KING GEORGE’S MEDICAL UNIVERSITY, LUCKNOW

K.G.M.U. COLLEGE OF NURSING

PROCEDURE ON

NEWBORN ASSESSMENT

SUBMITTED TO SUBMITTED BY

MS. SUPRIYA MS. DIVYA PAL

CLINICAL INSTRUCTOR M.Sc. NURSING I YEAR

Athough the approach and sequence of the physical examination differ according to the
child's age. Physical examination is a l part of preventive pediatric care. Neonatal
assessment is the health assessment of a newborn (i.e. from birth till 28 days of e) to
know about the well-being of baby, to rule out any congenital abnormalities, to make
parents aware about the newborn's arent status of health and development.
PURPOSES
• To ensure about the well-being of baby .
• To rule out any congenital anomalies .
• To make parents aware about child's physical health .
• To check baby's adjustment to environment.
IDENTIFICATION DATA
Name- B/o Sangeeta
Age of gestation- 35 weeks ,4 days

Gender- Female

Ward- NICU

APGAR SCORE- 05

ARTICLES
• Measuring tape
• Digital Thermometer
• Stethoscope
• Thermometer
• Infantometer
• Measuring tape
• Diary and Pen
• Wrist watch
• Percussion hammer
• Spirit swab
• Paper bag
• Torch
• Hammer
 STEPS OF PROCEDURE:

Preprocedural steps
• Arrange the articles to save time and energy
• Wash hands with soap and water to prevent cross infection.
• Dry the hands with towel to avoid touching the baby with wet hands.
• Review the mother's obstetric history, number of pregnancies, history of previous
pregnancies, and health during the pregnancy complications during and after the
pregnancy, history of any drug she has taken and her Rh typing to correlate the data to
review its effect on newborn's health.
• Review the health history of newborn child-date of birth, place of birth, the type of
delivery, any problem experienced by the child after delivery, immunization status of
the child, the weight and length, the infant's color and cry at birth, the breastfeeding
practice.
INTRAPROCEDURAL STEPS
• Assess the general appearance of the neonate/child which includes consciousness,
alertness, orientation, activeness grooming, etc.
• Check the vital signs of neonate.
Respiration:
• Check the respiratory rate of neonate by exposing his chest and abdomen. Note the
symmetry of the chest wall, the pattern of respiration, whether there is any chest
indrawing on respiration, grunting sound. Normally the respiration is quiet, rapid and
shallow. The child’s respiration is 32 br/m. The normal respiratory rate is 40-60/minute.
Temperature:
• Clean the thermometer with spirit swab from bulb to stem. Clean axilla with wet cotton
swab and let it dry. Shake the thermometer to bring the mercury down and keep the
bulb of the thermometer in the roof of the axilla parallel to the arm and body of child
for 3 minutes. Take out thermometer check the reading at eye level. Cleaned it with
spirit swab from stem/top to bulb. Recorded the reading in temperature sheet of child.
The normal temperature of infant is 36.8 Temperature less than 36.5°C is suggestive of
hypothermia. Temperature above 37.2°C is suggestive of fever.
Heart rate:
• Auscultated the heart sound of the child with stethoscope. Heart rate of the neonate is
122 beats/minute.
• After checking vital signs, assessed the baby from head to foot as mentioned below:
• Taken anthropometric measurements to obtain baseline data.
Face :
• Observed face for its shape and symmetry and face is small.
Head :
• Observe the shape of the head: Check for the birth injuries cephalohematoma and
caput succedaneum . microcephalic head found.
• Measure head circumference: Head circumference or occipital frontal circumference
(OFC) is measured by placing a soft nonstretchable measuring tape over the most
prominent part on the back of the head (occiput) and just above the eyebrows
(supraorbital ridges). Normal limits are 33-35 cm. Baby’s head is 30 cm.
• Palpated the anterior and posterior fontanels to determine whether they are open,
closed, depressed or bulging. Anterior fontanel is depressed. The anterior fontanel is
diamond shaped and closes at 12-18 months. Posterior fontanels is triangular in shape
and closes at one a half month after birth.

