INTRODUCTION
 http://www.youtube.com/watch?v=1kBo1Xc_MeY&feat
ure=related
Developed by D. Ann Currie, RN, MSN
2012
Neonatal Assessment
Gestational Age Assessment:
Physical Characteristics
 Resting posture
 Preterm - extended
 Term - flexed
 Skin
 Preterm - thin and transparent with veins prominent
 Term - opaque and disappearance of the vernix caseosa
Newborn Assessments
Newborn Measurements
Cephalhematoma and Caput
Succedaneum
Newborn Vital Signs
Common Reflexes
of the Newborn
Potential Birth Injuries
Gestational Age Assessment:
Physical Characteristics
 Lanugo
 Decreases as gestational age increases
 Sole (plantar) creases
 As gestation progresses, proceeds to the heel
 Breast bud
 Term: the tissue will measure between 0.5 and 1 cm
Gestational Age Assessment:
Physical Characteristics
 Ear form and cartilage distribution
 Preterm - relatively shapeless and flat, no recoil
 Term - some cartilage and slight incurving of the upper
pinna, good recoil
 Male genitals
 Preterm - small scrotum, few rugae, testes are palpable
in the inguinal canal
 Term - testes are generally in the lower scrotum, which is
pendulous and covered with rugae
Gestational Age Assessment:
Physical Characteristics
 Female genitals
 Preterm - clitoris is prominent, labia majora are small
and widely separated
 Term - labia majora cover the labia minora and clitoris
Assessment of
Neuromuscular Characteristics
 Square window
 Recoil
 Popliteal angle
 Scarf sign
 Heel to ear
 Ankle dorsiflexion
 Head lag
 Ventral suspension
Measurement and
Appearance
 Average weight of 3405 g at term
 Average length is 50 cm (20 in)
 Head circumference is 32-37 cm
 Chest circumference is 30-35 cm
 Skin – pink tinged
Head
 Proportionally larger than body
 Fontanelles
 Anterior
 Posterior
 Hair
 Face
Eyes
 Tearless crying
 Peripheral vision
 Can fixate on near objects
 Can perceive faces, shapes and colors
 Blink in response to bright light
 Pupillary reflex is present
Ears and Neck
 Ears
 Soft and pliable
 Ready recoil
 Pinna parallel with inner and outer canthus
 Neck
 Short with skin folds
Nose and Mouth
 Nose
 Small and narrow
 Must breathe through nose
 Mouth
 Lips pink
 Taste buds present
Chest
 Chest – cylindrical
 Breasts – engorged, whitish secretion
 Respirations
 Diaphragmatic
 30-60 per minute
 Heart rate 110-160 bpm
Abdomen
 Cylindrical and soft
 Bowel sounds present by 1 hour after birth
 Umbilical cord
 Initially white and gelatinous
 Two arteries, one vein
Genitalia and Extremities
 Genitalia
 Female – labia majora covers labia minora
 Male – testes descended, pendulous scrotum
 Extremities
 Short, flexible, and move symmetrically
 Legs are equal in length with symmetrical creases
Measurements
 Weight
 Length
 Head circumference
 Chest circumference
 Abdominal girth
 Temperature
Skin Variations
 Acrocyanosis
 Mottling
 Harlequin sign
 Jaundice
 Erythema toxicum
 Milia
Erythema toxicum.
Facial milia.
Skin Variations
 Vernix Caseosa
 Forceps marks
 Telangiectatic nevi
 Mongolian spots
 Nevus flammeus
 Nevus vasculosus
Mongolian spots
Head Variations
 Molding
 Cephalohematoma
 Caput succedaneum
Mouth Variations
 Cleft lip and palate
 Precocious teeth
 Epstein’s Pearls
 Thrush
Ear and Eye Variations
 Low set ears
 Edema of the eyelids
 Normal variations
 Subconjunctival hemorrhage
 Transient strabismus
 Doll’s Eye
Respiratory Variations
 Signs of respiratory distress
 Nasal flaring
 Intercostal or xiphoid retractions
 Expiratory grunting or sighing
 Seesaw respirations
 Tachypnea
Cardiac Variations
 Heart is large
 Low pitched murmur
 Decreased strength or absence of femoral pulses
Female Genitalia Variations
 Vaginal tag
 Pseudomenstruation
 Smegma
Male Genitalia Variations
 Hypospadias
 Phimosis
 Hydrocele
 Cryptorchidism
Variations in Extremities
 Gross deformities
 Extra digits or webbing
 Clubfoot
 Hip dislocation
The asymmetry of gluteal and thigh fat folds seen in infant with left developmental of the hip. B, Barlow (dislocation)
maneuver. Baby’s thigh is grasped and adducted (placed together) with gentle downward pressure. C, Dislocation is
palpable as femoral head slips out of acetabulum. D, Ortolani’s maneuver puts downward pressure on the hip and then
inward rotation. If the hip is dislocated, this maneuver will force the femoral head back into the acetabular rim with a
noticeable “clunk
Reflexes
 Tonic-neck
 Moro
 Grasping
 Rooting
 Sucking
 Babinski
 Trunk incurvation
Protective reflexes
 Blink
 Yawn
 Cough
 Sneeze
Brazelton’s Neonatal
Behavioral Assessment Scale
 Habituation
 Orientation to inanimate and animate visual and
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


auditory assessment stimuli
Motor activity
Variations
Self-quieting activity
Cuddliness or social behaviors
The End of Part 2