The document discusses assessments that are performed on newborn babies, including Apgar scoring, birth weight measurements, physical measurements, a physical exam assessing different body systems, and the Dubowitz/Ballard exam used to assess gestational age. Key reflexes in newborns are also outlined, such as the rooting, suck, Moro, tonic neck, grasp, Babinski, and stepping reflexes. The assessments and exams help doctors evaluate the health and development of newborns.

1. Newborn and
Infants
By: Jessica Beatriz
Avila

2. Assessments for Newborn Babies
 Each newborn baby is carefully checked at
birth for signs of problems or complications.
A complete physical assessment will be
done that includes every body system.
Throughout the hospital stay, doctors,
nurses, and other health care providers
continually assess the health of the baby,
observing for signs of problems or illness.
Assessment may include:

3. Apgar scoring
 The Apgar score is one of the first checks of
your new baby's health. The Apgar score is
assigned in the first few minutes after birth
to help identify babies that have difficulty
breathing or have a problem that needs
further care. The baby is checked at 1
minute and 5 minutes after birth for heart
and respiratory rates, muscle tone, reflexes,
and color.

4.  Each area can have a score of 0, 1, or 2,
with 10 points as the maximum. A total
score of 10 means a baby is in the best
possible condition. Nearly all babies score
between 8 and 10, 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, this can lower the
oxygen levels in the blood, which can lower
the Apgar score. Apgar scores of 3 or less
often mean a baby needs immediate
attention and care.

6. Birth weight
 A baby's birth weight is an important
indicator of health. The average weight for
term babies (born between 37 and 41
weeks gestation) is about 7 lbs. (3.2 kg). In
general, small babies and very large babies
are at greater risk for problems. Babies are
weighed daily in the nursery to assess
growth, fluid, and nutrition needs. 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 by 2 weeks of age. Premature and

7. Measurements
 Other measurements are also taken of each baby. These include the following:
 Head circumference. The distance around the
baby's head.
 Abdominal circumference. The distance around
the abdomen.
 Length. The measurement from crown of head to
the heel.
 Vital signs:
◦ Temperature (able to maintain stable body
temperature in normal room environment)
◦ Pulse (normally 120 to 160 beats per minute in
the newborn period)
◦ Breathing rate (normally 40 to 60 breaths per
minute in the newborn period

8. Physical exam
 A complete physical exam is an important part of newborn
care. Each body system is carefully examined for signs of
health and normal function. The doctor also looks for any
signs of illness or birth defects. Physical exam of a
newborn often includes the assessment of the following:
 General appearance. Physical activity, tone, posture, and
level of consciousness
 Skin. Color, texture, nails, presence of rashes
 Head and neck:
◦ Appearance, shape, presence of molding (shaping of
the head from passage through the birth canal
◦ Fontanels (the open "soft spots" between the bones of
the baby's skull
◦ Clavicles (bones across the upper chest

9.  Face. eyes, ears, nose, cheeks.
 Mouth. palate, tongue, throat.
 Lungs. Breath sounds, breathing
pattern.
 Heart sounds and femoral (in the
groin) pulses.
 Abdomen. Presence of masses or
hernias.
 Genitals and anus. For open passage
of urine and stool
 Arms and legs. Movement and
development.

10. Gestational assessment
 Assessing a baby's physical maturity is an important part
of care. Maturity assessment is helpful in meeting a baby's
needs if the dates of a pregnancy are uncertain. For
example, a very small baby may actually be more mature
than it appears by size, and may need different care than a
premature baby.
 An examination called The Dubowitz/Ballard Examination
for Gestational Age is often used. A baby's gestational age
often can be closely estimated using this examination. The
Dubowitz/Ballard Examination evaluates a baby's
appearance, skin texture, motor function, and reflexes.
The physical maturity part of the examination is done in
the first two hours of birth. The neuromuscular maturity
examination is completed within 24 hours after delivery.
Information often used to help estimate babies' physical
and neuromuscular maturity are shown below.

