newborn and infant

• APGAR


  • A - Activity
  • P - Pulse
  • G - Grimace
  • A - Appearance
  • R - Respiration
• APGAR score


  Rates respiration, reflexes, pulse, skin color, and muscle tone
• APGAR score


  • Respiration, crying
  • Reflexes, irritability
  • Pulse, heart rate
  • Skin color of body and extremities
  • Muscle tone
• APGAR score scale


  • Score 0
  • Score 1
  • Score 2
• Vital signs


  • Temperature 97.5 -99F (36.4-37.2C)
  • Breathing is easy and nonlabored
  • Respiratory Rate 30-60bpm
• Functional assessment


  • Newborn - APGAR scoring & anthropometric measurements
  • Infants & children - MMDST & some major developmental milestones
  • Adults/Elderly - PADC, Lawton Scale for IADL, KATZ index of independence on ADL, Barthel Index

  
• Initial newborn assessment - APGAR scoring


  • Provide numeric indicator of newborn's physiologic capacity to adapt to extra-uterine life
  • Assessed at 1 and at 5 minutes after delivery
  • Each of the five aspects is assigned a maximum score of 2
  • Maximum achievable total score is 10
  • Score under 7 suggests that the baby is having difficulty
  • Score under 4 indicates that the baby's condition is critical
  • Those with very low scores require special resuscitation measures and care

  
• Initial newborn assessment - Anthropometric measurements


  • Weight
  • Length
  • Head and Chest Circumference

  
• Newborn's weight


  • At birth most babies weigh from 2.7 to 3.8 kg (Kozier et al)… 2500 to 4000g (Weber & Kelly)
  • Just after birth, newborns lose 5% to 10% of their birth weight because of fluid loss (normal)
  • Regains birth weight in about 1 week
  • At 5 to 6 months, infants usually reach twice their birth weight
  • By age 12 months, infant's weight is usually 3 times their birth weight
  • Weigh the newborn unclothed using a newborn scale
• Newborn's length


  • Average length varies
  • Female babies are usually smaller in length than male babies
  • Rate of increase in height/length is largely influenced by the baby's size at birth and by nutrition
  • Measure the newborn from head-to-heel (from the top of the head to the base of the heels)
• Newborn's head and chest circumference

  • Normal head circumference (normocephaly) should be assessed in relation to chest circumference
  • Chest circumference of the newborn is usually less than the head circumference by about 2.5 cm (1inch)
  • As the infant grows, chest circumference becomes larger than the head circumference
  • At about 9 or 10 months, head and chest circumferences are almost the same
  • After 1 year of age, chest circumference is larger
  • A newborn's head circumference is measured around the skull above the eyebrows
  • Measure chest circumference by placing tape measure at nipple line and wrap it around the newborn

  
• Newborn reflexes


  • Rooting Reflex
  • Sucking Reflex
  • Palmar Grasp Reflex
  • Plantar Grasp Reflex
  • Tonic Neck Reflex
  • Moro Reflex
  • Babinski Reflex
  • Stepping Reflex
• Developmental screening test - MMDST

  • Adopted from Denver Developmental Screening Test (DDST)
  • A screening tool to identify developmental delays among children from birth to 6 years of age
  • Intended to estimate the abilities of a child compared to those of an average group of children of the same age
  • Not a test of intelligence
  • Four main areas of development are screened: Person-Social, Fine-Motor adaptive, Language, Gross Motor

  
• Immunity


  • Active Immunity - Acquired when a person produces antibody in response to an antigen
  • Passive Immunity - A resistance of the body to an infection in which the host receives natural or artificial antibodies produced by another source/host
• Immunization status


  • Incompletely immunized
  • Completely immunized
  • Fully immunized
• Immunization schedule (based on EPI, 2010)

  • At Birth - BCG1 and Hepatitis B1
  • 1 and a half month/6 weeks after birth - DPT1, OPV1, Hepatitis B2
  • 2 and a half month/10 weeks after birth - DPT2, OPV2
  • 3 and a half months/14 weeks after birth - DPT3, OPV3, Hepatitis B3
  • 6 months - Give Vitamin A
  • 9 months - Anti-Measles Vaccine + Vitamin A
• Estimating delivery date (EDC/EDD)

  Nagel's Rule - subtract 3 months from the first day of the last menstrual period (LMP) and add 7 days
• Subsequent physical assessment


