Each newborn baby is carefully checked at birth for signs of problems or complications. The healthcare provider will do a complete physical exam that includes every body system. Throughout the hospital stay, doctors, nurses, and other healthcare providers continually look at the health of the baby. They are watching for signs of problems or illness. Newborn Assessment may include the below.
Initial Care of the Newborn
• Observe or assist with initiation of respirations.
• Assess Apgar score.
• Note characteristics of cry.
• Monitor for nasal flaring, grunting, retractions,and abnormal respirations, such as a seesaw respiratory pattern (rise and fall of the chest and abdomen do not occur together).
• Assess for cyanosis.
• Obtain vital signs.
• Observe the newborn for signs of hypothermia or hyperthermia.
• Assess for gross anomalies.
APGAR Scoring System:
• Assess each of five items to be scored and add the points to determine the newborn’s total score.
• Five vital indicators
• Interventions: Apgar score
The newborn’s Apgar score is assessed and recorded at 1 minute and at 5 minutes after birth.
Newborn Physical Examination:
• Keep the newborn warm during the examination.
• Begin with general observations, and then perform assessments that are least disturbing to the newborn first.
• Initiate nursing interventions for abnormal findings and document findings.
• Heart rate (resting): 100 to 160 beats/min (apical); auscultate at the fourth intercostal space for 1 full minute to detect abnormalities
• Respirations: 30 to 60 breaths/min; assess for 1 full minute
• Assess heart rate and respiratory rate first while the newborn is resting or sleeping.
• Axillary temperature: 96.8 F to 99 F
• Blood pressure: 73/55 mm Hg
Body measurements (approximate)
• Length: 45 to 55 cm (18 to 22 inches)
• Weight: 2500 to 4300 g (5.5 to 9.5 lb)
• Head circumference: 33 to 35 cm(13.2 to 14 inches)
1. Head should be one-fourth of the body length (cephalocaudal development).
2. Bones of the skull are not fused.
3. Sutures (connective tissue between the skull bones) are palpable and may be overlapping because of head molding, but should not be widened.
4. Fontanels are unossified membranous tissue at the junction of the sutures.
5. Molding is asymmetry of the head resulting from pressure in the birth canal; molding disappears in about 72 hours.
6. Masses from birth trauma
• Caput succedaneum is edema of the soft tissue over bone (crosses over suture line); it subsides within a few days.
• Cephalhematoma is swelling caused by bleeding into an area between the bone and its periosteum (does not cross over suture line); it usually is absorbed within 6 weeks with no treatment.
7. Head lag
• Common when pulling the newborn to a sitting position
• When prone, the newborn should be able to lift the head slightly and turn the head from side to side.