Hair:

• Inspect the hair of neonate/child for texture, color, quality and elasticity, Checked for
any deviation from normal i.e. brittle, dry, alopecia or depigmentation.
Eye:
• Eyes are blue or gray at birth changing to the permanent color in 3-6 months.
• Child’s eye color is black.
• Observed for redness, swelling and discharge or yellow discoloration and
hypertelorism.Child’s sclera is little yellow.
• Inspected the cornea for any ulceration, dryness, inflammation, injuries and visual
acuity.
• Inspected pupil's size and shape.
Ears
• Ear examination: In newborn babies and infants, the direction of ear canal is upward
while in older children it runs downward and forward .
• To visualize the tympanic membrane pull the pinna of the ear with thumb and index
finger of one hand up and backward in older children and downward or laterally in
infants and newborn.
• In infants or newborn, inspect the external earlobe, i.e. pinna. Measure the alignment
of pinna by drawing an imaginary line from outer orbit of eye to occiput. The top of
pinna must meet or cross this line. Low set ears are associated with mental retardation
or renal abnormalities. Child’s pinna is normal.
• Look for any discharge. Assess the hearing capacity of child by performing whisper
test.
Nose:
• Observed for mucous accumulation inside the nares by hyperextending the neck of the
child and use thumb to push the tip of the nose upward while illuminating light into
nostrils.
• Checked for any bleeding and deviated nasal septum (DNS).There is no abnormality.
Mouth and Pharynx:
• Inspection of the exterior structures of the mouth. For cleft lip/palate in newborns.
• Lips should be moist, soft, smooth and pink in color.
• A tongue blade and a light source (flashlight) are necessary when examining the buccal
cavity .Child’s tongue has no abnormality.
In Children:
• Inspected for any oral ulcer, color of lips, shape and symmetry , it is normal in child.
• Gum bleeding, color and retraction of gums.
• Depressing the tongue toward the back may elicit the gag reflex.
• Inspected uvula for position and color
• Inspected throat for color, size and shape of tonsils and inflammation.
In Infants:
• Inspected for tongue tie and Epstein pearls.
• Color of palatine tonsils, they are normally of same color of mucosa and glandular.
• There is no oral thrush.
Neck
• Neck is short in children and should be examined for webbing, hairline, thyroid glands
and cysts. Neck is inspected for length symmetry, control of movement, pulsation and
edema. Assess for the following
• Lymph nodes for any enlargement and whether they are palpable. Lymph nodes are not
enlarge in child.
• Thyroid gland for any enlargement Range of motion for flexion, extension and rotation
• Rashes and skin folds in newborn baby.
• Presence or absence of nuchal rigidity Observed for deft lip and cleft palate, there is no
cleft lip or cleft palate.
• Observed the creases of neck for the accumulation of dirt, redness and excoriation
Chock for webbed neck.
Chest:
• Before examining the child, position the child in mother's lap expose the chest for
inspection
• It is bell-shaped and approximately the same circumference as abdomen and about 1
inch less than the head circumference.
• Its normal circumference ranges from 31 cm to 33 cm Inspected the chest for shape,
symmetry, size, movements etc .Baby’s chest shape is 28 cm.
• Look for chest indrawing.
• Retractions and depressions are seen in case of respiratory distress.
• Auscultated the chest for breath sounds.
Heart:
• Position the child in parent lap. Inspect the symmetry and shape of the anterior chest
from front and side view fine detail symmetry of rib cage. If bulging of the left side of
the chest wall indicate an enlarged heart Palpate and auscultate the hot and listen for S,
and 5, sounds, Auscultate the heart from all anatomic areas. Heart is normal in shape.
S1 and S2 sounds are normal.
Abdomen:
• On inspection the normal neonate's abdomen appears rounded and slightly protuberant.
Normal abdominal circumference is 29-31 cm. Abdominal circumference is 25 cm.
• Observe the umbilical cord for redness, pus and bleeding. After birth cord begins to
