PEDIATRIC

CONSIDERATIONS &
CARE FOR THE
NEWBORN
 PEDIATRIC ASSESSMENT
CONSIDERATIONS
PE is performed after birth and 24 hours after birth
NEWBORNS

Prioritize thermoregulation
Axillary and tympanic temperature is preferred over
rectal temperature (vs. rectal mucosa injury)
Apical pulse is taken to avoid discrepancies due to
immature peripheral circulation.
 PEDIATRIC ASSESSMENT
CONSIDERATIONS
Let the parent hold the infant during the PE to calm the child.
Start with the least invasive procedure first (assessing
INFANTS

respiration).
Reflexes are assessed routinely until 6 months unless the
child has cardiac anomalies.
Head circumference is assessed routinely until the child
reaches 1 year.
Similar assessment parameters to newborn assessment.
 PEDIATRIC ASSESSMENT
CONSIDERATIONS
Allow the child to play with the tools to be used prior to PE.
Gain the parent’s trust first, because this will be the basis of the child’s
TODDLERS

trust on you.
Generously praise the child for cooperating the in assessment.
Enforce the child’s independence during assessment (e.g. let him
remove his clothes on his own).
Assure the child that the procedure will not hurt him.
BP is taken routinely by 3 year old.
Oral temperature may be taken.
 PEDIATRIC ASSESSMENT
CONSIDERATIONS
Always explain the procedure to the child.
Offer the child the choice to whether being with the parent
SCHOOL-AGE &
ADOLESCENT

during the examination.

