Examination of New Born Baby

Subject: Midwifery III (Theory)

Overview

The evaluation includes a head-to-toe assessment to look for any diseases or conditions. During the first 48 hours, the hands and feet may seem bluish. Acrocyanosis can occur as a result of immature peripheral circulation. The face is examined for signs of the known syndrome, facial paralysis. The eyes of a newborn infant are difficult to inspect since they are generally closed and any attempt to open the lids causes a strong reaction. The spine is checked for straightness. A sacral dimple, or little indentation at the base of the spine, is extremely frequent in newborns. The normal full-term newborn infant has a number of primitive reflexes or specialized responses to certain stimuli that are dependent on the infant nervous system and gradually decrease as the infant grows.

The checkup includes a head-to-toe check for any diseases or conditions.

  • General appearance
  • Skin color
    - Face, chest, tongue, and lips are pink.
    - During the first 48 hours, hands and feet may seem bluish. Acrocyanosis can develop as a result of underdeveloped peripheral circulation.
  • State of alertness
  • Activity (muscle tone)
    - move legs and arms equally. Opens mouth and turns head to search for a nipple.
  • Posture
    - A term newborn baby's usual resting position includes a clinched hand. Both the arms and legs are flexed. Flexion is reduced in premature babies.
  • Growth status

Take all measurements (normal)

