Assessment of A Newborn

ASSESSMENT OF A NEONATE
AND AN INFANT
Andre Carlo C. de Veyra
Vital Statistics
A. Birth weightFilipinos- 2,700 g- 4,000 g

Male: 3.5 kg (7.7 kg)
Female: 3.4 kg (7.5 kg)
* Looses 5-10 % (6-10 oz) of the birth weight first few days after birth
(approx. 3-5 days)
Regains weight during the 10th-14th day after birth.
* 75 % - 90% of the newborns weight is fluid.
* Weight gain- 2lb/month during the first 6 mos. of life.
* Weight double during the 6th month of life and it triples during the 12th
month.
* Estimate weight:
Below 6 mos.- wt in gm= age in mos. X 600 + BW
6-12 mos.= age in mos. X 500 + BW
B. Height- 48 cm- 53 cm
* Average weight gain per quarter:

Birth- 3 mos. = 9 cm
3-6 mos.= 8 cm
6-9 mos.= 5 cm
9-12 mos.= 3 cm
C. Head circumference- 33-35 cm
* Measure across the center of the forehead and around the

most prominent portion of the posterior head (occiput).
D. Chest circumference- 2 cm less than the HC31-33 cm
* Measure at the level of the nipple; intramammary line
Vital Signs
A. Temperature- at birth 37.2 C

* 36.8 C- 37.2 C- most ideal temp
* 36.5 C- 37.4 C- normal range
B. Pulse- 120-160 bpm
* transient heart murmurs may be heard because of
incomplete closure of the fetal circulation shunts.
* Crying- 180 bpm
* At rest/sleeping- 90-110 bpm
C. Respiratory Rate- 30-60 cpm

D. BP- average: 74/47 mmHg
* range- 60-80/40-50 mmHg
* 10th day BP rises to 100/50 mmHg

* BP cuff must not be more than 2/3 length of the upper
arm or thigh.
Physiologic Function
A. Cardiovascular System
* during the first 24 hours circulation is sluggish
Blood values:
* Blood volume: 80-110 ml/kg body wt. or about 300 ml
* Erythrocyte: ^ million/ cubic mm
* Hemoglobin: 17-18 g/100 ml
* WBC: 15,000-30,000 cell/ cubic mm
B. Respiratory System
C. Gastrointestinal System- holds 60-90 ml of food

* passes out meconium during the first 24 hours of life.
* No meconium for the first 24-48 hrs indicative of
meconium ileus, imperforate anus, bowel obstruction.
* Observe the color of the meconium
bright green- infant who has been on phototherapy
clay colored- bile duct obstruction
blood flecked- anal fissure
* Meconium: tarlike blackish-greenish and odorless
* will change in color and consistency (green and loose)
during the 2nd-3rd day of life
* for breastfed babies during the 4th day they will pass 3-4
yellow, sweet smelling stools per day.
D. Urinary System
*passes out pink or dusky colored urine during the 1st 24
hrs. of life.
* no urine for the 1st 24 hrs. indicative of urethral
stenosis or absent kidney or ureter.
* Normal- Male: small projected arc
Female: steady stream
* Single voiding: 15 ml
* 1st-2nd day total: 30-60 ml
* specific gravity: 1.008-1.010
* with traces of protein
E. Immune System- difficulty forming antibodies up to 2

mos. of age.
F. Neuromascular system
* Normal: twitching or flailing movements of

extremities even without stimulus
* No muscle movement- narcosis, shock, or cerebral
injury
REFLEXES
1. Blink reflex
2. Rooting reflex- when a finger is brushed or stroked
near the corner of the mouth, the child will turn the
head in that direction.
- disappears during the 6th week
3. Sucking reflex- diminishes at 6 months of age
4. Swallowing, gag, and sneezing reflex
5. Extrusion reflex- extrudes any substance that is placed
on the anterior portion of the tongue; prevents
swallowing of inedible substances.
- disappears at 4 months of age.
6. Palmar grasp reflex- disappears 6th week- 3 months of age