Provide privacy.
Instruct that testicular self-examination may be performed
routinely by age of 13 years old.
Instruct that breast self-examination must be performed
routinely by age of 20 years old.
SIGNIFICANT DIFFERENCES
AND CONSIDERATIONS FORM
ADULT ASSESSMENT
1. Vital signs
2. General appearance
3. Mental status
4. Body measurements
a. Height and Weight
- Infants: Weigh infants while he lies down or sits on scale. Weigh him nude.
- Children > 2 y.o.: Have the child positioned on a standing scale. Weigh him each day
wearing similar clothing, at the same time, using the same scale.
- Standard graphs are used in determining appropriate weight-for-height measures. The
child’s weight for height is normal if it fails between the 10th – 90th percentile of the
graph. If weight for height falls <3rd percentile, the child exhibits failure to thrive.
SIGNIFICANT DIFFERENCES
AND CONSIDERATIONS FORM
ADULT ASSESSMENT
b. Head circumference
- place the tape measure round the infant’s eyebrows and around the
occipital prominence (most prominent part on the back of the head).
- Normal findings: 33 – 35 cm
c. Chest and abdominal circumference
- Chest circumference – place the tape measure at the level of the
nipples then around the child’s chest.
- Abdominal circumference – place the tape measure at the level of
the umbilicus then around the child’s abdomen.
- Normal findings (for both): 31- 33 cm
PHYSICAL ASSESSMENT
Skin
Head
 Assess for signs of kwashiorkor: striped appearance of the
hair.
 Typical findings: molding, caput succedaneum, and
cephalhematoma
 In assessing fontanels, place him in sitting position:
anterior (bregma) and posterior (lambda)
PHYSICAL ASSESSMENT
Eyes
Subconjunctival hemorrhage is
normal in newborns.
Assess the red reflex for congenital
cataract.
Nose
Remember: Newborns and infants
are obligate nose breathers.
PHYSICAL ASSESSMENT
Ears
 Low set ears suggest presence of chromosomal aberration.
 3 years old and younger: pull the pinna down and back.
 3 years and older: pull the pinna up then back.
Mouth
 Do not assess the child’s epiglottis if he is suspected with epiglottitis. –
Increase risk of airway obstruction
 Assess newborns for oral thrush (white patches in the tongue or buccal
mucosa).
PHYSICAL ASSESSMENT
Neck
Assess for head control in infants.
Chest
Breast
Breast edema may be present as influence by maternal
hormones.
Lungs
PHYSICAL ASSESSMENT
Heart
PMI (Point of Maximal Impulse) for children younger than 4 years old: 4th
ICS, Left AAL/lateral to the nipple.
PMI for children older than 4 years old (4-7 years old):
5th ICS Left MCL
Sinus arrythmia (marked increase in HR upon inhalation, then marked
decreased in HR upon exhalation) is normal in most school-age children and
adolescents. To assess HR properly, ask the child to hold his breath while
taking the HR.
Physiological splitting of S2 is normal as long as it coincides with inspiration.
PHYSICAL ASSESSMENT
Abdomen
Use diaphragm to properly assess for high-pitched
bowel sound, which can be heard one hour following
birth.
If the child is ticklish in the abdomen, distract him
during assessment.
PHYSICAL ASSESSMENT
Genitorectal area
Assess for the following structural alterations that may affect
fertility in adulthood:
a. Hypospadias: urethral opening is at the inferior/ventral/lower
surface
b. Epispadia: urethral opening is at the superior/dorsal/upper
surface
c. Hydrocele: fluid-filled scrotal sac; glows with transillumination
d. Varicocele: enlarged vein of the epididymis
PHYSICAL ASSESSMENT
Inguinal hernia
In infants, seen as a bulge in the groin area especially when crying.
In school-age children and adolescents, this is assessed with the child
standing up and by placing a fingertip at the inguinal ring in the groin area,
then coughing.
Extremities
Back
Neurologic function
Motor and sensory function
PHYSICAL ASSESSMENT
Vision
Routinely assessed by 3 years of age
Newborns are able to follow objects until midline only at a distance
approximately 8-10 inches.
Infants and toddlers are able to follow objects past midline.
Eye charts used in assessing vision include: Snellen’s chart, Preschool
E chart (if unable to read or using different language), Allen cards
(similar pictures instead of words on flashcards asked to be identified
at a distance of 15 feet), and Ishihara plates (for color vision;
normally, the child will identify images in the plates
PHYSICAL ASSESSMENT
Hearing
Routinely assessed by 3 years of age
Speech
Developmental Milestones
Use of Metro Manila Developmental Screening Test with the
following parameters: personal-social, fine motor-adaptive, language,
and gross motor.
Cognitive Development
PHYSICAL ASSESSMENT
Temperament: inborn reaction pattern of
individuals/manner of thinking, behaving, reacting.
Easy child: predictable, with mild to moderate intensity of
reactions; presents with positive moods
Difficult child: child with irregular habits and negative mood;
appears withdrawn
Slow-to-Warm-Up child: overall fairly inactive, slowly adapts to
situation; generally negative mood
Immunization
CARE FOR THE
