S.

NO

SPECIFIC
OBJECTIVES

TIME
CONTENTS

1.

Introduce the
topic.

3min

INTRODUCTIONMonitoring of neonate is the keynote of to their

successful outcome. Accurate observation is a vital
factor in the survival and future development of the
newborn. The initial physical examination should be
performed as soon as possible after birth. All
newborn should be thoroughly examined in the first
24-48 hours of age. The nurse must understand the
characteristics of the newborn to understand his
status effectively.

2.

Define the term

of newborn.

2min

3.

Explain the
purpose of
assessment.

2min

PURPOSE OF ASSESSMENTThe overall purpose of newborn examination are to1. Identify the physical and neurological
characteristics of newborn.
2. Identify and record evidence of common
neonatal problems and congenital anomalies.
3. Provide a basis for identification of needs and
plan nursing care of newborn.

4.

Enlist the
specific
examination
followed while
examining
newborn.

4min

SPECIFIC INSTRUCTIONSTo perform thorough skilled examination of

newborn, the following specific instructions should
be kept in mind.
1. Observation should be made when the
newborn is quiet and awake.

.
DEFINITION:A healthy infant born at term (between 38-42 weeks) should
have an average birth weight for the country (usually
exceeds 2500 gm.), cries immediately after birth, establishes
independent rhythmic respiration & quickly adapts to the
changed environment.
In India, the weight varies between 2.7-3.1 kg. with a
mean of 2.9 kg. the length is 50-52 cm.

TEACHING/
LEARNING
ACTIVITY
Lecture cum
discussion

A.V.
AIDS

EVALUATION

lcd

Lecture cun
discussion

Black
board

Define the term

of newborn?

Lecture cum
discussion

lcd

Who will explain

the purpose of the
assessment?

Lecture cum
discussion

Who will explain

the specific
instructions?

2. Ensure adequate light in examination room.

3. The temperature of the examination room is
maintained at 28+-2c. Avoid draft and chills
in the examination room.
4. Wash hands till elbow for 3min before and
after handling the newborn.
5.

Described
article required
for examination
of newborn.

2min

ARTICLES REQUIRED FOR EXAMINATION

1. Weighing machine to measure weight
2. Measuring tape to measure head
circumference, chest circumference and
abdominal girth
3. Infantometer to measure crown to heel
length
4. T.P.R. Tray to check temperature
5. Stethoscope to auscultate heart rate
6. Torch to check papillary reflex and to
observation oral cavity
7. Record sheet to record the findings

6.

Enumerate
various aspects
of history
related to
newborn.

4min

GUIDELINES FOR ASSESSMENTExamination of newborn includes reviewing history,

measurements, general appearance, vital signs and
head to toe assessment for identification of physical
characteristics and deviations, if any.
a) Information related to previous pregnancygravida, para, abortions, number of alive
children, still born.
b) Information related to present pregnancyEDD, registered, immunization, nutrition
during pregnancy, any history of illness like
PIH, eclampsia, anaemia, fever and DM
c) History of labour- presentation, duration of
labour, rupture of membranes, method of
delivery, medication during labour

Descibe the
physical
assessment of

5min

7.

PHYSICAL ASSESSMENT OF THE

NEWBORNPhysical assessment includes vital signs and head to

Lecture cum
discussion
.

lcd

Which article
used for
examination?

Lecture cum
discussion

lcd

Enumerate
various aspects of
history related to
newborn?

Lecture cum
discussion

lcd

Who will explain

the assessment of

the newborn.

toe examination.
VITAL SIGNS1. Respiratory rate (normal- 30-60 per min )
2. Heart rate- Apical rate (normal:120-160 per
min)
3. Temperature: either axillary or anal (normal
axillary temperature 36.5-37.5c ,95.5-99.3f )
4. Weight: weigh newborn at the same time each
time before feeding.( birth weight is 2500 gm)
5. Place newborn on flat surface and extend legs
fully before measuring to check length of the
baby.
6. Measure around the fullest part of the occiput
to check head circumference.( normal head
circumference 33-35.5 cm )
7. Measure the chest circumference over the
nipples and across the lower border of the
scapula. (normal 31-33 cm )
DETAILED PHYSICAL ASSESSMENTHead and face
- head size in proportion to body.
- Presence of moulding.
- Symmetry features
Fontannels
- Anterior fontanels: diamond shaped 3-4 cm
long, 2-3cm wide at 18 months.
- Posterior fontanels : triangle shaped, closed
by 8-12 weeks.
- Tense bulging fontanels indicate increase of
intra cranial pressure
- Sunken fontanel indicate dehydration
Eyes
-

colour
transient strabismus and nystagmus common
in newborn
dolls eye phenomenon

the newborn?

Nose and mouth

- nasal patency
- mucous secretions, if excessive indicate
tracheoesophageal fistula
- precocious teeth
- epsteins pearl over the hard palate
Ears and neck
- ear pliability and flexibility
- low set ears indicate chromosomal or organ
abnormality
- hearing
- neck size
Chest
- contour and symmetry ( normally round and
symmetrical )
- breast engorgement may be evident 2-3 days
after birth due to maternal hormone withdrawl
- respiration ( normally shallow, symmetrical,
synchronous with abdominal movement)
- breath sounds ( crackles may be present
during transitional period representing fetal
lung fluid and areas of atelectasis.)
- rhonchi indicate fluid, mucus or meconium I
the larger bronchi.
- Heart sound ( murmurs can be heard in case
of improper closure of foramen ovale or
ductus arterioles.
Abdomen
- contour of abdomen ( normally round )
- umbilical cord ( normally check for two
arteries and one vein )
- scaffold ( deflated ) sunken abdomen
indicates diaphragmatic hernia.
- Bowel sounds ( normally audible when
newborn is relaxed )

