M4

• APGAR Score


  A scoring system used to evaluate the condition of a newborn infant based on five criteria: appearance, pulse, grimace, activity, and respiration
• Record the APGAR Score Twice

  1. Minute Apgar Score
• Blood Pressure


  The pressure of the blood in the circulatory system
• Slate Blue Patches


  Bluish-gray discoloration of the skin, especially on the back and extremities, that is normal in newborns
• Neck


  • Lymphadenopathy (abnormal finding)
• Mouth and Pharynx


  The opening at the back of the mouth that leads to the esophagus and larynx
• Assessment of Heart


  Inspection
• Assessment of Musculoskeletal System

  Inspection
• Deep Tendon Reflexes


  Involuntary muscle contractions that occur in response to the stretching of a tendon
• Initial Assessment of Newborn and Infants

  A systematic and step-by-step physical examination of the newborn
• Purposes of Newborn Assessment

  • To provide an infant's state of development of well-being
  • To detect any deviation from normal
  • To assess the progress of the child
• Neonatal Period


  First 28 days
• Postneonatal Period


  29 days to 1 year
• Tips for Examining Newborns

  1. Dim the lights and rock the newborn to encourage the eyes to open

  2. Demonstrate calming maneuvers to parents

  3. Newborns are responsive 1-2 hours after a feeding

  4. Sequence should vary according to the child's age and comfort level

  5. Perform less invasive maneuvers early and potentially distressing maneuvers near the end of the examination

  6. If possible, do the physical examination in front of the parents so that they can interact with you and ask questions
• Typical Sequence for the Examination

  • Heart and Lungs
  • Head, Neck and Clavicles
  • Ears and Mouth
  • Hips
  • Abdomen and Genitourinary System
  • Lower Extremities and Back
  • Eyes (whenever they are spontaneously open or at end of examination)
  • Skin (as you go along)
• Classification of Newborn by Gestational Age

  • Preterm <34 weeks
  • Late Preterm 34-36 weeks
  • Term 37-42 weeks
  • Postterm >42 weeks
• Classification of Newborn by Birth Weight

  • Extremely low birth weight <1,000g
  • Very low birth weight <1,500g
  • Low birth weight <2,500g
  • Normal birth weight >2,500g
• APGAR Score


  Key assessment of the newborn immediately after birth that classifies the newborn's neurologic recovery from birth and immediate adaptation to extrauterine life
• APGAR Score Criteria


  • Appearance (Normal over entire body, Normal except extremities, Cyanotic of pale all over)
  • Pulse (>100 BPM, <100 BPM, Absent)
  • Grimace (Sneezes, cough or vigorous cry, Grimaces, No Response)
  • Activity (Active, Arms and legs flexed, Absent)
  • Respiration (Good, crying, Gasping, irregular, Absent)
• 1. Minute Apgar Score

  2. 10 Normal, 5-7 Some nervous system depression, 0-4 Severe depression, requiring immediate resuscitation
• 1. Minute Apgar Score

  2. 10 Normal, 0-7 High risk for subsequent central nervous system and other organ system dysfunction
• Ballard Scoring System


  • Posture
  • Square Window Test (wrist)
  • Arm recoil
  • Popliteal angle
  • Scarf Sign
  • Heal to ear test
  • Skin
  • Lanugo
  • Plantar surface
  • Breast
  • Eye/Ears
  • Genitals (male/female)
• Secondary Assessment of the Neonate

  1. Wait until 1-2 hours after feeding- baby is most responsive

  2. Observe the undressed newborn

  3. Newborns lie in a symmetric position

  4. Limbs semi-flexed and legs partially abducted at the hip
• Variations of Breech Presentation

  • Complete Breech (Both legs are adducted)
  • Incomplete Breech (One leg is abducted, while the other is adducted)
  • Frank Breech (Both legs abducted & externally rotated)
• Heart Rate - Normal Value

  Ranges between 120-140 bpm
• Respiratory Rate - Normal Value

  Ranges between 30 and 60 cpm
• Temperature - Normal Value

  97.6°F - 98.6°F Axillary, 36.44°C - 37°C Axillary
• Pulse Rate - Normal Value

  • Newborn 130 bpm (80-180 bpm)
  • 1 Year 120 bpm (80-140 bpm)
  • 5-8 Years 100 bpm (75-120 bpm)
  • 10 Years 70 bpm (50-90 bpm)
• Blood Pressure


  Systolic blood pressure gradually increases throughout childhood
• Normal Findings: Brief tremors of the body and extremities during vigorous crying and even at rest, Spontaneous motor activity, with flexion and extension alternating between the arms and legs
• Abnormal Findings: 4 days after birth, tremors at rest signal CNS disease from various possible causes, ranging from Asphyxia to drug withdrawal, Asymmetric movements of the arms and legs central or peripheral neurologic deficits, birth injury
• 1. 10% physiologic weight loss (6-10oz) during the 1st 10 days
• Anthropometric Measurements


  • Length - 46 to 54 cm (Female 53 cm, Male 54 cm)
  • Head Circumference - 34-35 cm
  • Chest Circumference - 32-33 cm
  • Weight - 2.5-3.4 kg (5.5-7.5lbs)
• Reasons for 5-10% physiologic weight loss: No more maternal hormone influence, Voids and passes stools, Limited caloric intake
• Ruddy Complexion


  Caused by the increased concentration of red blood cells in the blood vessels and decreased amount of subcutaneous fat
• Inspection


  A true strawberry pink is normal, whereas any hint of raspberry red suggests desaturation and requires urgent evaluation
• Vernix Caseosa


  Waxy or cheese-like white substance found coating the skin of newborn human babies
• Inspection


  It is important to detect central cyanosis because it is always abnormal
• Cutis Marmorata


  A reddish-purple mottled skin pattern common in newborns. It appears in response to cold temperatures bluish discoloration usually appears in the palms and soles
• Palpation


  Allow you to assess volume changes within the heart. For example, a hyperdynamic precordium reflects a big volume change