NEWBORN
NEONATE
First 28 days/4 weeks of life following birth.
Major physiological adjustments to extrauterine
life.
The major psychological task of neonates is to
adjust to the parental figures.
Bonding is the formation of attachment between
parent and child.
NEONATE: NURSING
IMPLICATIONS
Complete and thorough physical assessment
includes evaluation of neonate’s reflexes,
respiratory and cardiac functioning.
The Apgar assessment tool is performed at 1
minute and again at 5 minutes.
Parents are encouraged to cuddle the newborn
and establish eye contact.
NEONATE: NURSING
IMPLICATIONS
Bonding between a parent
and neonate; consider the
factors that may have an
impact on the early
attachment between this
father and daughter.
WELLNESS PROMOTION
DURING THE NEONATE
PERIOD
Teaching basic newborn needs (to be held, rocked,
and talked to).
Teaching hygienic practices.
Monitoring nutritional status.
Conducting screening tests.
Promoting early parent-neonate interaction.
SAFETY CONSIDERATIONS
DURING THE NEONATE
PERIOD
Accidents are the primary cause of neonatal
mortality.
Teaching parents about infant seats
Maintenance of skin integrity
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
1. Body Measurements
Weight
2.5 – 3.4 kg
Weight loss 5% -10% by 3-4 days after birth
Weight gain by 10th days of life
Gain ¾ kg by the end of the 1st month
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
1. Body Measurements
They loose 5 % to 10 % of weight by 3-4 days after
birth as result of :
Withdrawal of hormones from mother.
Loss of excessive extracellular fluid (ECF).
Passage of meconium (feces) and urine.
Limited food intake.
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
1. Body Measurements
Height
Boys average Height = 50 cm
Girls average Height = 49 cm
Normal range for both (47.5- 53.75 cm)
Head circumference
33-35 cm
Head is ¼ total body length
Skull has 2 fontanels (anterior & posterior)
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
1. Body Measurements
Anterior Fontanel
Diamond shape
The junction of the sagittal, corneal and frontal sutures forms it
Between 2 frontal & 2 parietal bones
3-4 cm in length and 2-3 cm width
It closes at 12-18 months of age
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
1. Body Measurements
Posterior Fontanel
Triangular shape
Located between occipital and 2 parietal bones
Closes by the end of the 1st month of age/ 2-3 months
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
1. Body Measurements
Chest circumference
31-33 cm
(usually 2–3cm less than head circumference).
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
2. Vital Signs
Temperature
36.3 to37.2C
The newborn has difficulty regulating body temperature due to low body fat
content
Brown fat is present in newborns. Breakdown of these aids in
thermoregulation by increasing metabolism.
Skin-to-skin contact is highly encouraged
Newborns are unable to shiver, contributing to thermoregulatory impairment
Provide early newborn care quickly to avoid heat loss
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
2. Vital Signs
Mechanisms of heat loss:
 Convection: flow of heat from newborn to cooler surrounding air.
Conduction: body heat transfer through direct contact with cooler
solid object.
Radiation: body heat transfer though indirect contact with cooler
solid object.
Evaporation: heat loss by vapor/liquid.
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
2. Vital Signs
Pulse
120 to 160 bpm
Rate: slightly irregular – due to immaturity of cardiac
regulatory centers
Transient murmurs may be present due to incomplete closure
of fetal circulation shunts.
Assess for presence/absence of peripheral pulses
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
2. Vital Signs
Pulse
Peripheral pulses:
Normally, femoral and brachial pulses are palpable.
Brachial pulse is sued in PALS/BLS in neonates.
If (+) femoral pulse, suspect coarctation of aorta.
Normally, radial and temporal pulses are non-palpable.
If (+) radial pulse, suspect patent ductus arteriosus (PDA).
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
2. Vital Signs
Respiration
Normal: 30 – 60 bpm
Physiologic apnea (<15 seconds is normal)
When counting breaths, observe neonate’s abdomen
Blood Pressure
Not assessed routinely unless child is suspected to have cardiac
anomalies.
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
3. Cardiovascular system
Acrocyanosis (pallor of the extremities with pinkish trunk) is
normal. Cause: Immaturity of peripheral circulation
Pressure changes in the cardiopulmonary system following a
neonate’s first breath cause closing of the fetal circulation
shunts.
Elevated RBC & WBC (due to trauma associated with
childbirth) and decreased clotting factors (due to inability of a
neonate’s body to synthesize Vitamin K initially) are expected.
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
4. Respiratory system
Vaginal birth is effective in expelling liquid in the lungs.
5. Gastrointestinal system
Initially the GIT is sterile. Bacterial flora that develops 24 hours after
