Highlights of the Neonatal Assessment...Newborn Assessment •Newborn historical data •Gestational...
Transcript of Highlights of the Neonatal Assessment...Newborn Assessment •Newborn historical data •Gestational...
Highlights of the
Neonatal
Assessment
Newborn Assessment
• Newborn historical data
• Gestational Age assessment
• Head to toe PE
“Ballard”
Neonatal Gestational
Maturity Assessment
Heel-to-ear maneuver. The position for assessing the heel-to-ear maneuver is demonstrated.
The degree of extension seen is consistent with a 28- to 30-week infant.
General posture. The typical, marked flexor posture of the term infant.
Square window test. The position for assessing the square window is shown. The 45-degree angle
seen between the palm and forearm is consistent with a gestational age of 30 to 32 weeks.
Scarf sign. The elbow cannot be drawn, with gentle traction on the upper extremity, across this
term infant’s chest. This is in contrast to the marked flexibility of a preterm infant.
Female at 28 weeks’ gestation:
prominent clitoris, small labia majora
Female at 32 weeks’ gestation:
increased fat deposit in labia majora
Female at 36 weeks to term gestation:
labia majora nearly covering
labia minora
Male at 28 weeks’ gestation:
tests high in scrotum
Male at 32 weeks’ gestation:
tests descending some scrotal rugae
Male at 36 weeks to term gestation:
testes well descended, increased
scrotal pigmentation
28 weeks’ gestation:
smooth sole
32 weeks’ gestation:
creases in anterior one third
36 weeks to term gestation:
creases over the majority of sole
28 weeks’ gestation:
no breast tissue, areola barely visible
32 weeks’ gestation:
visible areola, little breast tissue
36 weeks to term gestation:
well-defined areola, breast nodules
28 weeks’ gestation:
little cartilage, pliable
32 weeks’ gestation: increased cartilage,
in-curvi outer pinna
36 weeks to term gestation:
firm ear , well-formed margin
Lanugo. This fine body hair resembling “peach fuzz” is present on infants of 24 to 32 weeks’
gestation.
Premature skin. This premature infant demonstrates
translucent paper-thin skin with a prominent venous pattern
Postterm skin. Peeling and cracking of the skin are characteristics
of the infant delivered after 42 week’s gestation
Babies come in different sizes!!!
SGA LGA
AGA
Neonatal Physical Exam
Mottling
Skin abnormalities : color
AcrocyanosisBruising
Sebaceous HyperlasiaErythema toxicum
Neonatal pustular melanosis
Skin abnormalities : Rashes
Neonatal pustular melanosis
Macular hemangioma (stork bites)
Mongolian spotMongolian spot
Skin abnormalities : Nevi
Caput succedaneumMolding
Cephalohematoma
Head : Shape
Head : Eyes :Red Reflex
Epstein’s pearls
Natal teeth
Cleft lip and palate
Head: Mouth
Cleft lip and palate
Ebstein’s pearls
Genitalia (male)
• The penis: length > 2 cm, marked phymosis
• The meatus: hypospadias, epispadias
• Scrotum:
– Palpate the testes,
– Hydrocele (disappears in on year)
– Blue color (testicular torsion )
Hypospadias
Hydrocele
Ambiguous genitalia
Polydactyly
Syndactyly
Tied accessory digits
Extremities
Club footMetatarsus varus
Simian Crease
Extremities
Hair in the sacral
area
Dimple
Trunk and spine
Hips
Rooting Moro reflex
ATNRGrasp reflex
Nervous system :Tone and Neonatal reflexes
Plantar Grasp Reflex