Genitalia
Female- labia minora may have vernix
- labia majora ( normally covers minora and
clitoris )
- vaginal discharge ( may be present due to
maternal hormones )
Male- scrotum ( normally rugae present and both
testis descended in to the scrotum )
- penis ( urethral meatus normally located at tip
of glans )
Back and buttocks
- spine ( normally flat and round )
- patent and opening

Upper extremities
- flexion and movement ( normally well flexed
with symmetrical movement )
- grasp reflex ( normally present )
- muscle tone and strength
- brachial pulses ( normally present )
Lower extremities
- length and flexion ( normally short, bowed
and flexed )
- femoral and pedal pulses ( normally present )
Neurological assessment
- blinking, cough, sneeze and gag reflaxes are
present
- several reflexes are normally present at birth
and they are disappear in the first year of life.

8.

Explain the
reflexes of the
newborn.

5min

1 REFLEXES OF THE NORMAL NEONATE:1. Rooting reflex:-

Touching or stroking the cheek near the

corner of the mouth head turns towards the stimulation,
mainly to find food.
Disappeares in 3- 4 months when awake and 7-8
months when asleep.
2. Sucking reflex:-

Touching the lips with the nipples of the

breast- sucking movements to take in food.
Disappeares in 6 months.
3. Swallowing reflex:-

Accompanies the sucking reflex.food

reaching the posterior of the mouth is swallowed.
Does not disappear.
4. Gagging reflex:-

When more food is taken into the mouth that

can be successfully swallowed.immediately return of
undigested food.
Does not disappear.
5. Sneezing reflex:-

Foreign substancess entering the upper and

lower airways.clearing of upper air passage by sneezing
and lower air passage by coughing.
Does not disappears.
6. Blinking reflex:-

Exposure of eyes to bright light.protection

of eyes by rapid eyelid closure.
Does not disappears.
7. Dolls eye:-

Turn the neonates head slowly to right or left

side.normally eyes do not move.

Lecture cum
dicussion

lcd

Can you explain

the reflexes of the
normal neonate?

Disappears when fixation develops.

8. Palmer grasp:-

Object placed in neonates palm.grasping

of object by closing fingers around it.
Disappear in 6 weeks to 3 months.
9. Stepping/ dancing:-

Hold neonate in a vertical position with feet

touching a flat and firm surface.rapid
10. Moro/ startle:-

Startling the neonate with a loud voice or

apparent loss of support due to change in equilibrium. The
neonate is held in supine position supporting upper back and
head with one hand and lower back with other. The neonates
head is suddenly allowed to drop down back ward for an
inch.generalized muscular activity. Symmetric abduction
and extension of arms and legs with fanning of fingers. The
thumb and index fingers form a c shaped n both hand. The
extremities then flex and adduct. The baby may cry.
Strong up to 2 months disappears by 3-4 months.
11. Glabellar reflex:-

Tap gently over the fore head.the eyes will

blink.
12. Planter grasp:-

Pressure on the sole of foot behind toes.this

cause flexion of toes.
13. Tonic neck reflex:-

Sudden jolt.head turn to one side with leg

and arm on that side extended , while the leg and arm of
opposite side will flex.
The reflex normally disappears after 2-3 months.
14. Neck righting:-

When head is turned to one side.the

shoulder and trunk , followed by the pelvis will turn to that

side.
15. Babinskis sign:-

Scratching sole of foot.causes great toes to

flex and toes to fan.
16. Positive supporting reflex:-

When in erect position.baby will stiffen

lower extremities and support his weight.
17. Crossed extensor:-

When one leg is extended and the knee is held

straight, while the sole of foot is stimulated.the opposite
leg will flex.
18. Landaus reflex:-

When a baby is suspended horizontally with

head depressed against trunk and neck flexed.legs will be
drawn up to trunk .
Present form 3 months and is difficult to elicit after
one year.
19. Auditory blink reflex:-

Examiner loudly claps hands.eyes quickly

close.
20. Recoil of arm:-

When both arms are extended simultaneously

by pulling outwards and grasping wrists.--- both arm will
flex at elbows when released.
21. Withdrawal reflex:-

Pricking sole of foot.the babys leg being

flexed at hip, knee and ankle.
22. Placing reflex:-

When infant is held upright with dorsum of

foot gently touching the lower edge of the table.will try to

bring the foot above the table.

23. Parachute reflex:-

When the infant is held prone and lowered

suddenly toward the surface.he will extend arms and legs.
It appears at about 6-9 months and persist there after.
24. Perez reflex:-

When babys suspended horizontally when

there is tapping of head.trunk and neck flexed , legs will
be drawn up to trunk and back becomes rounded.
25. Chovestek sign:-

When there is tapping in the course of facial

nerve, there are facial twitching.

Sumarry:- After the demonstration the students are able to

do the neonatal assessment in a right manner & step by step.

DEMONSTRATION ON

NEWBORN ASSESMENT

Name:Guide:Group :Topic:- Newborn assesment

Venue;Date:Time :- 12 .00 noon
Method Of Teaching;- Lecture Cum Discussion & Demonstration
Genral Objective:At the end of seminar the group will be able to gain thorough knowledg about
Newborn assessment.
Specific objective:At the end of the seminar the group will be able to
Define newborn assessment
Enlist the Purposes of newborn assessment
Enlist the special instructions about newborn assessment
List if articles required
Explain the guideline of assessment
Enlist the various reflexes of newborn.