Normal Newborn

Normal Newborn: General Appearance [email protected] Well-flexed, full range of motion, spontaneous movement Common variations Legs extended with frank breech Signs of potential distress or deviations from expected findings Posture limp Asymmetry of movement Persistent tremor, twitching Vital Signs Temperature - range 36.5 to 37 axillary Common variations Crying may elevate temperature Stabilizes in 8 to 10 hours after delivery Signs of potential distress or deviations from expected findings Temperature is not reliable indicator of infection A temperature less than 36.5 Heart rate - range 120 to 160 beats per minute Common variations Heart rate range to 100 when sleeping to 180 when crying Color pink with acrocyanosis Heart rate may be irregular with crying Signs of potential distress or deviations from expected findings Although murmurs may be due to transitional circulation-all murmurs should be followed-up and referred for medical evaluation Deviation from range Faint sound Respiration - range 30 to 60 breaths per minute Common variations Bilateral bronchial breath sounds Moist breath sounds may be present shortly after birth Signs of potential distress or deviations from expected findings Asymmetrical chest movements Apnea >15 seconds Diminished breath sounds

Seesaw respirations Grunting Nasal flaring Retractions Deep sighing Tachypnea - respirations > 60 Persistent irregular breathing Excessive mucus Persistant fine crackles Stridor Blood pressure - not done routinely Factors to consider Varies with change in activity level Appropriate cuff size important for accurate reading Average newborn (1 to 3 days) oscillometry pressure value: 65/41 in both upper and lower extremities Sign of potential distress or deviations from expected findings Calf systolic pressure 6 to 9 mm Hg less than systolic pressure in upper extremities may be indicative of coarctation of the aorta General Measurements Head circumference - 33 to 35 cm Expected findings Head should be 2 to 3 cms larger than the chest Chest circumference - 30.5 to 33 cm Common variations Molding of head may result in a lower head circumference measurement Head and chest circumference may be equal for the first 24 to 48 hours of life Weight range - 2500 - 4000 gms (5 lbs. 8oz. - 8 lbs. 13 oz.) Length range - 48 to 53 cms (19 - 21 inches)

Skin Expected findings Skin reddish in color, smooth and puffy at birth

At 24 - 36 hours of age, skin flaky, dry and pink in color Edema around eyes, feet, and genitals Vernix caseosa Lanugo Turgor good with quick recoil Hair silky and soft with individual strands Nipples present and in expected locations Cord with one vein and two arteries Cord clamp tight and cord drying Nails to end of fingers and often extend slightly beyond Common variations Acrocyanosis - result of sluggish peripheral circulation

Mongolian spots in infants of African-American descent

Mottling

Physiologic jaundice

Milia

Erythema toxicum

Petechiae/ bruises over presenting part Skin tags usually around ears or digits (tied off) Harlequin color change

Signs of potential distress or deviations from normal findings Jaundice within 24 hours of birth General cyanosis Circumoral cyanosis between feedings Petechiae or ecchymoses other than on presenting part All rashes with exception of erythema toxicum Pigmented nevi Yellow vernix Hemangioma Pallor Forceps marks

Head Expected findings Anterior fontanel diamond shaped 2-3 - 3-4 cms Posterior fontanel triangular 0.5 - 1 cm Fontanels soft, firm and flat Sutures palpable with small separation between each

Common variations Caput succedaneum

Molding of fontanels and suture spaces

Signs of potential distress or deviations from normal findings Fontanels that are bulging or depressed Hydrocephalus Macrocephaly Cephalhematoma

Closed sutures

Eyes Expected findings Slate gray or blue eye color No tears Fixation at times - with ability to follow objects to midline Red reflex Blink reflex Distinct eyebrows Cornea bright and shiny Pupils equal and reactive to light

Common variations Edematous eyelids

Uncoordinated movements

May focus for a few seconds

Signs of potential distress or deviations from expected findings Discharges Chemical conjunctivitis

Opaque lenses Absence of Red Reflex Epicanthal folds in newborns not of Oriental descent "Doll's eyes" beyond 10 days of age Reflexes absent Subconjunctival hemorrhage

Expected findings Pinna top on horizontal line with outer canthus of eye

Loud noise elicits Startle Reflex Flexible pinna with cartilage present

Common variations Skin tags on or around ears

Signs of potential distress or deviations from expected findings Ear placement low Preauricular sinus

Clefts present Malformations Cartilage absent

Nose Expected findings Nostrils patent bilaterally Obligate nose breathers No nasal discharge

Common variations Sneezes to clear nostrils Bridge appears absent Thin white nasal mucus discharge

Signs of potential distress or deviations from expected findings Choanal atresia and discharge Malformation Nasal flaring beyond first few moments after birth

Mouth and Throat Expected findings Mucosa moist. Shortly after birth may visualize sucking calluses on central portions of lips.

