Neonatal assessment

1. NEONATAL ASSESSMENT
DR. ILOH,KENECHUKWU

2. The purposes of the routine newborn
assessment
 Determine the infant's gestational age
 Document normal growth and development for a given
gestational age
 Uncover signs of birth-related trauma or congenital
anomalies, and
 Evaluate the overall health and condition of the infant.
 The assessment begins with the establishment of a historical
database. Information may be obtained from antenatal, labor,
delivery, and postpartum records and a brief interview with
the parents

3. Newborn Historical Database
 Antenatal Records - Maternal age, Maternal medical history,
Obstetric history, Estimations of gestational age, Antenatal
ultrasound or fetal surveillance results (if available),
Complications of pregnancy,Adequacy of antenatal care
 Labour and delivery records - Date and time of delivery,
Duration of labor,Time of the rupture of membranes,
Complications or abnormalities of labor, Method of delivery or
type of anesthesia, Placental weight and morphologic
condition, Birth weight, Need for resuscitation and Apgar
scores, Maternal blood type

4.  Postpartum Records - Maternal postpartum complications,
Newborn vital sign records, Nursing documentation of the
activity and condition of the infant , Abnormal physical
findings noted by the nursing staff, Feeding, voiding, and
stool history, Observations of maternal–infant interactions.
 Parental Interview -Parental perceptions of; History of
parental and family illnesses, Health status and growth and
development of siblings and other family members, Degree of
education, preparation, and planning for newborn care,
Available social support systems, Medical follow-up plans.

5. NEWBORN EXAMINATION
 Preferably examine in the presence of one or both parents to
reassure them regarding normal variations and to discuss any
abnormal findings.
 The baby should remain at least partially clothed through as
much of the examination as possible, although a complete
and thorough examination is imperative.
 The examiner's hands should be warm to minimize the chance
that the infant will become uncomfortable because of heat
loss.
 Should follow the normal sequence of IPPA

6.  Observation must be done before the quiet infant is disturbed by
the examination.
 By visual inspection the clinician can assess skin and facies; general
tonus and symmetry of movement; respiratory rate, retractions,
and color; and abdominal contour.
 Auscultation of the heart and lungs should be done before more
stressful portions of the examination, which are likely to make the
infant fussy.
 Allowing the infant to suck on a gloved finger can help quiet the
infant and permit assessment of sucking strength and palate
integrity.

7. Skin
 PE of the skin, what does and can it mean?
 Cutis Marmorata
 Harlequin ColorChange
 Ecchymosis
 Macule
 Petechiae
 Vesicle
 Pustule

8. Cutis Marmorata

9. Harlequin Color Change

10. Ecchymosis (Bruising)
Increases Risk for Jaundice

11. Petechiae

12. Petechiae

13. Vesicle

14. Assessment of gestational age
 No differential diagnosis of newborn disease can be made without
knowing whether the patient is premature or full term and
whether he or she is small, large, or appropriate for gestational
age.
 The last menstrual period
 The ultrasound scan done early in pregnancy
 The Ballard assessment for gestational age determination of
newborns uses six morphologic and six neurologic criteria to
estimate gestational age on the basis of an examination
performed at 12 to 24 hours of life.
 Dubowitz assessment for GA determination.

15. Primitive reflexes
 Normal newborns exhibit a large number of easily elicited primitive
reflexes that are often altered or absent in the infant with neurologic
impairment.
 These reflexes may be transiently depressed in the infant who has
experienced difficulty in achieving the transition between intrauterine
and extrauterine existence.
 The persistent absence or asymmetry of one or more of these reflexes
may be a clue to the potential presence of neuromuscular abnormalities
requiring further investigation.
 They are present at or shortly after birth and normally disappear after
the first few months of life. Just as their absence may indicate
neurologic impairment at birth, their abnormal persistence may also be
a cause for concern and further evaluation

16.  The rooting reflex may be elicited by lightly stimulating the infant's
cheek and observing the reflexive attempts to bring the stimulating
object to the mouth.
 The sucking reflex is activated by placing an object in the infant's mouth
and observing the sucking movements.
 In the grasp reflex, transverse stimulation of the midpalm (without
touching the back of the hand) or midsole leads to flexion of the digits
or toes around the examiner's fingers.
 The Moro reflex, evaluates vestibular maturation and the relationship
between flexor and extensor tone. Elicitation of the reflex involves a
short (10 cm), sudden drop of the head when the infant is supine.The
full response involves extension of the arms, “fanning” of the fingers,
and then upper extremity flexion followed by a cry. An incomplete but
identifiable reflex becomes apparent at approximately 32 weeks’
gestation, and by 38 weeks it is essentially complete.

