Approach to the Normal Newborn

Approach to the Normal Newborn

Approach to the Normal Newborn

  1. Prenatal Interview
  2. 4 weeks prior to birth
  3. Provider office, end of day
  4. Topics to be covered
  5. Prenatal history
  6. Difficulty with conception
  7. Smoking, alcohol, drugs
  8. Prenatal care
  9. Complications
  10. STD during pregnancy- hepatitis, HIV, Herpes, syphilis
  11. General maternal/paternal health
  12. Social factors
  13. Breast feeding- colostrum is the first substance produced in the breast; passes immunoglobulins to the infant
  14. Anticipatory guidance- small objects, cover outlets
  15. Initial Evaluation
  16. Should take place at birth or shortly thereafter (within 12-24 hours)
  17. Normal deliveries
  18. Pediatrician presence not necessary (unless complications)
  19. Indications for pediatric presence
  20. C-section
  21. Multiple births
  22. Prematurity (<36 weeks=premature)
  23. Meconium staining (1st stool of infant, green staining out of womb; risk of infant aspiration of meconium)-CPAP
  24. Fetal distress- fetal deceleration (infant heart rate drops during contractions)
  25. Known anatomic anomaly
  26. Review of delivery record- 12-24 hours post delivery
  27. Length
  28. Duration of ruptured membranes- >24 hours prior to birth is a risk for infection to infant
  29. Mother/fetal course of labor-nuchal cord, fetal distress
  30. Apgar score- standard test to evaluate newborn

  1. One done at one minute
  2. 2nd done at 5 minutes
  3. Out of 10
  4. Normal score 9

  1. In the Delivery Room
  2. Normal newborn
  3. Clean childbirth
  4. Cord care- should have 2 arteries and 1 vein in umbilical cord
  5. Prevent hyper/hypothermia- keep baby warm
  6. Hepatitis B vaccine- if mother is HBsAG + give immunoglobulin
  7. Eye care- for gonorrhea and chlamydia; done immediately

  1. 1% silver nitrate or
  2. 1% tetracycline ointment

  1. Bonding with mother
  2. If mom HIV + give infant AZT within 8-12 hours

Apgar Score- normal score 9; lose 1 for color usually

0 / 1 / 2
Heart Rate / Absent / <100 / >100
Respiratory Effort / Absent / Slow, irregular / Good cry
Muscle Tone / Limp / Flexion of extremities / Active motor
Reflex / None / Grimace / Sneeze, cough
Color / Blue / Pink body, pale extremities / Pink

IF less than 7 at 5 minutes must due 2 additional evaluations at 10 and 20 minutes; less than 7 again must call NICU

  1. Normal Values
  2. Respiratory rate
  3. 30-60 breaths/min
  4. Heart rate
  5. 120-160 beats/min
  6. Urine
  7. Shoulder make urine by 12 hours- will be concentrated
  8. If not there may be anatomical or structural problem
  9. Meconium
  10. Should pass Meconium by 12 hours
  11. IF not passed think cystic fibrosis, hypothyroidism, obstruction, and Hirsch-Brungs disease
  12. Head circumference
  13. Length
  14. Taken recumbent until 2 years old
  15. Weight- usually let them go at 5 pounds
  16. Lose 5-7% of birth weight in 1st few days of life
  17. Physical Exam
  18. Head
  19. Fontanels- leaves room for brain expansion
  20. Anterior (1-4cm)- closes 15-18 months
  21. Posterior (<1cm)- closes by 2 months
  22. Molding
  23. Caput succedaneum- accumulation of serosanguinous, subcutaneous fluid in the head which extends across the suture lines; soft bump in the head
  24. Cephalohematoma- rupture of the blood vessels between the skull and the periosteum; limited by suture lines (won’t cross)
  25. Skin
  26. Erythema toxicum neonatorum- most common skin dysfunction in infant; red rash often seen where clothing rubs on body; blotchy and erythematous (legs, face, arms); resolves on its own
  27. Milia- superficial inclusion cysts on nose and face (whiteheads)
  28. Ear position- low set ears signifies down syndrome
  29. Lingual frenulum- if enlarged infant will have difficulty sucking
  30. Epstein pearls- eruption cysts on buccal mucosa and gingiva
  31. Teeth- no teeth at birth
  32. Hard and soft palate- evidence of cleft palate; must be surgically corrected
  33. Digits- polydactily- look for extra digits; tie it off
  34. Club feet or rocker bottom feet
  35. Femoral trochanter- look for evidence of congenital hip dislocations
  36. Ortoloni test and Barlow test
  37. Muscle tone- limp is a sign of hypothyroidism; spastic is sign of CP
  38. Genitalia- at birth testes should be in scrotum (abdomen)
  39. Abdomen- normal to be able to feel liver; not in RLQ (CHF)
  40. Umbilical hernia- right around umbilicus (closes by 1 year)
  41. Eyes- congenital cataracts (no red reflex)
  42. Reflexes
  43. Rooting reflex
  44. Stroke corner of mouth
  45. Suck
  46. Touch roof of mouth
  47. Moro
  48. Startled by loud sound/movement
  49. Tonic/neck
  50. Fencing
  51. Turn head to one side arm will extend, opposite arm with flex
  52. Grasp
  53. Stroke hand
  54. Babinski- normal for a child to have a positive Babinski (up to 2 y.o.)
  55. Stroke plantar surface of foot
  56. Stepping reflex
  57. Hold patient upright, with feet touching solid surface
  58. 1st physician office visit should be before 7 days of age (according to AAP)
  59. Cord care (for parents)- never pull cord off
  60. Keep dry, exposed to air
  61. Clean with alcohol or water each day
  62. Look for redness or pain
  63. Can put IV into cord
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