W10c - Newborn Assessment Flashcards
Components of the newborn physical assessment: Vitals
Heart rate
Respiratory rate
Temperature (axillary)
Oxygen saturation
Blood pressure (if indicated)
Newborn Assessment: Measurements
Weight
Length
Head circumference
Abdominal girth (if needed)
Newborn Assessment: Systems Review
Cardiovascular
Respiratory
Gastrointestinal
Genitourinary
Neurological
Newborn Assessment: Growth and Development
Gestational age assessment
Feeding ability
Tone and reflexes
Newborn Assessment: Head-to-Toe
Skin: Color, lesions, rashes, birthmarks
Head & Neck: Fontanelles, sutures, swelling, clavicles
Eyes/Ears/Nose/Mouth: Red reflex, palate, nasal patency, ear position
Chest: Symmetry, breath sounds, heart sounds, murmurs
Abdomen: Cord, bowel sounds, organomegaly
Genitalia: Patent anus, descended testes, normal labia
Musculoskeletal: Limb movement, hip abduction, spine
Neurological: Tone, reflexes (Moro, grasp, rooting, sucking)
What does a normal general appearance look like in a newborn?
Well flexed, pink, active, appropriate weight, no signs of respiratory distress.
Why might a newborn appear more pink if the mother had gestational diabetes?
Increased red blood cell production (polycythemia).
What birth weight defines a low birth weight newborn?
Less than 5.5 pounds (approx. 2500 grams).
What is considered a high birth weight newborn?
Greater than 8.8–9.9 pounds (approx. 4000–4500 grams).
Do neonates feel pain?
Yes
What are some physiological signs of pain in a neonate?
Increased heart rate and blood pressure, grimacing, clenched fists.
What are behavioral signs of neonatal pain?
Crying, turning away from stimulus, red face, grimace, clenched extremities.
What pain assessment tools are used in neonates?
PIPP (Premature Infant Pain Profile) and NIPS (Neonatal Infant Pain Scale).
What comfort measures can reduce pain in neonates?
Skin-to-skin contact, breastfeeding, sucrose, swaddling, pharmacological pain relief.
When should comfort measures be applied?
Before, during, and after painful procedures.
What is the average BW?
2500 g - 4000 g
5.5 to 8 lbs
What percentage of birth weight loss is acceptable for term infants?
Up to 10% in the first few days
Regained in the first two weeks
What is the average head circumference of a term infant?
34 cm (normal range: 32–36.8 cm)
What is the normal length range for term infants?
45 to 55 cm
What’s the difference between quiet alert and active alert states in a newborn?
Quiet alert: Still, focused, best state for bonding and feeding
Active alert: Increased motor activity, may be fussy or less attentive to stimuli
Name the finding
Erythema Toxicum
A common newborn rash that:
Appears between 24 to 72 hours of life
Typically resolves within a few weeks
Causes no discomfort and needs no treatment
Occurs as baby’s skin adjusts to the environment
Can look concerning to parents but is normal
Name the finding
Milia
Small white papules on the face
Caused by keratin-filled cysts
Common and benign
Exfoliate on their own within the first few weeks of life
Name the finding
Congenital Dermal Melanocytosis (Formerly “Mongolian Spot”)
Blue or slate-grey pigmentation present at birth
Commonly found on the back or buttocks
Benign and flat, may resemble a bruise
Fades within the first few years
Important to document to avoid mistaken suspicion of abuse
Name the finding
Lanugo
Fine, soft hair found on newborn’s face, shoulders, and back
More common in preterm infants
Helps with thermoregulation
Sheds spontaneously in the first few weeks of life
Normal finding, no treatment needed
Name the finding
Normal Skin Peeling
Due to skin drying out post-amniotic fluid exposure
Common in post-date infants
No treatment needed, but moisturizing is okay
Allow vernix to absorb naturally
Breastmilk can be applied as a gentle moisturizer
Name the finding
Facial Bruising
Often related to facial or occiput posterior (OP) presentation
Can occur with nuchal cord or difficult delivery
Breakdown of red blood cells increases risk of jaundice or hyperbilirubinemia
Monitor for signs of elevated bilirubin
Name the finding
Nevus Simplex ( “Nevi” or “Stork Bite”)
Red, flat, patch-like appearance
Typically located on back of neck, eyelids, or forehead
Benign and usually fades with time
What is the term given to the cheese like, whitish substance that fuses with the epidermis and serves as a protective coating for the fetus?