  • Weight- 2.5 to 3kg
  • Length- 50 to 52cm long from head to heel
  • Head circumference- 33 to 35cm
  • Chest circumference- 30-31cm
  • Skin
  • Color
    - Face, chest, tongue, and lips are pink.
    - Hands and feet may be bluish during the first 48hrs.
  • Texture- feel smoothness or dryness of the skin
  • Skin turgor- checks the elasticity of the abdominal skin to detect the degree of dehydration.
  • Vernix caessa
  • Nail
  • Milia- tiny white bumps on the face
  • Mongolian spots- a bluish patch of darker pigment, most commonly over the bottom
  • Stork marks- reddish or purple v-shaped marks on the back of his neck.
  • Head
  • Shape- the baby’s head appears large for the body and may have an elongated shape due to molding during delivery.
  • Scalp- observes for birth injuries, caput succedaneum, cephalohaematoma, etc.
  • Fontanelles
  1. Anterior fontanelle: It is the largest fontanelle and is located at the intersection of the sagittal suture, coronal suture, and frontal suture. It is usually the last to close, taking between 12 and 18 months.
  2. Posterior fontanelle: It is a triangular gap between bones in the human skull located at the intersection of the sagittal suture and the lambdoidal suture. It usually closes 8-12 weeks after delivery.
  • Sutures
  • Face
    The face is examined for the appearance characteristics linked with the known syndrome, facial paralysis.
  • Eyes
    A newborn infant's eyes are difficult to inspect because they are generally closed and any attempt to open the lids causes a strong reaction.
  • Mouth
    The mouth should be examined for cleft lip and cleft palate, and the gums should be palpated for any decidual teeth. For tongue tie, the tongue is examined (frenulum language).
  • Ears
    The eye canthus and pinna of the ear line are examined, as well as the size of the ear, lobe, and any abnormal growth on the auditory canal and pinna.
  • Neck
    Examine for mobility, torticollis, stiffness, and hypertension, excessive skin folds, short neck, congenital goiter, meningocele, and so on, as well as clavicle intactness.
  • Chest and Heart
    A healthy chest circumference is 31-33cm. Examine for breathing problems, rib fractures, and engorged breasts. The breathing rate is 30-60 breaths per minute, and abdominal respiration usually indicates respiratory obstruction. The heart rate ranges between 120 and 160 beats per minute.
  • Abdomen
    The abdomen is examined for form, distension, and umbilical hernia. Examine the cord stump and umbilicus for evidence of infection or abnormalities. There is frequently noticeable divarication of the recti muscles, which is insignificant.
  • Genitalia:
    Male- Normally, the testes are distended at birth or can be easily pulled down into the scrotum.
  • Observe for hypospadias, congenital hydrocele, phimosis
    Female- A newborn girl's vulva is more open than that of an older child, and her labia minora are quite large.
  • Limbs
    The normal newborn infant's limb posture is one of flexion with the head in the midline; the posture is symmetrical. Muscle tone is in the middle.
  • Hands and Feets
    Hand and foot should be checked for webbed fingers, extra fingers, excess growth, limb fractures, Erb's paralysis, and other anomalies. Talipes deformity, talipes varus, or talipes valgus should be checked on the feet.
  • Spine
    The straightness of the spine is determined. A sacral dimple is a little indentation at the base of the spine that is extremely frequent in infants. In most circumstances, this will not cause any issues. A deep sacral dimple may occasionally signal an issue with the lower part of the baby's spinal cord. This could have an impact on nerve function in this area. If the baby has a deep sacral dimple, he will be evaluated for other symptoms such as limb weakness, cold and blue feet, and incontinence.
  • Reflexes
    The normal full-term newborn infant has a number of primitive reflexes, or specialized responses to specific stimuli, that are dependent on the infant's neurological system and gradually fade away as the nervous system matures throughout the first three months. Some examples of primitive reflexes are:
  1. Moro reflex: The Moro reaction is an infantile reflex that occurs in all infants/newborns up to the age of 4 or 5 months in response to a rapid loss of assistance when the infant feels as if it is falling.
  2. Sucking and Rooting reflex: The rooting reflex is present at birth and eventually fades after a few months when it comes under deliberate control.
  • Stepping reflex: Although the walking or stepping reflex is present at birth, newborns this young are incapable of supporting their own weight.
  1. Tonic neck reflexes: It appears at one month of age and disappears at four months. It is also known as asymmetric tonic neck reflex or fencing posture.
  2. Palmer grasps reflex: It appears at birth and lasts till the child is 5 or 6 months old. When an object is placed in an infant's hand and stroked, the fingers close and grip the thing with a palmer grasp.
  3. Planter reflex: It is a typical reflex that involves the foot's plantar flexion, which pushes the toes away from the shin and curls them down. It happens when higher motor neuron control of the flexion reflex circuit is lost.
  • Landau reflex (ventral suspension): When the baby is held prone suspended over the examiner's arm, he raises his head and flexes his limbs for a brief while.
  • Glabellar tap: When the glabella (the junction between the nose and the forehead) is gently tapped, the newborn blinks.
Things to remember
  • The checkup includes a head-to-toe check for any diseases or conditions. During the first 48 hours, hands and feet may seem bluish. Acrocyanosis can develop as a result of underdeveloped peripheral circulation.
  • The face is examined for the appearance characteristics linked with the known syndrome, facial paralysis.
  • A newborn infant's eyes are difficult to inspect because they are generally closed and any attempt to open the lids causes a strong reaction.
  • The straightness of the spine is determined. A sacral dimple is a little indentation at the base of the spine that is extremely frequent in infants. In most circumstances, this will not cause any issues.
  • The normal full-term newborn infant has a number of primitive reflexes, or specialized responses to specific stimuli, that are dependent on the infant's neurological system and gradually fade away as the nervous system matures throughout the first three months.
Questions and Answers

To look for any issues or conditions, the examination goes from head to toe.

