CHIPOLA COLLEGE
NURSING PROGRAM
NEWBORN ASSESSMENT
Birth Data
Gestational Age____________ Male/Female
Weight_____________ Vital Signs: T _____
Length_____________ P_____
Head Circumference__________ R_____
Chest Circumference__________
Apgars: 1 minute________ 5 minutes_________
Supportive Data
Complications of Pregnancy_________________________________________________
Preexisting Maternal Condition______________________________________________
Prenatal care: yes/no
Maternal Age_______
Maternal smoking/alcohol/drugs (circle and explain)
Anesthesia used during labor and delivery______________________________________
Length of labor________
Length of membrane rupture__________
Amniotic Fluid clear/meconium stained
Complications of labor_____________________________________________________
Presentation_________
Type of delivery: Vaginal/C-section
Resuscitation measures____________________________________________________
Physical Assessment
Skin (Color, Appearance, Turgor, Birthmarks) ________________________________________________________________________
________________________________________________________________________
Head/Scalp (Fontanels, Molding, Cephalohematoma, Caput Succedaneum):___________
________________________________________________________________________
Eyes (Reactivity/Discharge):________________________________________________
Mouth and Throat:________________________________________________________ _______________________________________________________________________
Chest (Quality of Respirations, Lung Sounds, Effort, Retractions, Grunting):__________ _______________________________________________________________________
________________________________________________________________________
Heart (Apical Rate & Rhythm, Heart Sounds, Pulses):____________________________
________________________________________________________________________
Abdomen (Shape, Umbilicus, Hernia, Bowel Sounds):___________________________
________________________________________________________________________
Anogenital (Anal Patency, Stool Type, Genital Swelling):_________________________
_______________________________________________________________________
Reflexes (Moro, Tonic Neck, Palmar grasp, Step, Babinski, Rooting, Sucking):________
_______________________________________________________________________
_______________________________________________________________________
Extremities (Symmetry, Polydactyly or Syndactyly):_____________________________
________________________________________________________________________