birth is necessary in synthesizing Vitamin K to preventing bleeding.
Neonates are prone to regurgitation because of the immaturity of
cardiac sphincter.
Lower protein and glucose levels due to liver immaturity, which is
responsible for the synthesis of protein and storage of glucose.
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
6. Stool
Meconium
1st stool
Sticky, tart-like, blackish green, odorless
Composed of mucus, vernix, hormones, and
carbohydrates formed during the intrauterine
period.
Passed within 24-48 hours of birth
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
6. Stool
Transitional stools
Passed during 2nd – 3rd day of life
Green and loose
Breastfeed stools
Passed during by the 4th day of life
Passed 3-4 times daily
Light yellow and sweet smelling
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
6. Stool
Formula-fed stools
Passed during 2-3 times daily
Bright yellow and with slightly more
noticeable odor compared to breastfeed
stools
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
6. Stool
Bile duct obstruction is characterized by
acholic/clay-colored/gray stool
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
6. Stool
Red-streaked stools suggest presence of
anal fissure
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant
Findings
6. Stool
Mucoid/watery, loose stools may be
caused by milk allergy, lactose
intolerance, indigestion, or
malabsorption
NEWBORN: PHYSICAL
DEVELOPMENT
Considerations and Significant Findings
7. Urinary System
Voiding occurs within 1st 24 hours of life
Forceful urination suggests possible obstruction
8. Immune System
Fully functional by 2 months of age
9. Neuromuscular system
Twitching/flailing movements of extremities in absence of stimulus
occurs because of immaturity of nervous system
NEWBORN: REFLEXES
https://www.youtube.com/watch?v=rHYk1sYsge0
Blink reflex: present to protect the eye form any object by rapid
eye closure; triggered by shining a strong light to the eye or by
sudden movement towards the eye.
Rooting reflex: brushing or stroking the corner of a baby’s mouth
causes him to turn his head towards the side brushed or stroked;
present for the child to identify presence of food.
Disappears by 6 weeks of age, when the child is able to focus
NEWBORN: REFLEXES
Sucking reflex: suction motions are made by the child when his
lips are touched; helps in finding food
Disappears by 6 month of age
Swallowing reflex: occurs when the food reaches the posterior
third of the tongue.
Extrusion reflex: the tongue extrudes whenever something is
placed on its anterior portion; helps prevent ingestion of inedible
objects
Disappears by 4 month of age
NEWBORN: REFLEXES
Palmar grasp reflex: a newborn grasps objects placed at the palm
of his hand
Disappears by 6 weeks to 3 months of age
Step/Walk-in-Place reflex: hold the child in standing position
against a hard surface causes him to make quick, alternating steps
Disappears by 3 months
Placing reflex: toughing the anterior surface of the lower leg of the
child against a hard surface causes lower leg of the child against a
hard surface causes him to make quick, alternating steps
NEWBORN: REFLEXES
Plantar grasp reflex: grasping motion happens when an object
touches the soles of the child’s feet at the base of the toes.
Disappears by 8-9 months of age
Tonic neck/Boxer/Fencing reflex: with the newborn lying on his
back, the head of the child rolls into one side; his extremities on the
side where his head rolled are extended, while the extremities on
the opposite side are flexed
Disappears by 2-3 months
NEWBORN: REFLEXES
Moro/startle reflex: startling the newborn causes the infant to
abduct and extend their arms and legs with their fingers in C-
position, then they will adduct their arms and legs; as a form of
protection.
Disappears by 4-5 months of age
Babinski reflex: stroking the foot in an inverted J curve from the
heal upward causes fanning of the toes.
Disappears by 3 months
NEWBORN: REFLEXES
Magnet reflex: applying pressure on the soles of the child lying in
supine position triggers him to push back against the pressure
Crossed extrusion reflex: with an extended leg of an infant in
supine position and its corresponding foot irritated by a sharp
object, the opposite leg is raised and extended, as if pushing the
object away form the other foot.
Trunk incurvation reflex: touching the paravertebral area of a
child in prone position causes flexion of the child’s trunk and
swinging of the child’s hip towards the touch
NEWBORN: REFLEXES
Landau reflex: muscle tone must be manifested by placing the
child in a prone position with a hand underneath, supporting the
trunk.
Parachute reflex: lowering the child back to the examination table
in ventral suspension triggers the infant to extend extremities, as if
bracing himself form falling; distinct in patients with hemiplegia
and cerebral palsy
Disappears by 6-9 months
Neck righting reflex: body turns to side where head turns
Deep Tendon Reflex (DTR)
PERIOD OF REACTIVITY IN EXTRAUTERINE LIFE:
PERIODS OF IRREGULAR ADJUSTMENT IN THE
FIRST 6 HOURS OF LIFE DEVISED BY DESMOND