Vernix caseosa
Surfactant
Caput succedaneum
Acrocyanosis
Vernix caseosa
Made of shed skin cells, sebum, and lanugo
Fuses with the epidermis and serves as a barrier
Protective: antimicrobial, waterproof, and prevents fluid loss
Helps with thermoregulation and reduces skin trauma at birth
Often left intact after birth to support skin health
What marks on a baby’s skin may indicate an underlying problem that requires notification of a physician?
Congenital Dermal Melanocytosison the back
Telangiectatic nevi on the nose or nape of the neck
Petechiae scattered over the infant’s body
Erythema toxicum anywhere on the body
Petechiae scattered over the infant’s body
If localized (e.g., on face), may be due to birth trauma
If widespread, it may indicate sepsis, thrombocytopenia, or a coagulopathy
Requires urgent evaluation to rule out serious underlying causes
Other options listed are typically benign and do not require immediate medical attention
Where does jaundice typically appear first in a newborn?
Face and sclera (eyes)
What type of bilirubin causes jaundice in newborns?
Unconjugated (indirect) bilirubin
Why are newborns prone to jaundice?
Immature liver can’t conjugate bilirubin efficiently
How is bilirubin formed?
Hemoglobin → heme + globin → heme becomes bilirubin
What happens to bilirubin in circulation?
It binds to albumin
What happens to bilirubin if it doesn’t bind to albumin?
Kernicterus (bilirubin encephalopathy)
What is the visible sign of jaundice?
Yellow discoloration of skin, sclera, and mucous membranes
Overriding sutures
- Visually you will see a ridge and riding over of sutures
Normal finding that self-resolves
Name the finding
Head moulding
Temporary overlapping of a newborn’s cranial bones during passage through the birth canal.
It allows the head to change shape and fit through the maternal pelvis.
It’s a normal finding after vaginal delivery and typically resolves within a few days postpartum.
Name the finding
Cephalhematoma
Collection of blood between skull bone and periosteum
Does not cross suture lines
Localized to one side
Appears hours after birth
Associated with prolonged labor or birth trauma
Takes weeks to resolve
Increases risk of jaundice due to RBC breakdown
What is the key feature of a cephalhematoma?
Does not cross suture lines
Risk associated with cephalhematoma
Jaundice due to RBC breakdown
How does caput succedaneum differ from cephalhematoma?
Present at birth
Crosses suture lines
Resolves in a few days
Does not increase risk of jaundice
Name the finding
Bruising of the vertex
Probably a vacuum used
Bruising on the head with small lacerations
Likely used an internal monitor to measure fetal HR
How does a cephalhematoma form?
Pressure during delivery causes rupture of blood vessels between the periosteum (the membrane covering the skull) and the skull bone itself.
Blood accumulates in the subperiosteal space
Because the periosteum is tightly attached at suture lines, the swelling is restricted to one bone and does not cross suture lines
The hematoma is not visible immediately at birth but becomes apparent over several hours
As the blood breaks down over days to weeks, the infant is at increased risk for jaundice due to bilirubin release from red blood cells in the hematoma
How does a caput succedaneum form?
Oedematous fluid collects in the soft tissues of the scalp, usually due to pressure against the cervix during labor.
