What is included in the performance of a physical assessment of a newborn?
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Neurologic Examination: A neurological exam should include a more thorough assessment of tone & level of alertness than the initial inspection. Tone can be assessed by holding up the newborn under the bilateral axilla. Additional portions of the exam include the evaluation of appropriate cranial nerves and reflexes such as sucking reflex, grasp reflex, rooting reflex, Moro reflex, and Babinski reflex. Hypotonia or abnormal primitive reflex should warrant further investigation and possible neurological consult.[22]
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After birth, newborn babies are carefully checked for problems or complications. Throughout the hospital stay, physicians, nurses, and other care providers continually assess each infant for changes in health and signs of illness. One of the first assessments is a baby’s Apgar score. At one minute and five minutes after birth, infants are checked for heart and respiratory rates, muscle tone, reflexes, and color. This helps identify babies that have difficulty breathing or have other problems that need further care. Complete Physical ExamBecause birth weight is an important indicator of health, babies are weighed daily in the nursery. This indicates their growth, as well as their fluid and nutritional needs. Newborn babies may lose as much as 10 percent of their birth weight. In addition, each newborn undergoes a complete physical examination. Care providers evaluate vital signs, including temperature, pulse, and breathing rate. They also check the infant’s general appearance from head to toe, looking at everything from soft spots on the skull to breathing patterns to skin rashes to limb movement. Your baby’s head circumference, abdominal circumference, and length will also be measured. Your Baby’s MaturityMaturity assessment is helpful in meeting a baby’s needs if the dates of a pregnancy are uncertain. For example, very small babies may actually be more mature than they appear by size and may need different care than premature babies. An examination called the Dubowitz/Ballard Examination for Gestational Age is often used. This check evaluates a baby’s appearance, skin texture, motor function, and reflexes. The physical maturity component of the exam is conducted within the first two hours of birth. This looks at your baby’s skin, eyes, ears, chest, genitals, and feet, since these areas of the body look different at different stages of maturity. Next, within 24 hours after delivery, the Dubowitz/Ballard Examination looks at six aspects of the baby’s neuromuscular system. These include:
Additional TestsAfter birth, all newborns receive eye drops or an antibiotic ointment in their eyes. This is required by law to protect the baby from an unknown gonorrhea infection in the mother. Most babies also receive a vitamin K injection in the upper thigh. Vitamin K is an essential component of blood clotting. The injection helps prevent a serious problem called vitamin K deficiency bleeding. Finally, nearly all babies will have a simple blood test to check for disorders that are not apparent immediately after delivery. Some of these disorders are genetic, metabolic, or blood- or hormone-related. Your newborn may also undergo a hearing test. All of these examinations are important ways to learn about your baby’s well-being at birth. By identifying any problems, your baby’s physician can plan the best possible care. © 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. Each newborn baby is carefully checked at birth for signs of problems or complications. The healthcare provider will do a complete physical exam that includes every body system. Throughout the hospital stay, doctors, nurses, and other healthcare providers continually look at the health of the baby. They are watching for signs of problems or illness. Assessments may include the below. Apgar scoringThe Apgar score helps find breathing problems and other health issues. It is part of the special attention given to a baby in the first few minutes after birth. The baby is checked at 1 minute and 5 minutes after birth for heart and respiratory rates, muscle tone, reflexes, and color. A Each area can have a score of 0, 1, or 2, with 10 points as the maximum total. Most babies score 8 or 9, with 1 or 2 points taken off for blue hands and feet because of immature circulation. If a baby has a difficult time during delivery and needs extra help after birth, this will be shown in a lower Apgar score. Apgar scores of 6 or less usually mean a baby needed immediate attention and care. Sign Score = 0 Score = 1 Score = 2 Heart rate Absent Below 100 per minute Above 100 per minute Breathing effort Absent Weak, irregular, or gasping Good, crying Muscle tone Flaccid Some flexing of arms and legs Well-flexed, or active movements of arms and legs Reflex or irritability No response Grimace or weak cry Good cry Color Blue all over, or pale Body pink, hands and feet blue Pink all over Birth weightA baby's birth weight is an important marker of health. Full-term babies are born between 37 and 41 weeks of pregnancy. The average