Appearances generally

  • Skin tone: The lips, tongue, chest, and face are all pink.
  • The first 48 hours may see bluish hands and feet. Immature peripheral circulation may result in acrocyanosis.
  • Condition of alertness
  • Exercise (muscle tone): alternately move your arms and legs. his mouth while turning his head to look for a nipple.
  • Position: A term newborn baby's normal resting position includes clinched fists. Legs and arms are extended. Baby who is preterm has less flexion.
  • Size status
  • Take all measurement (normal)
    • Weight- 2.5 to 3kg
    • Length- 50 to 52cm long from head to heel
    • Head circumference- 33 to 35cm
    • Chest circumference- 30-31cm
  • Feel the smoothness or dryness of the skin's texture.
  • Skin turgor measures the abdominal skin's flexibility to gauge the degree of dehydration.
  • Caessa, Vernix
  • Nail
  • Tiny white blemishes on the face known as milia
  • A bluish patch of darker pigment known as a "Mongol spot," which typically appears on the bottom
  • Stork marks are v-shaped reddish or purple marks on his neck.
  • Head
  • Appearance: Due to molding during birth, the baby's head may appear enormous for the body and may have an extended shape.
  • Scalp: Checks for cephalohaematoma, caput succedaneum, and birth traumas, among other things.
  • Fontanelles
    • The largest fontanelle, the anterior one, is situated at the intersection of the frontal, coronal, and sagittal sutures. It is the largest fontanelle. Usually, it takes between 12 and 18 months for it to shut.
    • The posterior fontanelle is a triangular-shaped space between human skull bones that is found at the intersection of the sagittal suture and the lambdoidal suture. Typically, it closes 8 to 12 weeks after delivery.
  • Sutures
  • The head
    The face is examined for the physical traits linked to the recognized syndrome, facial paralysis.
  • Eyes
    Because a newborn baby's eyes are usually closed and opening them causes a strong reaction, it is challenging to check them.
  • The oral
    The gums should be felt for any decidual teeth, and the mouth should be examined for cleft lip and cleft palate. For tongue tie, the tongue is examined (frenulum language).
  • Ears
    The pinna and eye canthus of the ear, lobe size, and any abnormal growth on the pinna and auditory canal are all observed.
  • The head
    Check for mobility, torticollis, stiffness, and hypertension. You should also look for things like excessive skin folds, a short neck, a congenital goiter, a meningocele, etc. Check the clavicle to make sure it is intact.
  • The heart and chest
    31 to 33 cm is the average chest circumference. Check for breathing problems, rib fractures, and engorged breasts. The respiratory rate is between 30 and 60 breaths per minute, and belly breathing typically indicates respiratory blockage. The heart beats per minute range from 120 to 160.
  • the stomach
    For form, distension, and umbilical hernia, the abdomen is examined. You should check for any indications of infection or abnormalities on the cord stump and umbilicus. The recti muscles frequently show prominent divarication, however this is not very harmful.
  • The genitalia
    The male genitalia are typically distended at birth or are easily dragged into the scrotum.
  • Observe for hypospadias, congenital hydrocele, phimosis
    In comparison to an older child, a newborn girl's vulva is more open, and her labia minora are comparatively large.
  • Its limbs
    The natural newborn infant's limb posture is one of flexion with the head in the middle; the position is symmetrical. Middle-level muscle tone.
  • Feet and hands
    It is important to check the hands and feet for abnormalities such as webbed fingers, additional fingers, growth spurts, limb fractures, and Erb's paralysis. Talipes deformity, talipes varus, and talipes valgus should all be checked on the feet.
  • Spine
    A spine's straightness is determined. A sacral dimple, a little indentation at the base of the spine, is relatively typical in newborns. Most of the time, this won't result in issues. On occasion, a deep sacral dimple could be a sign of an issue with the baby's lower spinal cord. The way the local nerves work may be impacted by this. If a newborn has a deep sacral dimple, other symptoms such leg weakness, chilly and blue feet, and incontinence will be examined.
  • Reflexes
    The typical full-term newborn baby has a variety of primitive reflexes, or specialized reactions to certain stimuli, that are dependent on an infant neurological system and gradually go away over the course of the first three months as the nervous system grows. Some of the primitive reflexes are:
    • The infant feels as though it is falling due to the moro reflex, which is an infantile reflex that is typically present in all infants/newborns up to the age of 4 or 5 months.
      Sucking and rooting reflexes: The rooting reflex is present at birth and gradually goes away when voluntary control takes over during the first few months of life.
  • Stepping reflex: Although infants this young cannot support their own weight, the walking or stepping reaction is present at birth.
    • Asymmetric tonic neck reflexes, commonly referred to as fencing posture, first occur at one month of age and go away at four months.
    • Palmer grab reflex: it first arises at birth and lasts for about five or six months. The baby's fingers will close and form a palmer hold when you place something in their hand and rub their palm.
    • Planter reflex: This common reaction causes the foot to plantar flex, pulling the toes away from the shin and curling them downward. It happens when the flexion reflex circuit's upper motor neuron regulation is compromised.
  • Baby held prone suspended over the examiner's arm exhibits the Landau reflex (ventral suspension), which causes the infant to momentarily hold his head level with his body and flex his limbs.
  • When the glabella (the junction between the nose and the forehead) is lightly tapped, a neonate will respond by blinking.

 

© 2021 Saralmind. All Rights Reserved.