During a vaginal delivery, the baby’s head presses against the dilating cervix
This pressure slows venous and lymphatic return, allowing fluid to accumulate in the scalp’s soft tissue
The swelling is present at birth and crosses suture lines (because it’s superficial, above the periosteum)
It’s soft, sometimes bruised, but resolves within a few days
It does not increase the risk of jaundice because it’s just fluid, not pooled blood
Subgleal Hemorrhage
Rare but potentially life-threatening condition where blood collects in the subaponeurotic space (area between the scalp and the skull bone).
How does a subgleal hemorrhage form?
Shearing of emissary veins during vacuum-assisted or traumatic deliveries causes bleeding into the subgaleal space
Area is large and not limited by suture lines, so blood can spread over the entire scalp, even down to the neck
Bleeding may not be obvious right away, but swelling increases over hours, becoming fluctuant and boggy
Can lead to hypovolemic shock.
Baby can lose up to 40% of total blood volume into this space
S/S of Subgleal Hemorrhage
tachycardia
pallor
hypotonia
progressive head circumference increase
jaundice from RBC breakdown
Name the finding
Eyelid edema
-normal
-may not open eyes completely, especially in the presence of bright light
Potential cause of eyelid edema
Use of erythromycin topical ointment
(Very rare, but she mentioned it in class)
Local irritation of the conjunctiva
Name the finding
-low set ears
-below eye line
-baby also looks hypotonic - poor tone in facial features
Name the finding
Skin tag
-normal, often benign
-ears form at same time as kidneys, so if you see a lots of skin tags on ears, look at kidneys due to timing of gestation
Name the finding
Tight Frenulum
-heart shape appearance
-impacts ability to feed
Name the finding
Epstein Pearl
-normal, benign
-spontaneously resolve
Name the finding
Yeast infection/Oral Thrush
-doesn’t wipe away
-if breastfeeding - also chance that breastfeeding individual has infection
What are the normal features of a newborn umbilical cord?
Contains 2 arteries (smaller, more erect) and 1 vein (larger, flatter)
Dark color is normal due to blood coagulation
Can be meconium stained (entirely dark) without being pathologic
Cord clamp is applied to prevent bleeding
Umbilical Cord Care Considerations
Watch for signs of infection, bleeding
Teach parents to keep it outside of the diaper so it doesn’t become contaminated
Name the finding
Umbilical hernia
Observe for 1 year, will likely resolve
Beyond one year, intervention
How many voids should a newborn have per day in the first 5 days?
Day 1 = 1 void
Day 2 = 2 voids
Day 3 = 3 voids
Day 4 = 4 voids
Day 5 = 5–6 wet diapers per day
What are peach-colored crystals in a newborn’s diaper?
Uric acid crystals – normal finding in first few days
When should a newborn pass their first stool?
Within the first 24 hours (up to 48 max)
What does meconium look like?
Thick, tarry, dark brown/black
What should stool look like after meconium in a breastfed baby?
Pasty, mustard yellow
What should stool look like after meconium in a formula-fed baby?
Clay, grey/yellow, green or brown
By when should all meconium be passed?
By day 5 of life
What is meconium?
First stool composed of:
- Amniotic fluid
- Intestinal secretions
- Shed mucosal cells
- Possibly ingested maternal blood
When should meconium be passed in healthy vs LBW infants?
Healthy: 12 - 24 hours, up to 48
LBW: Delayed (?)
A dyad is attending their first well baby visit with their primary HCP.
The infant is 6 days old. When the diaper is removed, meconium is noted.
Is this normal or abnormal?
Abnormal
After day 5
Should be passing transitional stool at this point
What does transitional stool look like?
Greenish brown to yellowish brown
When does transitional stool appear?
Usually appears by the THIRD day AFTER initiation of feeding
How does transitional stool compare to meconium?
Thinner and less sticky compared to meconium
What does milk stool look like in breastfed infants?
Yellow to golden
Pasty consistency
Odour similar to sour milk
Thinner than transitional stool
When is milk stool usually observed?
