NEWBORN

ASSESSMENT
BALDONO DANIELLI JEAN G.
BSN 2-1
WEIGHT
• A baby's birth weight is an important marker of health. Full-
term babies are born between 37 and 41 weeks of pregnancy.
The average weight for full-term babies is about 7 pounds
(3.2 kg). In general, very small babies and very large babies
are at greater risk for problems. Babies are weighed every
day in the nursery to look at growth, and the baby’s need for
fluids and nutrition. 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
within the first 2 weeks after birth. Premature and sick
babies may not begin to gain weight right away.
Converting grams to pounds and ounces:
1 lb. = 453.59237 grams; 1 oz. = 28.349523
grams; 1000 grams = 1 Kg.
LENGTH
• A newborn’s length at birth in relation to weight is a second
important determinant used to confirm that a newborn is
healthy.
 the average birth length ( 50th percentile ) of a mature female
newborn is 49 cm ( 19.2 in.).
 For mature males, the average birth length is 50 cm (19.6 in.).
 The lower limit of expected birth length is arbitrarily set at 46
cm (18 in.).
 Although rare, babies with lengths as great as 57.5 cm ( 24
in.). Have been reported.
CHEST CIRCUMFERENCE
• Chest circumference is measured at the level of the nipples. If
a large amount of breast tissue or edema of the breasts is
present, this measurement will not be accurate until the edema
has subsided. The chest circumference in a term newborn is
about 2 cm (0.75 to 1 in.) less than head circumference.
HEAD CIRCUMFERENCE
• Head circumference is measured with a tape measure drawn across
the center of the forehead and then around the most prominent
portion of the posterior head ( the occiput) In a mature newborn,
the head circumference is usually 34 to 35 cm ( 13.5 to 14 in.).
• A mature newborn with a head circumference greater than 37 cm
(14.8 in ) or less than 33 cm ( 13.2 in.) should be carefully assessed
for neurologic involvement, although some well newborn have
these measurements.
TEMPERATURE
• The temperature of newborn is about 99⁰ F ( 37.2⁰ C ) at birth
because they have been confined in their mother’s warm and
supportive uterus. Temperature well fall almost immediately to
below normal because of heat loss,the temperature of birthing
rooms ( approximately 68 to 72⁰ F[ 21 to 22⁰ C]), and the
infant’s immature temperature- regulating mechanisms if the
baby is not protected from heat loss at birth and in the
moments afterwards.
 Convection is the flow of heat from the newborn’s body surface to cooler
surrounding air. Eliminating drafts, such as from air conditioners , is an
important way to reduce convection heat loss.

 Radiation is the transfer of body heat to a cooler solid object not in contact
with the baby, such as cold window or air conditioner. Moving an infant as far
from the cold surface as possible helps reduce this type of heat loss.

 Conduction is the transfer of body heat to cooler solid object in contact with
a baby. For example, a baby placed on the cold base of a warming unit
quickly loses heat to the colder metal surface. Covering surfaces with a
warmed blanket or towel is necessary to help minimize conduction heat loss.

 Evaporation is loss of heat through conversion of a liquid to a vapor.