1st Period of • First 30 minutes of life

Reactivity • Child is alert and exploring (searching activity),
makes sucking sounds
• Elevated HR, RR
Resting Phase • Slower HR, RR; sleep for 90 minutes
2nd Period of • 2nd to 6th hour of life
Reactivity • Child gags on accumulated oral secretions, waking
him; child becomes alert and responsive
APPEARANCE OF A NEWBORN:
INTEGUMENT
Ruddy complexion of elevated
RBC levels and low amount of
subcutaneous fat
Other Findings:
Acrocyanosis: pinkish trunk +
bluish extremities due to
immature peripheral
circulation; appears during the
1st 24 to 48 hours of life.
APPEARANCE OF A NEWBORN:
INTEGUMENTPhysiologic jaudince/
hyperbilirubinemia: yellowish
discoloration of the skin due to
RBC destruction occurring during
the 2nd and 3rd day of life.
 APPEARANCE OF A NEWBORN:
INTEGUMENT

Harlequin sign: with the child in side-lying position, the

dependent side of the body remains pinkish while the
nondependent side becomes bluish; caused by immature
APPEARANCE OF A NEWBORN:
INTEGUMENT
Hemangiomas:
vascular tumor of the
skin.
APPEARANCE OF A NEWBORN:
INTEGUMENT
Nevus flammeus/
Portwine stain:
macular purple/ dark-
red lesion present on
the face and thighs at
birth
APPEARANCE OF A NEWBORN:
INTEGUMENT
Stork’s beak marks/
telangientasia: lighter
pink patches of nevus
flammeus found at the
nape.
APPEARANCE OF A NEWBORN:
INTEGUMENT
Strawberry
hemangioma: elevated
areas formed by
immature capillaries of
endothelial cells; may
appear up to 2 weeks
after birth; fades with
time; associated with
high estrogen levels
during pregnancy.
APPEARANCE OF A NEWBORN:
INTEGUMENT
Cavernous
hemangioma: dilated
vascular spaces similar to
strawberry hemangiomas
in appearance; do not
fade with time and may
be present in internal
organs, making them
prone to bleeding.
APPEARANCE OF A NEWBORN:
INTEGUMENT
Mongolian
spots/slate gray nevi:
collection of
pigmented cells/
melanocytes
manifested as slate
gray patches across the
buttocks, sacrum,
arms, and legs.
APPEARANCE OF A NEWBORN:
INTEGUMENT
Vernix caseosa:
white, cream cheese-
like substance that
served as skin
lubricant in utero;
color similar to
amniotic fluid; not to
be rubbed off skin.
APPEARANCE OF A NEWBORN:
INTEGUMENT
Lanugo: fine downy
hair found in
newborn’s shoulders,
back, and upper arms;
more in premature
infants; disappears by
2 weeks of age.
APPEARANCE OF A NEWBORN:
INTEGUMENT
Desquamation: peeling of skin
within 24 hours after birth;
normally occurs in the palm of
the hands and soles of the feet.
APPEARANCE OF A NEWBORN:
INTEGUMENT
Milia: pinpoint white
papules at cheek or at
nose bridge of the
newborn; disappears
by 2-4 weeks.
APPEARANCE OF A NEWBORN:
INTEGUMENT
Erythema toxicum:
newborn rash
appearing at 1st – 4th
day of life up to 2
weeks; has no pattern,
miniscule, and is
sporadic in
appearance.
APPEARANCE OF A NEWBORN:
INTEGUMENT
Forceps marks:
circular or linear
contusion matching
the rim of the blade of
the forceps on infant’s
cheek; disappears in
1-2 days.
OBSTETRIC FORCEPS
APPEARANCE OF A NEWBORN:
HEAD
Anterior Fontanel
Posterior Fontanel
ANTERIOR & POSTERIOR
FONTANEL
APPEARANCE OF A NEWBORN:
HEAD
Other findings:
Molding: temporary
alteration in fetal head
shape due to fitting on
cervical contours
during delivery.
APPEARANCE OF A NEWBORN:
HEAD
Other findings:
Cephalhematoma:
collection of blood
beneath the periosteum
caused by pressure on
fetal head during delivery;
may cross suture lines;
reabsorbed weeks after
birth; may cause jaundice.
APPEARANCE OF A NEWBORN:
HEAD
Other findings:
Caput Succedaneum:
edema in the scalp on
the presenting part of
the head during
delivery; crosses suture
lines; disappears in 3rd
day of life.
APPEARANCE OF A NEWBORN:
HEAD
Other findings:
Craniotabes:
softening of the
cranial bones due to
pressure on fetal head
against the mother’s
pelvic bone in utero.
APPEARANCE OF A NEWBORN:
EYES
To inspect the newborn’s
eyes, place him in supine
position then lift his head.
Subconjuctival
hemorrhage: rupture of
conjunctival capillaries due
to pressure on fetal head on
birth; disappears 2-3 weeks
after birth.
APPEARANCE OF A NEWBORN:
EARS
Do not attempt to visualize the tympanic
membrane because it is filled with amniotic
fluid and vernix caseosa.
APPEARANCE OF A NEWBORN:
MOUTH
Epstein pearls: small,
round, glistening, well-
circumcised cysts on palate
due to calcium deposition in
utero.
APPEARANCE OF A NEWBORN:
CHEST
Witch’s Milk
(Galactorrhea): thin,
watery fluid form the
breast of a newborn as
an effect of residual
maternal hormones in
fetal circulation.
APPEARANCE OF A NEWBORN:
ABDOMEN
Abdomen is protuberant
Bowel sounds may be heard within
an hour after birth
Drying of the umbilical cord
occurs 2-3 days after birth.
It falls off around 6-10 days after
birth.
Kidney is palpated within the first
few hours after birth to assess for
renal agenesis (absence of kidneys).
APPEARANCE OF A NEWBORN:
ANOGENITAL AREA
Pseudomenstruation may
occur in newborn girls
because of maternal
hormones in circulation.
Cryptorchidism may
occur as a result of
testicular agenesis,
ectopic testes, or
undescended testes.
APPEARANCE OF A NEWBORN:
EXTREMITIES
Presence of Simian
crease suggests
chromosomal aberrations.
Expect newborn to have
flat soles and bowed legs.
NEWBORN SENSES
Touch

