most effective way of
treating port wine stains is with a special type of laser. This is
done when the baby is older by a plastic surgery specialist.
Newborn breast swelling Breast enlargement may occur in newborn boys and girls
around the third day of life. In the first week, a milky
substance, sometimes called "witch's milk," may leak from the
nipples. This is related to the mother's hormones and goes
away within a few days to weeks. Do not massage or squeeze
the breasts or nipples, as this may cause an infection in the
breast.
Gestational Assessment
Gestational Assessment
What is a gestational assessment?
Points are given for each area of assessment, with a low of -1 or -2 for extreme
immaturity to as high as 4 or 5 for postmaturity. Areas of assessment include the
following:
Six evaluations of the baby's neuromuscular system are performed. These include:
posture - how does the baby hold his/her arms and legs.
square window - how far the baby's hands can be flexed toward the wrist.
arm recoil - how far the baby's arms "spring back" to a flexed position.
popliteal angle - how far the baby's knees extend.
scarf sign - how far the elbows can be moved across the baby's chest.
heel to ear - how close the baby's feet can be moved to the ears.
A score is assigned to each assessment area. Typically, the more neurologically mature
the baby, the higher the score.
When the physical assessment score and the neuromuscular score are added together, the
gestational age can be estimated. Scores range from very low for immature babies (less
than 26 to 28 weeks) to very high scores for mature and postmature babies.
All of these examinations are important ways to learn about your baby's well-being at
birth. By identifying any problems, your baby's physician can plan the best possible care.
Measurements
Measurements
Assessing a newborn's weight:
A baby's birthweight is an important indicator of health. The average weight for term
babies (born between 37 and 41 weeks gestation) is about 7 lbs (3.2 kg). In general, small
babies and very large babies are more likely to have problems. Babies are weighed daily
in the nursery to assess growth and fluid and nutrition needs. Newborn babies may lose as
much as 10 percent of their birthweight. This means that a baby weighing 7 pounds 3
ounces at birth might lose as much as 10 ounces in the first few days.
In most cases the metric system is used for weighing babies. This chart will help you
convert grams to pounds.
Pounds
Ounces 2 3 4 5 6 7 8 9
Warning Signs Other measurements are also taken of each baby. These include:
head circumference - the distance around the baby's head (head circumference is
normally about 1/2 the baby's body length plus 10 cm).
Warning Signs
What warning signs may indicate a problem with a newborn?
Your newborn baby is going through many changes in getting used to life in the outside
world. Almost always this adjustment goes well, however there are certain warning signs
you should watch for. Some general warning signs with newborns include, but are not
limited to:
no urine in the first 24 hours at home. This can be difficult to assess, especially with
disposable diapers.
no bowel movement in the first 48 hours.
a rectal temperature over 100.4° F (38° C) or less than 97.5° F (36.5° C).
a rapid breathing rate over 60 per minute, or a blue coloring that does not go away.
Newborns normally have irregular respirations, so you need to count for a full minute.
There should be no pauses longer than about 5 seconds between breaths.
retractions, or pulling in of the ribs with respirations.
wheezing, grunting, or whistling sounds while breathing.
odor, drainage, or bleeding from the umbilical cord.
yellow coloring of the eyes, chest, or extremities.
crying, irritability, or twitching which does not improve with cuddling and comfort.
a sleepy baby who cannot be awakened enough to nurse or nipple.
any signs of sickness (i.e., cough, diarrhea, pale color).
the baby's appetite or suck becomes poor or weak.
Every child is different, so trust your knowledge of your child and call your child's
physician if you see signs that are worrisome to you.
Apgar scoring:
The Apgar score is one of the first checks of your new baby's health. The Apgar score is
assigned in the first few minutes after birth to help identify babies that have difficulty
breathing or have a problem that needs further care. The baby is checked at one minute
and five minutes after birth for heart and respiratory rates, muscle tone, reflexes, and
color.
Each area can have a score of zero, one, or two, with ten points as the maximum. A total
score of ten means a baby is in the best possible condition. Nearly all babies score
between eight and ten, with one or two points taken off for blue hands and feet
because of immature circulation. If a baby has a difficult time during delivery, this can
lower the oxygen levels in the blood, which can lower the Apgar score. Apgar scores of
three or less often mean a baby needs immediate attention and care. However, only 1.4
percent of babies have Apgar scores less than seven at five minutes after birth.
Measurements:
Other measurements are also taken of each baby. These include the following:
Physical examination:
A complete physical examination is an important part of newborn care. Each body
system is carefully examined for signs of health and normal function. The
physician also looks for any signs of illness or birth defects. Physical examination
of a newborn often includes the assessment of the following:
o vital signs:
fontanels (the open "soft spots" between the bones of the baby's
skull)
Gestational assessment:
Assessing a baby's physical maturity is an important part of care. Maturity
assessment is helpful in meeting a baby's needs if the dates of a pregnancy are
uncertain. For example, a very small baby may actually be more mature than it
appears by size, and may need different care than a premature baby.
An examination called The Dubowitz/Ballard Examination for Gestational Age is
often used. A baby's gestational age often can be closely estimated using this
examination. The Dubowitz/Ballard Examination evaluates a baby's appearance,
skin texture, motor function, and reflexes. The physical maturity part of the
examination is done in the first two hours of birth. The neuromuscular maturity
examination is completed within 24 hours after delivery. Information often used
to help estimate babies' physical and neuromuscular maturity are shown below.
Physical maturity:
The physical assessment part of the Dubowitz/Ballard Examination looks at
physical characteristics that look different at different stages of a baby's
gestational maturity. Babies who are physically mature usually have higher scores
than premature babies.
Points are given for each area of assessment, with a low of -1 or -2 for extreme
immaturity to as much as 4 or 5 for postmaturity. Areas of assessment include the
following:
o plantar creases - these creases on the soles of the feet range from absent to
covering the entire foot, depending on the maturity.
o breast - the thickness and size of breast tissue and areola (the darkened
ring around each nipple) are assessed.
o eyes and ears - eyes fused or open and amount of cartilage and stiffness of
the ear tissue.
o genitals, female - appearance and size of the clitoris and the labia.
Neuromuscular maturity:
Six evaluations of the baby's neuromuscular system are performed. These include:
o posture - how does the baby hold his/her arms and legs.
o square window - how far the baby's hands can be flexed toward the wrist.
o arm recoil - how far the baby's arms "spring back" to a flexed position.
o scarf sign - how far the elbows can be moved across the baby's chest.
o heel to ear - how close the baby's feet can be moved to the ears.
When the physical assessment score and the neuromuscular score are added together, the
gestational age can be estimated. Scores range from very low for immature babies (less
than 26 to 28 weeks) to very high scores for mature and postmature babies.
All of these examinations are important ways to learn about your baby's well-being at
birth. By identifying any problems, your baby's physician can plan the best possible care.