  • Head circumference - Macrocephaly, Microcephaly
  • Skin, Hair, and Nails - Physiologic Jaundice, Birthmarks, Milia, Harlequin Sign

  
• Schedule/ Child's Age


  • At Birth
  • 1 and a half month/6 weeks after birth
  • 2 and a half month/10 weeks after birth
  • 3 and a half months/14 weeks after birth
  • ***6 months
  • 9 months
• Vaccines


  • BCG1 and Hepatitis B1
  • DPT1, OPV1, Hepatitis B2
  • DPT2, OPV2
  • DPT3, OPV3, Hepatitis B3
  • Anti-Measles Vaccine
• ***Give Vitamin A
• ASSESSMENT OF A PREGNANT WOMAN

  1. Estimating delivery date (EDC/EDD)

  2. Estimating gestational date (AOG/age of gestation)

  3. Maternal assessment (history)
• ASSESSMENT OF A PREGNANT WOMAN – ESTIMATING DELIVERY DATE


  Nagel's Rule – subtract 3 months from the first day of the last menstrual period (LMP) and add 7 days
• SUBSEQUENT PHYSICAL ASSESSMENT


  • HEAD CIRCUMFERENCE
  • SKIN, HAIR, AND NAILS
  • HEAD, NECK AND CERVICAL LYMPH NODES
  • EYES
  • EARS
  • MOUTH, NOSE, THROAT, AND SINUSES
  • HEART
  • ABDOMEN
  • MALE GENITALIA
  • FEMALE GENITALIA
  • AND RECTUM
  • MUSCULOSKELETAL
• Macrocephaly


  Very large head
• Microcephaly


  Oddly shaped head
• Physiologic Jaundice


  • Thermo regulation (blood – natural heat regulator)
• Fontanelle


  • Full range of motion
  • Face is normally proportionate & symmetric
  • The neck is usually short with skin folds between the head and shoulder during infancy

  
• Abnormal


  • Very large head
  • Oddly shaped head
  • One-sided flattening of the head
  • Third fontanelle
  • Caput Succedaneum – causes swelling (edema) on the top of the scalp that is usually noticeable at birth
  • Cephalohematoma – a buildup of blood (hemorrhage) underneath a newborn's scalp
  • Hyperextension of the head
  • Limited ROM
  • Unusual proportions
  • Short, webbed neck
  • Distended neck
  • Enlarged or thyroid or palpable mass
• Eyes


  • Inner canthus distance approximately 2.5cm
  • Horizontal slant, no epicanthal folds
  • Outer canthus aligns with tips of the pinnas
• Abnormal Eyes


  • Hypertelorism
  • Sun-Setting
  • Brushfield Spots
• Ears


  • Top of pinna should cross the eye-occiput line and be within a 10-degree
  • No unusual structure or markings should appear on the pinna
  • No excessive cerumen, discharge, lesions, excoriations, or foreign body in external canal
• Abnormal Ears


  • Low-set ears
  • Abnormal shape
  • Presence of foreign body or cerumen (earwax)
  • Purulent discharge
  • Purulent, serous discharge
  • Bloody discharge
  • Clear discharge
• Mouth, Nose, Throat, and Sinuses

  • Epstein's Pearls
  • Gums appear pink and moist
  • Teeth may begin erupting at 4-6 months
  • Tonsils are not visible
  • Nose is midline in face, septum is straight, and nares are patent
• Abnormal Mouth, Nose, Throat, and Sinuses

  • Cleft Lip & Palate
• Heart


  • PMI 4th left intercostal space midcostal line
• Abnormal Heart


  • Dexterocardia
  • Cardiomegaly
• Abdomen


  • Abdomen is prominent in supine position
  • Umbilicus is pink, no discharge, odor, redness or herniation
  • Cord should have 3 vessels
  • Normal bowel sounds (10-30)
  • Abdomen is soft to palpation and without masses and tenderness
• Abnormal Abdomen


  • Inflammation, discharge and redness of umbilicus
  • Diastasis recti
  • A bulge at the umbilicus
  • Abnormal insertion of cord, discolored cord, or two-vessel cord
  • A rigid abdomen
• Male Genitalia


  • Penis is normal size for age and no lesions are seen
  • The foreskin is retractable in uncircumcised child
  • Urinary meatus is at tip of glans penis and has no discharge or redness
  • Scrotum is free of lesions
  • Testes are palpable in scrotum with the left testicle usually lower than the right