Newborns are wet when born, so they can lose great deal of heat as the
amniotic fluid on their skin evaporates. To prevent this type of heat loss, lay a
newborn on the mother’s abdomen immediately after birth and cover with a
warm blanket for skin contact ( Moore, Anderson, Bergman, et al., 2012).
RESPIRATION
• The respiratory rate of a newborn in the first few minutes of life may be
as high as 90 breaths/min. As respiratory activity is established and
maintained over the next hour, this rate well settle to an average of 30 to
60 breaths/min. Respiratory depth, rate, and rhythm are likely to be
irregular, and short periods of apnea ( without cyanosis ), ssometimes
called periodic respirations, are also common and normal during this
time. Respiratory rate can be observed most easily by watching the
movement of a newborn’s abdomen because breathing primarily
involves the use of the diaphragm and abdominal muscles. Coughing
and sneezing reflexes are present at birth and help clear the airway.
Newborns are obligate nose breathers and shows sign of distress if their
nostrils become obstructed. Short peroids of crying, which increase the
depth of respirations and aid in aerating deep portions of the lungs, may
be beneficial to a newborn. Long periods of crying, however, exhaust
the cardiovascular system, become fatiquing, and serve no purpose.
BLOOD PRESSURE
• The blood pressure of a newborn is approximately 80/60
mmHg at birth. By the 10th day, it rises to about 100/50 mmHg
and remains at that level for the infant year.
CARDIOVASCULAR SYSTEM
• Changes in the cardiovascular system are necessary after birth
because now, the lungs are responsible for oxygenating blood that
was formerly oxygenated by the placenta. As soon as the umbilical
cord is clamped, which stimulates a neonate to take in oxygen
through the lungs, fetal cardiovascular shunts begin to close.
• With the first breath, blood preasure decrease in the pulmonary
artery ( the artery leading from the heart to the lungs ). As this
pressure decrease, the ductus arteriosus, the fetal shunt between the
pulmonary artery and aorta, begins to close. At the same time,
increased blood flow to the left side of the heart causes the foramen
ovale ( the opening between the right and left atria ) to close because
of the pressure against the lip of the structure ( permanent closure
does not occur for weeks).
BLOOD VALUES
• A newborn’s blood volume is 80 to 110 ml/kg of body weight or about
300 ml total. Because a newborn has more red blood cells than the
average adult, the hemoglobin level averages 17 to 18 g/100 ml of
blood ( the average for an adult is 11 to 12 g/ml). A newborn’s
hematocrit is between 45% and 50% (for an adult, 36% to 45%). A
newborn’s red blood cell count is about 6 millions cells/mmᶟ ).
• ( for an adult, 3.5 to 5.5 million cells/mmᶟ). Capillary heel sticks may
reveal a falsely high hematocrit or hemoglobin value because of
sluggish peripheral circulation. Before obtaining a blood specimen
from a heel , warm the foot bt wrapping it in a warm cloth to increase
circulation and improve the accuracy of this value. Once proper lung
oxygenation has been established, the need for the high red cell count
diminishes so, within a matter of days, red cell begin to destroyed. As
these cells are broken down, bilirubin is released and the serum indirect
bilirubin level rises. At birth, the indirect bilirubin level is between 1
and 4 mg/100 ml.
BLOOD COAGULATION
• Vitamin K , synthesized through the action of intestinal flora, is
responsible for the formation of factor II ( prothrombin ), factor VII
( proconvertin ), and factor IX ( plasma thromboplastin
component), and factor X ( Stuart – Prower factor ) in the clotting
sequence. Because a newborn’s intestine is sterile at birth unless
membranse were ruptured more than 24 hours, it will take about 24
hours for flora to accumulate and for ongoing vitamin K to be
synthesized. This cause most newborns to be born with a lower
than usual level of vitamin K, leading to a prolonged coagulation or
prothrombin time. Beacause almost all newborns can be predicted
to have this diminished blood coagulation ability, vitamin K
( Aqua-MEPHYTON ) is usually administered intramuscularly into
the lateral anterior thigh, the preferred site for all injections in
newborns, immediately after birth (Box 18.3). If parents object to
an injection, vitamin K can be administered orally.
APGAR
• The Apgar score helps find breathing problems and other
health issues. It is part of the special attention given to a
baby in the first few minutes after birth. The baby is
checked at 1 minute and 5 minutes after birth for heart
and respiratory rates, muscle tone, reflexes, and color. A
baby who needs help with any of these issues is getting
constant attention during those first 5 to 10 minutes. In
this case, the actual Apgar score is given after the
immediate issues have been taken care of.
• Each area can have a score of 0, 1, or 2, with 10 points as
the maximum. Most babies score 8 or 9, 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
and needs extra help after birth, this will be shown in a
lower Apgar score. Apgar scores of 6 or less usually mean a
baby needed immediate attention and care.
Sign Score = 0 Score = 1 Score = 2

Heart rate Absent Below 100 per minute Above 100 per
minute
Breathing effort Absent Weak, irregular, or Good, crying
gasping
Muscle tone Flaccid Some flexing of arms Well-flexed, or active
and legs movements of arms
and legs