11. Physical maturity
 The physical assessment part of the
Dubowitz/Ballard Examination looks at
physical characteristics that look different at
different stages of a baby's gestational
maturity. Babies who are physically mature
usually have higher scores than premature
babies.
 Points are given for each area of
assessment, with a low of -1 or -2 for
extreme immaturity to as much as 4 or 5 for
postmaturity. Areas of assessment include
the following:

12.  Skin textures (for example, sticky, smooth, or peeling).
 Lanugo (the soft downy hair on a baby's body). Absent
in immature babies, then appears with maturity, and then
disappears again with post maturity.
 Plantar creases. These creases on the soles of the feet
range from absent to covering the entire foot, depending
on the maturity.
 Breast. The thickness and size of breast tissue and areola
(the darkened ring around each nipple) are assessed.
 Eyes and ears. Eyes fused or open and amount of
cartilage and stiffness of the ear tissue.
 Genitals, male. Presence of testes and appearance of
scrotum, from smooth to wrinkled.
 Genitals, female. Appearance and size of the clitoris and
the labia.

13. Neuromuscular maturity
 Six evaluations of the baby's neuromuscular
system are done.
 A score is assigned to each assessment area.
Typically, the more neurologically mature the
baby, the higher the score. The areas of
assessment include:
 Posture. How does the baby hold his or her
arms and legs.
 Square window. How far the baby's hands can
be flexed toward the wrist.
 Arm recoil. How much the baby's arms "spring
back" to a flexed position.
 Popliteal angle. How far the baby's knees
extend.

14.  Scarf sign. How far the elbows can be
moved across the baby's chest.
 Heel to ear. How close the baby's feet
can be moved to the ears.
 When the physical assessment score
and the neuromuscular score are added
together, the gestational age can be
estimated. Scores range from very low
for immature babies (less than 26 to 28
weeks) to very high scores for mature
and post mature babies.
 All of these exams are important ways to
learn about your baby's well-being at
birth. By identifying any problems, your
baby's doctor can plan the best possible
care.

15. Newborn-Reflexes
 Root reflex. This reflex begins when the corner of
the baby's mouth is stroked or touched. The baby
will turn his or her head and open his or her mouth
to follow and "root" in the direction of the stroking.
This helps the baby find the breast or bottle to
begin feeding.
 Suck reflex. Rooting helps the baby become ready
to suck. When the roof of the baby's mouth is
touched, the baby will begin to suck. This reflex
does not begin until about the 32nd week of
pregnancy and is not fully developed until about 36
weeks. Premature babies may have a weak or
immature sucking ability because of this. Babies
also have a hand-to-mouth reflex that goes with
rooting and sucking and may suck on fingers or
hands.

16.  Moro reflex. The Moro reflex is often called
a startle reflex because it usually occurs
when a baby is startled by a loud sound or
movement. In response to the sound, the
baby throws back his or her head, extends
out the arms and legs, cries, then pulls the
arms and legs back in. A baby's own cry
can startle him or her and trigger this reflex.
This reflex lasts about 5 to 6 months.

17.  Tonic neck reflex. When a baby's head is
turned to one side, the arm on that side
stretches out and the opposite arm bends
up at the elbow. This is often called the
"fencing" position. The tonic neck reflex
lasts about 6 to 7 months.
 Grasp reflex. Stroking the palm of a baby's
hand causes the baby to close his or her
fingers in a grasp. The grasp reflex lasts
until about 5 to 6 months of age.

18.  Babinski reflex. When the sole of the foot
is firmly stroked, the big toe bends back
toward the top of the foot and the other toes
fan out. This is a normal reflex up to about 2
years of age.
 Step reflex. This reflex is also called the
walking or dance reflex because a baby
appears to take steps or dance when held
upright with his or her feet touching a solid
surface.

19. END