Assessment of the baby: at birth Flashcards
What are the two parts of the assessment of a baby at birth?
Immediately assessing adjustment from intrauterine to extra-uterine life using Apgar score, and a complete physical examination to confirm normality and detect deviations from the norm.
What 5 variables does the Apgar assess?
Respiratory effort, heart rate, colour, muscle tone and reflex irritability
How frequently is the Apgar score assessed?
At 1 min, 5 mins and 10mins – although may be more frequent if any scores are low and resuscitation is required
What does Apgar stand for?
Appearance (colour), Pulse (heart rate), Grimace (response to stimuli), Activity (muscle tone), Respiratory effort
Explain values for Apgar scoring
Each variable is assigned a score of 0, 1 or 2, so the baby is given a total score out of 10.
What does an Apgar score of 7-10 suggest?
The baby is in good condition.
What does an Apgar score of 4-6 suggest?
Moderate depression, requiring some degree of resuscitation but mat also be due to other factors such as prematurity, effects of maternal drugs, congenital malformation etc.
What does an Apgar score of 0-3 suggest?
Severe depression, usually already undergoing resuscitation.
What would a score of 0 for appearance look like?
Blue, pale
What would a score of 1 for appearance look like?
Body pinks, limbs blue
What would a score of 2 for appearance look like?
All pink
What would a score of 0 for pulse look like?
Absent
What would a score of 1 for pulse look like?
<100
What would a score of 2 for pulse look like?
> 100
What would a score of 0 for grimace look like?
None
What would a score of 1 for grimace look like?
Grimace
What would a score of 2 for grimace look like?
Cry
What would a score of 0 for activity look like?
Limp
What would a score of 1 for activity look like?
Some flexion of limbs
What would a score of 2 for activity look like?
Active movements, limbs well flexed
What would a score of 0 for respiratory effort look like?
None
What would a score of 1 for respiratory effort look like?
Slow, irregular
What would a score of 2 for respiratory effort look like?
Good, strong cry
When is a complete physical examination of the baby undertaken?
After the first hour of life to allow a long period of skin-to-skin contact between mother and baby.
What features of the baby should be assessed during its physical examination?
Head, neck, clavicles, arms, chest, abdomen, genitalia, legs, spine, skin, elimination, weight, length
What features of the head should be assessed during the physical examination of the baby?
Head circumference, shape of the face, eyes nose, mouth and ears.
What should you consider when examining the baby’s head in general?
Look for signs of moulding and caput succedaneum, visible signs of trauma and bruising; Feel along suture lines and fontanelles
What can a large anterior fontanelle be an indication of?
Prematurity or hydrocephalus
What can a small anterior fontanelle be an indication of?
Microcephaly
What can a raised anterior fontanelle be an indication of?
Raised intracranial pressure
What can a depressed anterior fontanelle be an indication of?
Dehydration
What measurement is taken of the baby’s head?
Occipitofrontal circumference
What should you consider when examining the shape of the baby’s face?
That it is symmetrical
What is associated with moderate facial asymmetry?
Prolonged second stage, forceps delivery, macrosomia and birth trauma
What should you consider when examining the baby’s eyes?
Look to see two eyes are present and assess size, shape and any slanting, cataracts, discharge, conjunctival haemorrhage or coloboma.
What should you consider when examining the baby’s nose?
Look at the shape of the nose and width of the bridge (should be no greater than 2.5cm at term), and if the nose is squashed or nostrils are flared.
What could be a concern if the baby’s nose is squashed?
That the baby’s ability to breathe is affected.
What may flared nostrils be an indication of?
Respiratory illness
What should you consider when examining the baby’s mouth?
Look at the mouth to see formed and symmetrical lips, the area between the nose and lips (cleft lip), the inside of the mouth with a light source, a high, arched and intact palate, the presence of white spots on the gums or palate and the length of the frenulum
What could asymmetry of the lips indicate?
Facial palsy
What may be the cause of a small mouth?
Micrognathia
What is the usual reason behind white spots on the gums or palate?
Epstein’s pearls or teeth
What should you consider when examining the baby’s ears?
Look to see the two fully formed ears, in the correct position, containing enough cartilage (should spring back into position when moved forward gently), well-formed pinna with defined curves in the upper part, patency of external auditory meatus, presence of accessory skin tags or auricles
What may low set ears be an indication of?
Underlying chromosomal abnormality
What may accessory skin tags or auricles on the ears be an indication of?
Renal abnormalities
What should you consider when examining the baby’s neck?
Look for symmetry, any swelling, that the baby is able to move and flex the head to either sides, any webbing or redundant skin folds at the back of the neck
What is limited lateral movement of the neck associated with?
Torticollis
What could webbing of the neck be an indication of?
A chromosomal abnormality
What are redundant skin folds at the back of the neck suggestive of?
Trisomy 21
What should you consider when examining the baby’s clavicles?
That they are intact
What should you consider when examining the baby’s arms?
Check to see arms are of same length, can move freely and spontaneously, number of digits and any webbing between them, polydactyly or syndactyly, number of palmar creases, nails for any paronychia
What could a lack of arm movement be an indication of?
Underlying trauma (e.g. fractures, nerve damage) or poor motor control associated with neurological impairment
What could a singular palmar crease be an indication of?
Chromosomal abnormality e.g. trisomy 21
Why should nails be checked for any paronychia?
They may become infected or get caught on bedding, causing them to tear and bleed.
What should you consider when examining the baby’s chest?
Look for symmetry of movement with respiration, respiration rate, signs of respiratory distress, well-formed and symmetrical nipples and areolae
What could widely spaced nipples and areolae be indicative of?
Underlying chromosomal abnormality
What should you consider when examining the baby’s abdomen?
Rounded abdomen, moves in synchrony with chest during respiration, intact with no abnormal swellings, umbilical cord securely clamped with no signs of haemorrhage
What should you consider when examining the baby’s genitalia (boys)?
Length of penis (usually 3cm), position of urethral meatus, foreskin not retracted and adherent to glans penis, presence of two testes
What can physical retraction of foreskin lead to at this age?
Phimosis
What should you consider when examining the baby’s genitalia (girls)?
Examine vulva, presence of clitoris, urethral and vaginal orifices, mucoid discharge
What should you consider when examining the baby’s legs?
Assess symmetry, size, shape and posture, same length, moving freely, shape and position of feet in relation to the legs, oedema or ‘rocker bottom’ feet, number of toes and any webbing, polydactyly or syndactyly
What may a lack of leg movement indicate?
Underlying trauma (e.g. fractures, nerve damage) or poor motor control associated with neurological impairment
What should you consider when examining the baby’s spine?
Any obvious abnormality (e.g. spina bifida), swelling, dimpling or hairy patches, curvature of vertebral column, any dimples or sinuses in cleft of the buttocks, presence of anal sphincter
What may swelling, dimpling or hairy patches on the back indicate?
Abnormality of the spinal cord or vertebral column
What should you consider when examining the baby’s skin?
Condition, colour, rashes or marks, swelling or spots, Mongolian blue spot
What should you consider when examining the baby’s elimination?
Record passage of urine or meconium (indicate patency of renal and lower gastrointestinal tract respectively
What should you consider when examining the baby’s weight?
Record in weight kilograms
What should you consider when examining the baby’s length?
Record crown-heel length in two stages: crown to base of the spine, and base of spine to heel
What should you ensure when carrying out a birth examination? (6 things)
The procedure is explained and consent gained, hands are washed and dried, good lighting, baby kept warm and either placed skin to skin or dressed following the procedure, findings are discussed with parents, documented and acted upon accordingly
