New Born Assessment

Question 0

Assess:

Answer 0

General appearance
Breathing pattern
Skin color and characteristics
Posture: body symmetry and spontaneous position
Muscle tone: flexion and spontaneous movement.

Question 1

Approach:

Answer 1

Keep neonate warm
Handle him gently
Keep him calm
Adjust the order of exam as needed- ex: if baby is crying don’t take respirations.note quality of cry, resp. Effort, color, and facial symmetry.

Question 2

Affect:

Answer 2

Alert and responsive

Question 3

Cry:

Answer 3

Strong and lusty

Question 4

Quiet:

Answer 4

Resp. Rate- check abdominal movement for 1 minute. 40-60 breath/ min

Question 5

HR:

Answer 5

Warm stethoscope to auscultate apical pulse for full minute.
HR- 120-160
Note point of maximal impulse
Located lateral to mid clavicle line at 3rd or 4th intercostal space.

Question 6

Temp:

Answer 6

Auxiliary temp.

Question 7

Platform balance scale (weight)

Answer 7

To nearest 10 grams

Full term 2,500-4,250 grams

Question 8

Measurement:

Answer 8

Length- extend legs by holding knees together and pushing them down for accuracy.
Full term: 48-53 CM long.
Head circumference:
Measure around occipital area just above eyebrows at widest point.
Chest circumference: should be 2-3 CM smaller than head circumference.

Question 9

Inspect skin

Answer 9

Pink- pinkish brown
Observe for dry peeling skin
Lanugo and vernix
Note any birth marks
Rations
lesions
Palpate texture and turgor
Mongolian spots are common variation in normal pigmentation in black, Asian, and Hispanic neonates.

Question 10

Assess head:

Answer 10

Shape
Symmetry
Note and overriding of cranial bones
And cranial swelling/ fontanels bulging.
Gently palpate fontanels (flat), suture lines (ridges,moveable) and cranial bones.

Question 11

Facial features

Answer 11

Positioning
Symmetry 
Eyes: size and shape- symmetrical
Eyelids- puffy
Iris- even colored
Cornea- bright shiny
Sclerae- bluish white
(Dark room)Elicit pupillary light reflex: pupils constrict equally
Check for red reflex (red glow)
Tracking

Question 12

Ears:

Answer 12

Size, shape, and alignment
Noting skin tags or pits
Palpate the auricle which should be flexible.

Question 13

Nose

Answer 13

Midline
Symmetrical
Slightly flattened
Watch neonate breath(no nasal flaring, or narrowing of nasal passages).

Question 14

Mouth:

Answer 14

Inspect lips- symmetrical and pink
Mouth- midline
Tongue- proportionately sized
Frenulum- allow normal tongue movement.
Mucosa- pink and moist
Rooting reflex- brush neonate’s cheek near his mouth (should turn his head towards that side and open his mouth)
Sucking reflex- should suck on finger strongly.
Palpate hard and soft palates (should be continuous)

Question 15

Neck:

Answer 15

Lift shoulders and let head lag- symmetrical, multiple skin folds, and displays full range of motion.
Palpate trachea- midline
Lymph node- not palpable
Thyroid- difficult to palpate unless enlarged.
Clavicles- no crepitus or lumps

Question 16

Chest

Answer 16

Inspect configuration
Thorax should be rounded with xiphoid.
Note chest movement
Inspect nipples and breast tissue.
Palpate for breast enlargement and scant white discharge that resolve in a few weeks.

Question 17

Breath sounds:

Answer 17

Use neonatal stethoscope
Listen over interspaces
Using diaphragm auscultate heart sounds at point of maximal impulse, then
Aortic area, pulmonic area
Triscuspid, mitral area
Use bell to auscultate again
Heart sounds should be loud

Question 18

Abdomen

Answer 18

Auscultate bowel sounds
Listen in all four quadrants
Note size and shape (round, symmetrical, and protuberant)
Moves with respirations
Inspect umbilical stump: at birth- white with two umbilical arteries and one vein. 10-14 days- should fall off.

Question 19

Palpating abdomen

Answer 19

Flex knees and hips to relax abdominal muscles. Tone should be soft.
Palpate for livers edge (1-2 CM below right costal margin)
Spleen tip (at left costal margin)
Palpate all 4 Quad systematically to detect any masses
Place one hand under flank and press down with other hand to palpate the kidneys.
Also inspect the femoral area (no bulges)
Palpate Femoral pulses and inhuinal lymph nodes

Question 20

Arms

Answer 20

ROM and muscle tone
Term- arms should be well flexed and should move smoothly and symmetrically.
Assess scarf sign- (arm a crossed chest)elbow should not reach midline.
Arm recoil (flex neonate arms for five seconds, extend, release) should flex briskly and fully.

Question 21

Hands:

Answer 21

Normal colored
Nails that cover nail bead
No extra fingers or webbing
Note any palmar creases.
Assess square window sign(flex hand on forearm) angle should be nearly zero degrees.
Test palmar grasp- index fingers in the neonate’s palm(should grasp your finger tightly.
Pull up slowly and note head lag(should be minimal)
Note radial and brachial pulses
Then note each pulse at same time on same side.

Question 22

Leg

Answer 22

ROM
Muscle tone
Perform ordolloni maneuver- flex neonate hips and knees, then abduct both legs simultaneously until they nearly touch the table.
Barlow’s maneuver- bring knees together and push laterally on upper inner thigh.
Heel to ear maneuver- 90 degrees or less
Knee to chest and extend leg gently- less than 90 degree.

Question 23

Feet and toes

Answer 23

Alignment
Inspect
Observe soles of feet- deep creases
Check Babinski reflex- stroke side of foot from heel up and across the ball- great toe dorsiflex and others hyperextended and fan up.

Question 24

Male

Answer 24

Penis: 2-3 CM long w/ centered meatus
If not circumcised do not try to retract the skin
Inspect and palpate scrotum- deep rug are and feel tested and both side of pendulus scrotal sack

Question 25

Female:

Answer 25

Inspect external genitalia
Normally labia majors are swollen and cover labia manora and clitoris
With thumb on labia majora push laterally (hymin should appear thick and may have a tag) may see vaginal discharge but should find no bulges.

Question 26

Neurological system:

Answer 26

Rotate head from side to side assess dolls eye reflex (eyes shift to opposite direction)
Lift and hold at eye level should be straighten legs and trunk when upright and stay in had without slipping.
Turn around- put one foot on table to elicit stepping reflex

Question 27

Spine:

Answer 27

Hold neonate upright
Length should be straight
Gluteal folds should be symmetrical
No sinus opening protrusion or tufts of hair
Assess trunkal incurvation reflex(press firmly on one side of thoracic spine)
Pelvis should flex towards stimulated side.

Question 28

Rectum:

Answer 28

Buttocks firm and rounded with no masses or lesions

Spread buttocks and inspect anal opening should be patent.

Question 29

BP

Answer 29

Doppler ultrasound device

Question 30

Pinna

Answer 30

Insert otoscope
Auditory canal should be patent
Tympanic membrane- white, highly vascular and intact.
Morro reflex: suddenly drop neonate’s head back (extend and abduct his arms and open his hands, then flex his arms and close fists)