17.  Galant's infantile reflex is a truncal incurvation reflex. It can be
elicited by holding the infant in ventral suspension and
stroking from shoulder to hip along one side of the spine.The
infant will contract the abdominal musculature and laterally
flex toward the stimulated side. Lack of the Galant reflex may
indicate a spinal cord lesion.

18. Anthropometry
 Weight
 Appropriate for GA
 Small for GA (IUGR)
 Large for GA.
 Length
 Head circumference
 Chest circumference
 Etc

19. Assessment for birth trauma
 Caput Succedeneum - Normal transit of the fetal head through the birth canal
induces molding of the skull and scalp edema, especially if labor is prolonged.
The edema, which can be massive, is known as a caput succedaneum. Much of
this edema is present at birth and tends to overlie the occipital bones and
portions of the parietal bones bilaterally
 Cephalhematoma - a localized collection of blood beneath the periosteum of
one of the calvarial bones; it may be bilateral, but is most often unilateral. It is
distinguished from a caput Succedeneum by the fact that its borders are limited by
suture lines, usually those surrounding the parietal bones
 Subgaleal hematoma - a collection of blood within scalp tissues extending
beneath the epicranial aponeurosis. Palpation of a large caput succedaneum
reveals firm, nonpitting swelling. In contrast, the cranial swelling of subgaleal
bleeding is boggy due to the palpation of clotted blood just beneath the
epicranial aponeurosis.

20.  Fracture of a clavicle can occur during delivery when the infant is
large, in breech position, or if there is fetal distress requiring rapid
extraction. If undisplaced, the fracture may not be painful, and the
infant may be asymptomatic.The diagnosis may be suspected by
palpation of crepitus or an asymmetrical Moro reflex.
 Superficial bruising can occur when delivery is difficult.This is
relatively common with breech presentations and can include
swelling and discoloration of the labia or scrotum. When bruises
are extensive, significant secondary jaundice may develop as the
extravasated blood is broken down and resorbed.

21. Peripheral nerve injuries 1
 Unilateral facial nerve palsy is the most common peripheral nerve injury, with an
incidence as high as 1.4 per 1000 live births.
 Injury can result from direct trauma from forceps or from compression of the
nerve against the sacral promontory while the head is in the birth canal.
 With pronounced nerve injury, there is decreased facial movement and forehead
wrinkling on the side of the palsy, eyelid elevation, and flattening of the
nasolabial folds and corner of the mouth.
 Crying accentuates the findings, with the most obvious sign being asymmetrical
movement of the mouth.
 The side that appears to droop when crying is the normal side.
 The prognosis for facial nerve palsies is excellent, and recovery usually occurs
within the first month.

22. Face

23. Peripheral Nerve Injury 2
 The incidence of brachial plexus trauma with current obstetric management is
approximately 0.7 per 1000 live births.
 Although lesions have classically been divided into those affecting upper spinal
segments (Erb's palsy) and those affecting lower segments (Klumpke's palsy), the
distinction may not be clear-cut in some cases.
 Injury to the C5 and C6 fibers is most often identified by the child's arm hanging
limply adducted and internally rotated at the shoulder and extended and
pronated at the elbow.
 Injury affecting the lower segments of C7 andT1 rarely occurs in isolation, causing
weakness of the wrist and hand, and ultimately leads to a claw-hand deformity.
 There may be sensory loss along the ulnar side of the hand and forearm in the
distribution of theT1 dermatome. If theT1 root is affected with interruption of
the sympathetic innervation at that level, Horner's syndrome may be apparent.

24. Respiratory distress
 The differential diagnosis and subsequent management of the
infant with respiratory distress are the most frequent challenges
encountered by the practitioner of newborn medicine.
 Problems posed by prematurity, the failure of the necessary
transition to extrauterine existence, infectious complications,
metabolic derangements, and various congenital and acquired
abnormalities of the cardiopulmonary system may all lead to a
similar presentation in the newborn period.
 Infants with respiratory distress may present with tachypnea or
cyanosis , or both, and varying degrees of a triad of signs, which
include grunting, flaring, and retractions (GFR)

25.  Grunting is a characteristic involuntary guttural expiratory
sound made by infants as they exhale against a closed glottis
in an attempt to maintain expiratory lung volume.
 Flaring refers to the reflexive opening of the nares during
inspiration.
 Retractions are the result of increased respiratory effort with
high negative intrathoracic pressures leading to an inward
collapse of the relatively compliant chest wall of the newborn
during inspiration.

26.  Differentials – classical respiratory distress
syndrome, transient taccypnea of the newborn
(RFLFS), meconium aspiration syndrome,
aspiration syndromes, pneumonias,
congenital heart diseases

27. Chest

28. Mouth

29. Abdomen
 Size
 Shape
 Movement

30. Abdomen

31. Genitourinary

32. Hypospadius

33. Hymenal Tag

34. Musculoskeletal