- begins to grasp meaningfully at about 3
months of age.
7. Step (walk)-in-reflex- if baby is held in a vertical position with
feet touching a hard surface baby will take few quick alternating
steps.
- diminishes at 3 mos. of age.
8. Placing reflex- same with step-in-reflex only that it is elicited by
touching the anterior surface of a newborns leg against the edge
of a bassinet or table.
9. Plantar grasp reflex- to toes of the newborn grasps grasp as in
the same manner as the fingers do.
-diminishes at 8-9 months
10. Tonic-neck reflex- when the baby lies on his/her back head is
turned on one side, the arm and leg on the side to which the
head is turned the arms and leg extend while the opposite on
contracts.
- also known as boxing or fencing reflex
- disappears at 2-3 mos
11. Moro (startle) reflex- when startled with a loud sound or when
held supine and head is allowed to drop for an inch or so, the
baby will abduct and extend his arms and legs.
- fingers assume a typical C position then
arms into an embrace position and pull up
their legs against the abdomen (adduction)
- very strong during the 1st 8 weeks.
- fades at the end of the 4th or 5th month.
12. Babinski reflex: fans toes
Normal: Positive (+) Babinski up to 3 months
13. Magnet reflex- pressure applied on the sole of the foot the baby
pushes against the pressure.
- used to check the spinal cord integrity.
14. Crossed extension reflex- one leg is extended and irritated the
other leg will raise and extend.
15. Trunk incurvation reflex
16. Landau reflex

17. Deep tendon reflex
Senses
A. Hearing
B. Vision- cannot follow past midline of vision, able to
focus on black and white at a distance of 9-12 inches.
C. Touch
D. Taste
E. Smell- 5th day can recognize the smell of the mother.
APPEARANCE
Skin
A. Color- ruddy complexion

Hyperbilirubinemia- jaundice
Normal during the 2nd-3rd day of life because of the
breakdown of fetal RBC.
Cephalhematoma-a collection of blood under the
periosteum of the skull bone.
Pallor
Pale color- may be indicative of CNS damage
Gray color- infection
BIRTHMARKS
1. Hemangiomas- vascular tumors of the skin
1a. Nevus flammeus- macular purple or dark red lesion (port-wine stain)
- commonly found on the face and the thighs
- does not blanch on pressure and does not fade.
1b. Strawberry hemangioma- elevated areas formed by immature capillaries and
endothelial cells.
- not present in preterm babies.
- caused by increased estrogen level.
- will shrink in size after a year.
1c. Cavernous hemangioma- dilated vascular space, usually raised similar to
strawberry hemangioma.
- dilated capillaries in entire dermal and subdermal
layers.
- can be removed through surgery.
Mongolian spots
Vernix caseosa- white, cream cheese-like substance
Observe the color: yellow (bilirubin) green (meconium)
Lanugo- fine, downy hair that covers the newborns shoulders, back, and
upper arms sometimes the forehead and the ears.
37th-39th week of gestation more lanugo is present
40th week less is present
42nd (post mature)- rarely present.
- disappears at 2 wks of age
Desquamation- extremely dry skin may be present during the 1st 24 hrs. of
life.
Dry skin with leathery texture is found among post term infants
and those who suffered from interutero malnutrition.
Milia- pinpoint white papule, disappears by the 2nd-4th week of age.
Erythema toxicum
Craniotabes- localized softening of the cranial bone.

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ASSESSMENT OF A NEONATE

A. Birth weightFilipinos- 2,700 g- 4,000 g

* Average weight gain per quarter:

* Measure across the center of the forehead and around the

* Measure at the level of the nipple; intramammary line

A. Temperature- at birth 37.2 C

C. Respiratory Rate- 30-60 cpm

* 10th day BP rises to 100/50 mmHg

C. Gastrointestinal System- holds 60-90 ml of food

E. Immune System- difficulty forming antibodies up to 2

* Normal: twitching or flailing movements of

6. Palmar grasp reflex- disappears 6th week- 3 months of age

16. Landau reflex

A. Color- ruddy complexion

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