Assessment of the newborn

ASSESSMENT OF THE NEWBORN

Dr.Ekawati Lutfia Haksari, MPH, Sp.A(K)Dr. Setya Wandita, M.Kes.,Sp.A(K)

Dr.Tunjung Wibowo,M.Kes., MPH., Sp.A

Skills Laboratory, Faculty of Medicine

Universitas Gadjah Mada1

General Examination of The Newborn

• Should be done on a radiant warmer with sufficient lighting unless there are signs of overheated.

• Keep communicate with the mother while examining the baby



Before the baby is undressed :

• Examine :a. Colorb. Respiratory ratec. Postured. Movemente. Reaction to stimulif. Obvious abnormality

• Weigh the baby and record the weight (if he/she has not been weighed yet).

General Examination of The Newborn



Skin Color

• At term appear paler than preterm.• Look for :

a. Jaundice (yellowish skin)

Jaundice (Depkes & IDAI, 2007) “Kramer” grade of jaundice(Depkes &

IDAI, 2007) Skills Laboratory, Faculty of

MedicineUniversitas Gadjah Mada

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b. Cyanosis

Acrocyanosis dan Central Cyanosis (Perinasia,2006)

c. Pallord. Plethorhea, very red skin.

Skin Color



Pale Plethorea

Icteric Cyanotic

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Respiratory rate

• Normal : - 40 – 60 breaths per minute, no chest

indrawing, no grunting on expiration.

- small baby might have mild chest indrawing.- periodically stop breathing for a few second.- count respiratory rate during a full minute.

Mild chest indrawing (MMBBL,Depkes,IDAI,MNH-JPEIGO 2004) Skills Laboratory, Faculty of


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• Important signs : a. Respiratory rate consistently more than 60

or less than 30.b. Grunting on expiration c. Chest indrawingd. Apnea

– No Breathing within 20 seconds or more, OR– Less than 20 seconds, With

– Cyanosis OR– bradycardia

Respiratory rate



Respiratory rateParameter 0 1 2Respiratory rate/minute

<60 60-80 >80

Cyanosis none Cyanosis dissolves with O2 supplementation

Cyanosis is persistent even though oxygen is applied

Retraction none Mild retraction Severe retraction

Breathing sound Good breathing sound in both lungs

Decrease breathing sound in both lungs

No breathing sound in both lungs

Grunting none Can be heard with stethoscope

Can be heard without stethoscope.

Downe’s Score of Clinical Respiratory Distress

Score ≤ 3 = Mild

4-5 = Moderate

≥ 6 = severe



Posture and Movement

Posture of normal neonate

Posture of small neonate (MMBBL,Depkes,IDAI,MNH-JPEIGO 2004)

Posture of neonate with breech presentation

(MMBBL,Depkes,IDAI,MNH-JPEIGO 2004)



• Look for1. Opisthotonus 2. Irregular, jerky movements of the body, limbs, or

face (convulsion or spasm).3. Jitteriness

Posture and Movement

Opisthotonus (MMBBL,Depkes,IDAI,MNH-JPEIGO 2004)



Reaction to stimulation (muscle tone and level of alertness)

The normal newborn baby ranges from quiet and alert and is consolable when upset. The baby is arousable when quiet or asleep.

Important sign !• Lethargy• Floppiness• Irritability• Drowsiness (sluggish)• Reduced activity• Unconciousness



A. SKINConsidered normal as long as the baby’s general condition is normal.- Milia- Erythema toxicum- Exfoliation of the skin in the body, back and

abdomen after the first day.

Obvious abnormality



Abnormality :- Redness or swelling of the skin or soft

tissues- Pustule or blister- Cut or abrasion- Bruise- Thrush- Birth mark or skin tag- Loss of elasticity

Obvious abnormality



B. UMBILICUSNormal white-bluish on day 1. It then begins to dry and shrink and falls off after 7 to 10 days.

Abnormal red, swollen, draining pus or foul smelling. The skin surrounding the umbilicus is red and hardened. There might be bleeding from umbilicus.

Omphalitis (Depkes & IDAI, 2007)

Obvious abnormality



C. HEAD AND FACE Baby’s head may be moulded from a vertex

birth, this will resolve spontaneously over a period of three to four weeks.