Usually appears by the fourth day
What does milk stool look like in formula-fed infants?
Pale yellow to light brown
FIRMER consistency
Odour like normal stool
A nurse notes the following characteristics in a diaper of a male born 18 hours ago
Is this normal or abnormal?
Normal
Uric acid crystals
Not concerning in the first few days of life
This WOULD be concerning after the first week – sign of dehydration
Diaper of a female born 18 hours ago
Normal or abnormal?
Normal
Pseudo menses
Withdrawing from maternal hormones
What is pseudomenses in a newborn?
A small amount of vaginal bleeding in newborn females
What causes pseudomenses in newborns?
Withdrawal of maternal estrogen after birth
Name the finding
Facial Nerve Palsy
Unilateral facial weakness due to trauma of the 7th cranial nerve, often from pressure during birth or forceps use.
Often resolves spontaneously within days to weeks if due to birth trauma.
Name the finding
Sacral Dimple
Concern for neural tube defects
How open is it?
If it’s deep, large, located above the gluteal cleft, has discharge, or is associated with a skin tag or tuft of hair it may indicate spinal abnormality.
What are common risk factors for developmental hip dysplasia?
Family history, female sex, breech presentation
What is the Ortolani test?
A maneuver used to detect hip dislocation: hips are flexed to 90° then abducted. A ‘click’ may indicate a dislocated hip being reduced into the socket.
What is the Galeazzi (Allis) sign?
Knees are flexed with feet flat on the table. Unequal knee height suggests femoral shortening—possible hip dysplasia.
What are visual signs of hip dysplasia in infants?
Asymmetric thigh or gluteal folds, shortened leg on affected side, limited abduction.
What is the rooting reflex?
Infant turns head toward stimulus and opens mouth when cheek is stroked.
What is the sucking reflex?
Infant opens mouth and begins to suck when object touches lips or mouth.
What is the Moro reflex?
Startle reflex: symmetrical abduction and extension of arms, then return to flexion.
What is the grasp reflex?
Infant’s fingers curl around examiner’s finger (palmer), toes curl down (plantar).
What is the tonic neck reflex?
“Jousting Reflex”
When infant’s head is turned to one side, the arm and leg on that side extend; the opposite side flexes.
What is the Babinski reflex in infants?
Stroke sole of foot → toes fan out and big toe dorsiflexes (normal in infants).
Why is vitamin K given at birth?
To prevent hemorrhagic disease of the newborn due to low vitamin K levels at birth.
Where is the vitamin K injection given?
In the vastus lateralis (thigh muscle), intramuscularly.
When should vitamin K be given after birth?
Within the first few hours, up to 6 hours after birth.
What is the vitamin K dose for newborns ≥1500g?
1 mg IM injection.
What is the vitamin K dose for newborns <1500g?
0.5 mg IM injection.
Why don’t newborns have enough vitamin K?
GI flora that synthesizes vitamin K is not present at birth.
What gauge and length is used for IM injections in newborns?
25 gauge, 5/8 inch (16 mm) to 7/8 inch (22 mm)
Preferred IM injection site in newborns?
Vastus lateralis
Maximum volume per IM injection in newborns?
0.5 mL
What angle is used for newborn IM injections?
90 degrees
What should be considered with IM injections in newborns?
Pain management strategies (e.g., skin-to-skin, sucrose)
When should the first newborn bath occur?
Delay until at least 24 hours after birth (WHO); if not possible, wait at least 6 hours
Why delay the first newborn bath?
Allows time for physiological stabilization and transition to extrauterine life
Preferred method of bathing newborns?
Immersion bath (reduces heat loss better than sponge bath)
Daily hygiene for newborns without full bath?
Wipe hands, face, and buttocks with warm water
Bathing precautions if cord still intact?
Ensure the cord is dried well after bath to prevent infection
Should drying agents be used on newborn skin?
No—avoid products that dry out the skin
