Neonatal Physical Assessment - PowerPoint Presentation

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Neonatal Physical Assessment

Prepared by : Sabha . Mariam . Alaa . Nabila . Nermin

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physical examination

The aim of the first examination performed within 24 hours of birth is to detect any .observable congenital malformations“The baby should have a complete physical examination within 24 hours ofbirth, as well as within 24 hours before discharge”.

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Apgar scoring

1. The Apgar score helps find breathing problems and other health issues.2. It is part of the special attention given to a baby in the first few minutes after birth. 3. The baby is checked at 1 minute and 5 minutes after birth for heart and respiratory rates, muscle tone, reflexes, and color. 4. A baby who needs help with any of these issues is getting constant attention during those first 5 to 10 minutes

.

5. Each

area can have a score of 0, 1, or 2, with 10 points as the

maximum.

.

6. Most

babies score 8 or

9

7. Apgar

scores of 6 or less usually mean a baby needed immediate attention and care

.

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The Apgar Scoring System

Sign

Score

=

0

Score

=

1

Score

=

2

Heart rate

Absent

Below

100

per

minute

Above

100

per

minute

Breathing

effort

Absent

Weak, irregular, or

gasping

Good, crying

Muscle tone

Flaccid

Some flexing of

arms and legs

Well

-

flexed, or active

movements of arms and legs

Reflex or

irritability

No response

Grimace or weak

cry

Good cry

Color

Blue all over,

or pale

Body pink,

hands

and feet blue

Pink all over

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Measurement

There are 3 components for growth measurements in :neonates 1. Weights:- A healthy term baby weights approximately .2.6 kg - 3.8 kg- Babies less than 2.5 kg are considered low birth weights.

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2. Length

- Acceptable newborn lengths ranges from 48 – 52 cm at birth.

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3. head circumference :- The head circumference measurement of

the

occipitofrontal

diameter

should

be

in

the

range

of 32–36 cm for

a term baby.

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4. Chest circumference

- Normal range 33 – 35 cm.

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Vital Sings :

1. Temperature .- should be taken axillary - the normal temperature for newborn is 36.5 – 37.50c .& Methods of heat loss :Convection.Radiation.

Evaporation.

Conduction.

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2. Respiratory rate & Heart rate

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Assessment of the neonatal skin

The colour of the skin is generally considered a reflection of good health, but is most difficult to assess accurately in the first few hours of extra uterine life and the midwife needs to distinguish between different types and degrees of blue skin to know if the baby is well or whether to refer to the neonatal registrar.

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A blue skin as a result of other

factors* Most babies will haveperipheral shutdown (acrocyanosis) * Perioralcyanosis

* Jaundice

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* petechiae

which are pinpoint hemorrhagic spots on the skin, usually as a result of a tightening cord around the neck* RashesWords to describe rashes

Red

&

Flat

Pustules

vesicles

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Port wine stain:

red, purple markings

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Common skin lesions found at

birthVascular birth marks found at birthVascular proliferationsVasculature malformations

Cavernous

haemangioma

:

similar to the strawberry

but

invades deeper into the vascular tissues

Mongolian blue

spots:

blue-black

discoloration

usually found over the buttocks

Pigmented

naevi

:

a dark brown patch on the lower back with speckles.

Milia :small white follicular cysts commonly known as milk spots.

Strawberry haemangioma:bright red in colouror ‘stork marks:superficial capillaries that blanche on pressure, resolve spontaneously

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Assessment

of the neonatal head

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The

bones, sutures and fontanelles can then be e

x

a

m

i

n

e

d

*

The

posterior

fontanelle

(lambda)

closes

.

around

6 weeks*The

anterior fontanelle (bregma) closes at

18 .months of age

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Abnormal head

macrocephalymicrocephaly(below the 2nd centile)

s

m

a

l

l

h

e

ad

i

s a

ss

oc

i

a

tedwith poor

brain developmen

t.

(greater than the 97th centile)

large head

is also associ

ated with

hydroc

epha

ly a

nd co

ngen

ital s

yndro

mes.

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Cephalhematoma

caput succedaneum

O

b

s

e

r

v

a

t

i

o

n

and

palpation of the scalp

will indicate the presence and degree of

caput succedaneum which will resolve in 2–3

days. is a subperiosteal collection of blood between the skull and the periosteum.

* Disappear within afew weeks.

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Anencephaly 

is the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development

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Encephalocele

A sac-like protrusion of the brain through an .opening in the midline of the skull

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Cuts, abrasions and bruises

These are carefully assessed as they may serve as .portals of entry for infection

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congenital torticollis

The head may be held to one side and is the result of traction and tearing of the muscle. Physiotherapy referral will be made once diagnosed

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Assessment

of the neonatal faceFacial palsyaffected side of the face droops and the infant is unable to

close the

eye tightly on that

side.When

crying

the

mouth is pulled

across

to the normal side

.

This is a result of damage to the

seventh cranial

nerve (facial

),known

as Bell's palsy,

during the application of forceps or from head compression against the sacral promontory during birth. Spontaneous resolution is usually within 7–10 days; this may extend to months or years if the damage is severe

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Eye:

The eyes should be symmetrically positioned on the face in relation to the other facial features such as eyelids, eyebrows and the slant of the palpebral fissures.The outer and inner canthal distance can be divided equally. * Cataracts– Eyes appear cloudy

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Ear:

The ear position should be similar on both sides. Malformed and/or low set ears are associated with chromosomal abnormalities or urogenital malformations and warrant referral. argue that peri-auricular skin tags can indicate hearing impairment.

peri-auricular

Normal ear tag

microtia

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Mouth

Lip and Palate:Cleft lip can be either unilateral or bilateral and can extend into the hard and soft palate.A cleft palate is not always obvious and requires thorough assessment in order to confirm its presence.

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Cleft lip and/or palate may be familial or may be as a result of maternal medication (e.g. phenytoin) or chromosomal abnormality (e.g. Down syndrome

).The baby may also experience problems with feeding.

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Chin

Microganthia Normal chin

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ankyloglossia

A tight frenulum that is attached too far forward to the floor of the mouth restricts mobility of the tongue to different degrees and will give the appearance of tongue-tie (ankyloglossia).* Treatment for severe tongue-tie is frenulotomy (surgical division of the frenulum), especially when breastfeeding is being adversely affected.

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Chest

Chest In drawing (Retractions)

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umbilicus

The cord should be checked for bleeding. The cord vessels should have two arteries and one vein.

A

A

v

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comparison

OMPHALOCELE• The internal organs remain in a sac• Protrudes through the umbilicus GASTROSCHESIS• The umbilical cord is not involved• The internal organs are NOTenclosed in a sac

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Anus

Inspection for the presence and appearance of the anus is vital.The presence of meconium does not always exclude imperforate anus (anal atresia).

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Spine or back assessment :

Spina bifida: defect in closure of the neural tube that is associated with malformation of the vertebra & spinal cord.

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Saccrococcygeal Teratoma

.* A tumor found in the midline of the body• In newborns, the most common location is the .sacrococcygeal region- at the base of the spine• This is a mass of tissue, and does not come

out

.

of

the

spinal cord

as in

Spina

bifida

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Limbs, hands and feet

normal hand

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Erb's palsy

* is a paralysis of the arm caused by injury to the upper group of the arm's main nerves,* (C5,6) - Upper Lesion.Klumpke's palsy * is a variety of partial palsy of the lower roots of the brachial plexus.* (C8,T1) - Lower lesion.

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Neurological Examination

• Means looking at muscles and nervesHypotonia

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Reflex

الاستجابة

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Thank You