Palate high arched

Uvula midline Minimal or absent salivation Tongue moves freely and does not protrude Well developed fat pads bilateral cheeks Sucking reflex

Rooting reflex Gag reflex Extrusion reflex

Common variations Epstein's pearls on ridges of gums

Signs of potential distress or deviations from expected findings Cleft lip or cleft palate Circumoral pallor Lip movement asymmetrical Reflexes absent or incomplete Protruding tongue Candida Albicans

Diminished tongue movement Percocious teeth

Neck Expected findings Short and thick Turns easily side to side Clavicles intact Tonic neck reflex present Neck-righting reflex present Some head control

Signs of potential distress or deviations from expected findings Torticollis-stiff neck drawing head to one side Resistance to flexion Webbing of neck Large fat pad on back of neck Palpable crepitus, movement with palpation of clavicle

Chest

Expected findings Evident xiphoid process Equal anteroposterior and lateral diameter Bilateral synchronous chest movement Symmetrical nipples

Common variations "Witch's milk" Enlarged breasts Accessory nipples

Signs of potential distress or deviations from expected findings Asymmetrical chest movements Sternum depressed Marked retractions Absent breast tissue Flattened chest Supernumerary nipples Nipples widely spaced Bowel sounds auscultated

Abdomen

Expected findings Dome-shaped abdomen Abdominal respirations Soft to palpation Well formed umbilical cord Three vessels in cord Cord dry at base Liver papable 2 - 3 cms below right costal margin Bilaterally equal femoral pulses Bowel sounds auscultated within two hours of birth Voiding within 24 hours of birth Meconium within 24 - 48 hours of birth

Common variations Small umbilical hernia

Signs of potential distress or deviations from expected findings Bowel sounds absent Peristaltic waves visible Abdominal distention Palpable masses Scaphoid-shaped abdomen Omphalocele Base of cord with redness or drainage Cord with two vessels

Female Genitalia Expected findings Edematous labia and clitoris Labia majora are larger and surrounding labia minora Vernix between labia

Common variations Hymenal tag Pseudomenstruation Smegma Increased pigmentation

Ecchymosis and edema after breech birth "Red brick" pink-stained urine due to uric acid crystals

Signs of potential distress or deviations from expected findings Labia fused Fecal discharge from vaginal opening Imperforate hymen Ambiguous genitalia Widely separated labia

Male Genitalia Expected findings Urinary meatus at tip of glans penis Palpable testes in scrotum Large, edematous, pendulous scrotum, with rugae Smegma beneath prepuce Stream adequate on voiding

Common variations Prepuce covering urinary meatus Erections Increased pigmentation Edema and ecchymosis after breech delivery

Signs of potential distress or deviations from expected findings Non palpable testes Hypospadius Epispadius Scrotum smooth Ambiguous genitalia

Back and Rectum

Expected findings Intact spine without masses or openings Trunk incurvature reflex Patent anal opening "Wink reflex" present

Signs of potential distress or deviations from expected findings

Limitation of movement Fusion of vertebrae Spina bifida Tuft of hair Imperforate anus Anal fissures Pilonidal cystExtremities Expected findings Maintains posture of flexion Equal and bilateral movement and tone Full range of motion all joints Ten fingers and ten toes Legs appear bowed Feet appear flat

Palmar creases present

Sole creases present

Negative hip click Grasp reflex present

Signs of potential distress or deviations from expected findings Unequal tone Asymmetrical movement of extremities Polydactyly

Syndactyly Unequal leg length Asymmetrical skin creases posterior thigh

Dislocation of hip

Simean crease Persistent cyanosis of nail beds Marked metatarus varus

Neuromuscular System Expected findings Maintains postion of flexion When prone, turns head side to side Holds head and back in horizontal plane when held prone Ability to hold head momentarily erect

Signs of potential distress or deviations from expected findings Hypotonia Quivering

Limp extremities or straightening of extremities Clonic jerking Paralysis