Moulage (MMBBL, Depkes RI, IDAI, MNH-JPEIGO 2004)

Obvious abnormality



Cephalhematoma

Caput Succedaneum

Subgaleal hemorrhage with skull fracture

Extracranial injury

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Hidocefalus Anencafali

Myelomeningochele Bibir sumbing

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Paralisis N. Facialis Strabismus

Microcephal

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Look for :- Hidrocephalus- Bulging of the anterior fontanelle- Sunken fontanelle- Swelling on scalp thet is not restricted to the

area over the fontanelles.- Face paralysis- Unable to breastfeed without dribbling milk. Face Paralysis (MMBBL, Depkes RI, IDAI, MNH-JPEIGO 2004)

Obvious abnormality



D. EYENotice !- Pus draining from eye- Red or swollen eyelids- Subconjuctival bleeding

Suppurative eyes (Depkes & IDAI 2007)

Obvious abnormality

• Skills Laboratory, Faculty of MedicineUniversitas Gadjah Mada



E. Mouth and NoseMouth examination must carefully inspect for ;

- Cleft lip- Cleft palate- Thrush- Central cyanosis- Profuse nasal discharge- Dry tongue and mucous membrane

Obvious abnormality

Skills Laboratory, Faculty of MedicineUniversitas Gadjah Mada

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Obvious abnormality

F. ABDOMEN AND BACK Look for :

- Abdominal distension- Gastroschisis- Spina bifida

Abdominal Distension (MMBL, Depkes RI, MNH-JPEIGO 2004)


Universitas Gadjah Mada 29

Obvious abnormalityG. LIMBS

Abnormalities :- Abnormal position and movement of limbs- Baby’s arms or legs move asymmetrically- Baby cries when his/her leg, arm or shoulder is

touched or moved.- Club foot- Extra finger (s) or toe (s)

Erb palsy (MMBL, Depkes RI, MNH-JPEIGO 2004)


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Heart Rate

» determined using a stethoscope• Normal heart rate : 100 -160 beats per minute• It is not uncommon for the heart rate to be

more than 160 beats per minute for short period of time during the first few days of life, especially if the baby is distressed.

NOTICE! Heart rate consistently more than 160 or less

than 100 beats for minute.


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Body temperature

• Normal axilla temperature in neonate ranges from 36.5° C to 37.5° C.

Birth Weight• Normal birth weight : 2500 – 4000 g• Low birth weight : <2500 g• Very low birth weight : <1500 g• Extremely low birth : <1000 g• Large birth weight : >4000 g


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Lubschenco Growth Chart

Large for gestational age

Appropriate for gestational age

Small for gestational age


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Urine and Stool• Normal condition :

- have 6-8 watery stools per day.- Vaginal bleeding in female newborn during the first week of life.

Notice!• Passes urine less than six times per day after

day 2• Diarrhoea• Has not passed meconium within 24 hours of

birth.Skills Laboratory, Faculty of


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Breast Feeding• Baby has fed well at birth but is now feeding

poorly or has stopped feeding.• Baby has not fed well since birth• Baby is not gaining weight (proven or suspected)• Mother has not been able to breastfeed

successfully• Baby is having difficulty feeding and is small or a

twin.• Baby is vomiting forcefully, regardless of the

method of feeding after every feeding, or is vomiting bile or blood.


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APGAR SCORE

• To examine a neonate’s condition• Not for determining resuscitation of neonates• Show prognosis of neonate


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APGAR SCORE0 1 2

Heart rate per minute

absent <100 >100

Respiratory effort

absent Slow, irregular Good, crying

Muscle tone limp Some flexion Active motion

Response to stimulation

No response grimace Good response

Color Blue or pale Pink body, blue extremities

Completely pink


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Primitive ReflexHow to examine…..1. Moro reflex2. Palmar and plantar grasping reflex3. Tonic neck reflex4. Rooting and sucking reflex5. Swallowing reflex6. Babinski reflex7. Automatic reflex


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Estimating Gestational Age

DUBOWITZ SCORE

A. Neurologic signsB. External signs


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Estimated gestational age :(0.2642 x (total score)) + 24.595

Regression graph of Dubowitz score

Estimating Gestational Age


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Examples

Skin


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Ear

(Depkes & IDAI, 2007) (Depkes & IDAI 2007)


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Breast

(Depkes & IDAI, 2007) (Depkes & IDAI,2007)


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Female Genital

(Depkes & IDAI,2007)

(Depkes & IDAI,2007)


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Male Genital

(Depkes & IDAI, 2007) (Depkes &IDAI,2007)


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Plantar Dermatoglify

(Depkes & IDAI, 2007)


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QUESTION ?

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Thank You

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Assessment of the newborn

Health & Medicine

Transcript of Assessment of the newborn