shrink .It changes in color from yellow brown to black and slough off by 6-10 days
after the birth, leaving a granulating area that heals in another week.
Upper Extremities:
• The arm should move symmetrically and equally well. If an arm does not move
normally, the baby may have sustained a birth injury in mature neonates, the hands are
 plump. Look for a single transverse palmar crease, which is classically in babies with
Down's syndrome.
• Assess for syndactyly and polydactly.
Lower Extremities:
• Watched and inspected for range of motion and symmetry although it is normal.
• Assessed for hip dislocation , club foot , polydactyly or syndactly , talipes equinovarus
and talipes valgus of feet. But all are in normal condition.
Back:
• Inspected the back for Spina bifida. The spine should be palpated with a finger to
exclude spina bifida and any scoliosis. There is no sign of Spina bifida and scoliosis.
• Observed for Mongolian spot at the back but not found.
Anogenital Area:
Buttocks are plump and firm. In the anal region, there should be no redness or fistulas.
The newborn infant passes meconium within 24 hours and check for patent rectum
Look for patency of the anus to rule out an imperforate anus.
Female Genitalia:
• The female genitalia may be slightly swollen from the action of the maternal hormones.
There can be signs of pseudomenstruation. There is no abnormal sign in child. Labia
majora and labia minora is in normal shape.
Urine:
• Urine is passed frequently. Urination may be delayed until the second day
• Note down the frequency, color and amount of urine.
NEUROLOGICAL ASSESSMENT:
• Nervous system of infant is strikingly immature when compared with the child or adult.
The bodily functions and responses to external stimuli are carried on chiefly by the
midbrain and reflexes of spinal cord. Certain reflexes are absolutely essential and
protective to the life of newborn. Successful use of the reflex mechanism is an evidence
of normal functioning of nervous system.
Reflexes:
• Moro: Baby's body is supported with one arm and hand, and the head with the other
hand. The hand holding the head is then lowered a few centimetres, allowing the baby's
head to drop back. In positive response, the baby abducts and extends the arms, and
then flexes them. A clearly unilateral response suggests some local abnormality, such
 as a fracture or brachial plexus injury in the arm on the side that does not respond. In
Baby moro’s reflex is present.
• Rooting: Touching or stroking the cheek alongside of mouth causes neonate to turn
head toward that side and begin sucking. Baby is not active towards rooting reflex, or
rooting reflex is absent.
Sucking itself is a reflex, and failure of sucking response beyond the 36th week of
gestation suggests significant neurological impairment.
• Sucking: Begin strong sucking movement in response to stimulation. Baby has no
sucking reflex.
• Palmar Grasp: Grasp finger when palm is stimulated and held momentarily.
• Plantar Grasp: Toes curl downward when sole of foot is stimulated .
• Babinski: Fanning and extension of all toes when one side of sole is stroked from heel
upward. Babinski reflex is present.
• Tonic Neck: When head is turned to one side, extremities on same side extend and on
opposite side flex .
• Doll's Eye: As head is moved toward right or left, eyes lag behind and do not
immediately adjust to new position.
MEASUREMENT OF HEIGHT AND WEIGHT:
Height:
• Place the child in supine position over the newspaper.
• Slide a scale over the head to the newspaper and make a mark.
• Hold the infant's leg straight and make a mark, where the infants rub touches the
newspaper. Measure the distance between 2 marks in centimeter from top of head to
heal of foot. Normal height is 49-50 cm .Baby’s height is 45 cm.
Weight:
• Uncover the baby.
• Place the baby on clean infant weighing machine.
• Record the weight.
• Normal weight of neonate is 2.5-3 kg. Baby’s weight is 2.3 kg.
POSTPROCEDURAL STEPS:
• Wash and clean all articles and replace at respective places.
• Wash hands properly.
 Documentation: Document assessment on child's proforma with age, gender,
anthropometric measurements and significant assessment.