Features of a healthy newborn Flashcards
What are the transitions to extra uterine?
airway apgar score onset of respiration circulatory adaptation thermal adaptation
What is in the first examination of the newborn?
general appearance colour inspection of: the head including fontanelles and suture the face including eyes, ears, nose and mouth the neck the chest and abdomen the spine the genitalia the anus limbs with hands and feet identification of birthmarks and birth injuries
What do you look for in general appearance?
Normal term baby weight is around 3.5kg
average length is 50cm
most babies appear plump and have a prominent abdomen
What would you expect with sleeping and waking?
from birth the baby appears alert for about 1 hour then relaxes and sleeps
sleeping and waking rhythms take time to settle
initially waking periods are related to hunger but within a week the waking periods last longer and meet the need for social interaction
What do you expect with crying?
the cry of a baby distinguishes different needs and its the way they communicate
it is possible to identify which may be hunger, thirst, pain general discomfort
maternal anxiety and difficulties relating to crying can be improved with info and support from the midwife
Describe the 2 sleep state
deep sleep- hard to awake, eyes closed, some jerky makeup
light sleep- drowsy; eyes closed, may be sucking
describe the awake state
drowsy or semi dozing quiet alert active alert crying be aware of feeding cues
what should the eyes look like?
eyes should be visualised and check the lens is clear
What should the nose look like?
babies are nasal breathers
the nose id often squashed in utero or it may not be completely patent
What should the mouth look like?
A clean finger should be inserted to check cleft palates. tongue/ tongue tie, neonatal teeth. Lips and muscous membranes should be pink and well perfused
what does babies vision be like?
babies are sensitive to bright lights they may frown or blink
can recognise a human face at a distance of 15-20cm
can establish
eye contact with the mother which establishes bonding
can track a moving object by 5 days and from 2 weeks can differentiate mothers face from a strangers
no tears are present in newborns therefore they can become infected easily
What should ears look like?
inspected noting their size, shape, position, abnormalities for example skin tags or dimples
ear abnormalities can be associated with chromosomal anomalies and syndromes and should be reported to neonatal staff
What should a new born babies hearing be like?
new born babies eyes turn towards sound
can discriminate between voices, giving preference to their mothers
neonatal screening is performed on all babies usually within 4-6 weeks to identify early and follow up any baby with hearing impairments
What should a babies smell and taste be like?
babies will prefer the smell of milk to other things and will prefer breastmilk
turn away from unpleasant smells
nasal flaring can be indicative of respiratory destress sneezing can be common
What should the chest and abdomen be like?
chest and abdomen movements should be in sync
respirations may still be irregular 30-40 bpm
auditory assessment of breathing
abdomen should be rounding
haemostasis of the umbilical cord is vital and secured by a plastic clamp
What should the spine be like?
best examined by lying the baby face down with its abdomen and chest in the palm of one hand
The back should be visualised and palpated, Any abnormality of the skin, for example swelling, tuft if hair, birthmarks should be noted
any sacral dimple should be closed
What should the genitalia and anus be like?
Should be examined carefully for completeness and patency
Check patency of anus and whether the baby has based meconium. usually within the first 24 hours of birth. should pass urine in the first 24 hours initially 20-30mls per day rising to 100-200ml daily as fluid intake increases.
What should meconium be like?
soft, greenish black substance accumulated in the intestine from approx 16th week of intrauterine life consisting of epithelial cells, swallowed amniotic fluid, fatty acids and bile pigment .
First stool passed within 48 years. As food is digested, the stool changes colour to a greenish brown, indicating that the gI tract is patent
5th day onwards the stool becomes yellow
How does meconium changes with breastfed babies?
soft, bright yellow, inoffensive stools. May pass five or more times a day as a lactation is establishing
After 3-4 weeks, may only pass one soft yellow stools every 2-3 days as there are few waste products from breastmilk
How does meconium changes with formula fed babies?
Paler, more formed stools with slightly offensive odour
More regular stool when feeding is established, although constipation is more likely
What should the limbs and digits be like?
note length and movement of limbs
digits should be counted and separated to ensure no webbing or extra digits
the axillae, elbows, groin should also be inspected for abnormalities
Feet and toes and checked for extra digits and any deformity such as talipes equinovarus
What should a babies sense of touch be like?
Babies are sensitive to touch
skin to skin contact immersion in water
stroking, cuddling and rocking movements
grasp relex enhances bonding
Why are length and weight measured?
to provide parameters against which future growth can be monitored
Describe vitamin K
In the UK it is advised that all babies should be given vitamin K as free circulating vitamin K is low after birth and rises gradually after 3-4 days
Vitamin K deficiency bleeding (VKDB) is a bleeding tendency that results from a lack of vitamin K that leads to reduced clotting factors and resultant bleeding.
Vitamin K is poorly transferred through the placenta and naturally low in breastmilk
NICE guidelines recommends 1mg
Reflexes
Moro rooting sucking and swallowing grasp walking and stepping crawling Babinski
What happens following the check?
Explain finding to parents
documentation
record your findings in the baby’s case notes and any abnormalities are referred to the neonatal team
Identification and security in clinical setting
Identify name tags x2 baby in the cot when travelling security cameras visitor restrictions staff ID badges
What is checked in the daily examination of the baby?
hospital or home general appearance colour activity and tone eyes mouth cord skin' jaundice feeding urinary output stools sleeping pattern
What body systems is activity, behaviour, cry and tone checking?
respiratory
cardiovascular
skeletal-muscular
neurological
What body system is colour and temp assessing?
Respiratory
Cardiovascular and blood physiology
metabolic
immunological
What body system is urinary output assessing?
renal
immunological
What body system is feeding and stool assessing?
gastrointestinal
immunological
What body system is skin integrity/ rashes/ spots assessing?
immunological
skin care
vernix caseosa should be left to absorb as an antibacterial and anti-fungal skin barrier
skin is an important role in temp regulation, barrier to infection, balances electrolytes and stores fat
baby products along with exposure to urine or faeces could disrupt the protective barrier
advice to parents
breastfeeding nappy changes bathing reducing the risk of cot death/ SIDS safety in the home importance of seeking early medical advice if the baby becomes unwell
When is the full systematic physical examination of the newborn offered?
with 6-72 hours after birth and again at 6-8 weeks of age
includes examination of the hips and listening for heart murmurs