Smell Vision

Hearin
Taste
g
NEWBORN SENSES: TOUCH
•It is the most highly developed sense.
•It is mostly at lips, tongue, ears, and forehead.
•The newborn is usually comfortable with
touch.
NEWBORN SENSES: VISION

•Pupils react to light

•Bright lights appear to be unpleasant
to newborn infant.
•Follow objects in line of vision
NEWBORN SENSES: HEARING
•The newborn infant usually makes some
response to sound from birth.
•Ordinary sounds are heard well before 10 days
of life.
•The newborn infant responds to sounds with
either cry or eye movement, cessation of activity
and / or startle reaction.
NEWBORN SENSES: TASTE
•Well developed as bitter and sour fluids are resisted
while sweet fluids are accepted.
NEWBORN SENSES: SMELL
•Only evidence in newborn infant’s search for the
nipple, as he smell breast milk.
NEONATAL WELL-BEING
ASSESSMENT
1. APGAR SCORING
Used to assess survivability of the child in the
extrauterine environment.
Performed after the first minute and on the fifth minute
of life.
APGAR Interpretation
0-3 Needs resuscitation
4-6 Needs airway clearance and supplemental oxygen
7 - 10 Survives in extrauterine environment
 APGAR SCORING
PARAMETER 0 1 2
Appearance* Blue, Pale Acrocyanotic Pinkish
Pulse Negative (-) Slow; <100 >100
Grimace** No response Grimace Cough, sneeze, cry
Some flexion of Full flexion of the
Activity*** Flaccid
the extremities extremities
Slow, irregular;
Respiration Negative (-) Good, strong cry
weak cry

*also COLOR
** also REFLEX IRRITABILITY
*** also MUSCLE TONE
NEONATAL WELL-BEING
ASSESSMENT
2. SILVERMANN-ANDERSEN
INDEX
Assessment of respiratory distress in newborns
Silvermann-Andersen Interpretation
0 (-) Respiratory distress
0-3 Mild Respiratory distress
4-6 Moderate distress
>6 Impending Respiratory failure
7 - 10 Severe Respiratory distress
NEONATAL WELL-BEING
ASSESSMENT
3. BALLARD’S SCALE OF
GESTATIONAL

AGE
Used in assessing child’s gestational age; also
applicable for premature neonate and neonates
with miscalculated gestational age.
Neuromuscular Maturity
Physical Maturity
BREASTFEEDING
Prolactin: hormone responsible for milk production
Oxytocin: hormone responsible for let-down reflex/milk
ejection
Colostrum: thin, watery, yellowish fluid produced since
the 4th month of pregnancy, ingested by breastfed children
during the 1st 3-4 days of life; high in protein, low
carbohydrate and fat.
True/mature breastmilk: appears on 10th day after birth
CONTRAINDICATIONS TO
BREASTFEEDING:
1. Neonates with galactosemia
2. Herpes lesions on the breast
3. Restricted maternal diet
4. Maternal radioactive exposure
5. Breast cancer
6. Maternal active TB, hepatitis B and C, CMV, HIV, untreated varicella
7. Mother on chemotherapy
8. Mother on specific drugs that pass to breastmilk
MATERNAL ADVANTAGES OF
BREASTFEEDING:
1. Protective vs. breast cancer
2. Oxytocin release
3. Empowering effect on mother
4. Economical and efficient
5. Served as bonding for mother and child
6. Means of family planning (lactation-amenorrhea
method)
NEONATAL ADVANTAGES OF
BREASTMILK:
1. Maternal antibody transmission (IgG)
2. Presence of bifidus factor in BM causing good bacteria
proliferantion
3. Composition ideal for child’s needs
4. Effect on dental disk formation
ESSENTIAL NEWBORN CARE
Administrative Order 2008-0029
Implementing Health Reforms for Rapid Reduction
of Maternal and Newborn Mortality (MNCHN
Strategy)
Administrative Order 2009-0025
Adopting Policies and Guidelines on Essential
Newborn Care (ENC)
Eventually changed to EINC from ENC