weight for full-term babies is about 7 pounds (3.2 kg). In general, very small babies and very large babies are at greater risk for problems. Babies are weighed every day in the nursery to look at growth, and the baby’s need for fluids and nutrition. Newborn babies may often lose 5% to 7% of their birth weight. This means that a baby weighing 7 pounds, 3 ounces at birth might lose as much as 8 ounces in the first few days. Babies will usually gain this weight back within the first 2 weeks after birth. Premature and sick babies may not begin to gain weight right away. Most hospitals use the metric system for weighing babies. This chart will help you convert grams to pounds. Converting grams to pounds and ounces:1 lb. = 453.59237 grams; 1 oz. = 28.349523 grams; 1,000 grams = 1 Kg. Pounds Ounces 2 3 4 5 6 7 8 9 0 907 1361 1814 2268 2722 3175 3629 4082 1 936 1389 1843 2296 2750 3203 3657 4111 2 964 1417 1871 2325 2778 3232 3685 4139 3 992 1446 1899 2353 2807 3260 3714 4167 4 1021 1474 1928 2381 2835 3289 3742 4196 5 1049 1503 1956 2410 2863 3317 3770 4224 6 1077 1531 1984 2438 2892 3345 3799 4252 7 1106 1559 2013 2466 2920 3374 3827 4281 8 1134 1588 2041 2495 2948 3402 3856 4309 9 1162 1616 2070 2523 2977 3430 3884 4337 10 1191 1644 2098 2551 3005 3459 3912 4366 11 1219 1673 2126 2580 3033 3487 3941 4394 12 1247 1701 2155 2608 3062 3515 3969 4423 13 1276 1729 2183 2637 3090 3544 3997 4451 14 1304 1758 2211 2665 3118 3572 4026 4479 15 1332 1786 2240 2693 3147 3600 4054 4508 MeasurementsThe hospital staff takes other measurements of each baby. These include:
The staff also checks these vital signs:
Physical examA complete physical exam is an important part of newborn care. The healthcare provider carefully checks each body system for health and normal function. The provider also looks for any signs of illness or birth defects. Physical exam of a newborn often includes:
Gestational assessmentThe healthcare provider will check how mature the baby is. This is an important part of care. This check helps figure out the best care for the baby if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than they appear by size and may need different care than a premature baby needs. Healthcare providers often use an exam called the Dubowitz/Ballard Examination for Gestational Age. This exam can closely estimate a baby's gestational age. The exam looks at a baby's skin and other physical features, plus the baby’s movement and reflexes. The physical maturity part of the exam is done in the first 2 hours of birth. The movement and reflexes part of the exam is done within 24 hours after birth. The provider often uses the information from this exam to help with other maturity estimates. Physical maturityThe physical maturity part of the Dubowitz/Ballard exam looks at physical features that look different at different stages of a baby's gestational age. Babies who are physically mature usually have higher scores than premature babies. Points are given for each area of assessment. A low of 1 or 2 means that the baby is very immature. A score of 4 or 5 means that the baby is very mature (postmature). These are the areas looked at:
Maturity of nerves and musclesThe healthcare provider does 6 checks of the baby's nerves and muscles. A score is given for each area. Typically, the more mature the baby is, the higher the score. These are the areas checked:
When the physical assessment score and the nerves and muscles score are added together, the healthcare provider can estimate the baby’s gestational age. Scores range from very low for immature babies to very high scores for mature and postmature babies. All of these exams are important ways to learn about your baby's well-being at birth. By finding any problems, your baby's healthcare provider can plan the best possible care. What are the components in an assessment of a newborn?The baby is checked at one minute and five minutes after birth for heart and respiratory rates, muscle tone, reflexes, and color. Each area can have a score of zero, one, or two, with 10 points as the maximum. A total score of 10 means a baby is in the best possible condition.
What are the physical examination of a newborn baby?During the examination, the healthcare professional will also: look into your baby's eyes with a special torch to check how their eyes look and move. listen to your baby's heart to check their heart sounds. examine their hips to check the joints.
What are the steps to performing a newborn assessment?Physical exam of a newborn often includes assessment of the following:. Vital signs: Temperature. ... . General appearance. Physical activity, muscle tone, posture, and level of consciousness or whether or not an infant is awake and alert.. Skin. ... . Head and neck: ... . Face. ... . Mouth. ... . Lungs. ... . Heart sounds and femoral (in the groin) pulses.. When performing a newborn assessment the nurse should measure?A full newborn nursing assessment should include measurements such as weight, length, head circumference, and vital signs. The assessment should start by generalizing the infant's appearance, including position, movement, color, and breathing (Overview, 2020).
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