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SHARON GAN 2 West - Austin Hospital School of Nursing and Midwifery

Examination and assessment of the newborn baby. SHARON GAN 2 West - Austin Hospital School of Nursing and Midwifery . Objectives. Revise transition of intrauterine to extrauterine life of a newborn Perform a systematic examination of the newborn - view video

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SHARON GAN 2 West - Austin Hospital School of Nursing and Midwifery

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  1. Examination and assessment of the newborn baby SHARON GAN 2 West - Austin Hospital School of Nursing and Midwifery

  2. Objectives • Revise transition of intrauterine to extrauterine life of a newborn • Perform a systematic examination of the newborn - view video • Know the characteristics of the newborn including reflexes and its implications.

  3. Examination of the Newborn • The transition from intrauterine to extrauterine life is a dramatic one and demands considerable physiological alterations by the baby to ensure survival • The uterine environment has provided oxygen, nutrition, excretion and thermoregulation and a dulled environment to the stimuli of the outside world

  4. Examination of the Newborn • The fetus is subjected in labour to intermittently diminished supply of oxygen during contractions, compression of the head and chest, extension of the limbs, hips and spine during birth • The baby then emerges to encounter light, noises, cool air, gravity and tactile stimuli

  5. Examination of the Newborn • Once born the baby has to make rapid adjustments to the respiratory and circulatory systems as well as controlling body temperature • These initial adaptations are crucial to the baby’s subsequent well being

  6. Examination of the newborn • A complete examination will be done prior to discharge from hospital • Top to toe • Check history – congenital problems? Birth problems? • Involve parents and explain what she is doing (and share results) • Be careful and methodical • If abnormality found, handle sensitively and arrange paediatric follow up • Answer questions and give appropriate education • Unwrap baby and examine gently in warm, well lit space

  7. General observations • Overall appearance – color, behaviour, activity • Breathing - 36-60 breaths per minute • Pink • Vernix caseosa • Post mature - less vernix, drier skin, creases on feet • Variable amount of hair • Blue/green eyes • Lanugo - fine hair, usually on preterm baby • Note - movement and tone • HR – 100-160bpm • Temp – 36.5-37.1 degrees (PA) • Cry – not high pitched

  8. Neurological examination • Note symmetry • State – alert, sleepy • Lethargy • Irritability • Posture • Tone • Muscle strength • Reflexes

  9. Examination of the Newborn • There are some reflexes that the midwife can test for soon after birth • The assessment should be done while the baby is in a quiet, alert state • Weak or absent responses may indicate immaturity, cerebral damage or abnormality

  10. A healthy baby? • A healthy, term baby: • Can maintain stable temperature • Will initiate feeds, suck well and settle between feeds • They are not excessively irritable, tense, sleepy or floppy • Pass meconium and urine within 24 hours

  11. Examination of the Newborn • The Moro reflex is a response to a sudden stimulus • The baby is held supine with head and trunk supported, the head and shoulders are allowed to fall back • The baby responds by abduction and extension of the arms with the fingers fanned, accompanied by a tremor

  12. Examination of the Newborn • Rooting reflex is obtained by stroking of the cheek or the side of the mouth and the baby will turn to the source of the stimulus • Sucking and swallowing reflexes can be observed when the baby is feeding • Gag, cough and sneeze reflexes are to protect the baby from airway obstruction • Grasp reflex is obtained by placing a finger in the palm of the baby’s hand and the baby will grasp the finger

  13. Examination of the Newborn • Walking and stepping reflexes are found when the baby is supported upright with the feet touching a flat surface • The baby will simulate walking • Crawling reflex present when baby is placed on stomach, knees drawn, kick their legs out, shuffle and move in a crawling motion

  14. Central Nervous System

  15. Summary • Review assessment of a newborn • Consider reflexes present in newborn, interpret results and care for the babies in our care.

  16. References • Fuloria, M &Kreiter, S. (2002). The newborn examination: Part 1. American Family Physician, 65 (1): 61 – 68 • Fuloria, M &Kreiter, S. (2002). The newborn examination: Part 2. American Family Physician, 65 (2): 265 – 270 • Yang, M. (2004) Newborn neurologic examination. • Video: Examination of the newborn

  17. Questions and Comments mlmlblog.wordpress.com

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