Reflex or No response Grimace or weak cry Good cry

irritability
Color Blue all over, or Body pink, hands and Pink all over
pale feet blue
MEASUREMENT
• The hospital staff takes other measurements of each baby.
These include:
• Head circumference. The distance around the baby's head.
• Abdominal circumference. The distance around the belly
(abdomen).
• Length. The measurement from top of head to the heel.
• The staff also checks these vital signs:
• Temperature. This checks that the baby is able to have a stable
body temperature in normal room.
• Pulse. A newborn’s pulse is normally 120 to 160 beats per
minute.
• Breathing rate. A newborn’s breathing rate is normally 40 to
60 breaths per minute.
PHYSICAL EXAM
• A complete physical exam is an important part of newborn
care. The healthcare provider carefully checks each body
system for health and normal function. The provider also looks
for any signs of illness or birth defects. Physical exam of a
newborn often includes:
• General appearance. This looks at physical activity, muscle
tone, posture, and level of consciousness.
• Skin. This looks at skin color, texture, nails, and any rashes.
• Head and neck. This looks at the shape of head, the soft spots
(fontanelles) on the baby’s skull, and the bones across the
upper chest (clavicles).
• Face. This looks at the eyes, ears, nose, and cheeks.
• Mouth. This looks at the roof of the mouth (palate), tongue, and
throat.
• Lungs. This looks at the sounds the baby makes when he or she
breathes. This also looks at the breathing pattern.
• Heart sounds and pulses in the groin (femoral)
• Abdomen. This looks for any masses or hernias.
• Genitals and anus. This checks that the baby has open passages
for urine and stool.
• Arms and legs. This checks the baby’s movement and
development.
GESTATIONAL ASSESSMENT
• The healthcare provider will check how mature the baby is.
This is an important part of care. This check helps figure out
the best care for the baby if the dates of a pregnancy are
uncertain. For example, a very small baby may actually be
more mature than he or she appears by size, and may need
different care than a premature baby needs.
• Healthcare providers often use an exam called the
Dubowitz/Ballard Examination for Gestational Age. This
exam can closely estimate a baby's gestational age. The
exam looks at a baby's skin and other physical features,
plus the baby’s movement and reflexes. The physical
maturity part of the exam is done in the first 2 hours of
birth. The movement and reflexes part of the exam is done
within 24 hours after birth. The provider often uses the
information from this exam to help with other maturity
estimates.
PHYSICAL MATURITY
• The physical maturity part of the Dubowitz/Ballard exam looks at
physical features that look different at different stages of a baby's
gestational age. Babies who are physically mature usually have
higher scores than premature babies.
• Points are given for each area of assessment. A low of -1 or -2
means that the baby is very immature. A score of 4 or 5 means
that the baby is very mature (postmature). These are the areas
looked at:
• Skin textures. Is the skin sticky, smooth, or peeling?
• Soft, downy hair on the baby’s body (lanugo). This hair is not
found on immature babies. It shows up on a mature infant, but
goes away for a postmature infant.
• Plantar creases. These are creases on the soles of the feet.
They can be absent or range up to covering the entire foot.
• Breast. The provider looks at the thickness and size of
breast tissue and the darker ring around each nipple
(areola).
• Eyes and ears. The provider checks to see if the eyes are
fused or open. He or she also checks the amount of
cartilage and stiffness of the ears.
• Genitals, male. The provider checks for the testes and how
the scrotum looks. It may be smooth or wrinkled.
• Genitals, female. The provider checks the size of the
clitoris and the labia and how they look.
MATURITY OF NERVES AND
MUSCLES
• The healthcare provider does 6 checks of the baby's nerves and
muscles.
• A score is given to each area looked at. Typically, the more
mature the baby is, the higher the score. These are the areas
checked:
• Posture. This looks at how the baby holds his or her arms and
legs.
• “Square window.” This looks at how far the baby's hands can
be flexed toward the wrist.
• Arm recoil. This looks at how much the baby's arms "spring
back" to a flexed position.
• Popliteal angle. This looks at how far the baby's knees
extend.
• “Scarf sign.” This looks at how far the baby’s elbows can
be moved across the baby's chest.
• Heel to ear. This looks at how near the baby's feet can be
moved to the ears.
• When the physical assessment score and the nerves and
muscles score are added together, the healthcare provider
can estimate the baby’s gestational age. Scores range from
very low for immature babies to very high scores for
mature and postmature babies.
• All of these exams are important ways to learn about your
baby's well-being at birth. By finding any problems, your
baby's doctor can plan the best possible care.
BALLARD SCORING
• The Ballard Maturational Assessment, Ballard Score,
or Ballard Scale is a commonly used technique of 
gestational age assessment. It assigns a score to various
criteria, the sum of all of which is then extrapolated to
the gestational age of the fetus. These criteria are
divided into physical and neurological criteria. This
scoring allows for the estimation of age in the range of
26 weeks-44 weeks. The New Ballard Score is an
extension of the above to include extremely 
pre-term babies i.e. up to 20 weeks.
• The scoring relies on the intra-uterine changes that the
fetus undergoes during its maturation. Whereas the
neurological criteria depend mainly upon muscle tone,
the physical ones rely on anatomical changes.
The neonate (less than 37 weeks of age) is in a state of
physiological hypotonia. This tone increases throughout
the fetal growth period, meaning a more premature baby
would have lesser muscle tone