Ch. 20- Assessment of the Normal Newborn

Nevus flammeus

"port-wine stain" is a permanent, flat, pink to dark reddish-purple mark that varies in size and location and does not blanch with pressure.

Nevus vasculosus

"strawberry hemangioma" consists of enlarged capillaries in the outer layers of the skin. It is dark red and raised with a rough surface, giving a strawberry life appearance.

Grunting

A noise made on expiration when air crosses partially closed vocal cords. Persistent grunting is a common sign of respiratory distress syndrome

Flaring of the nares

A reflex widening of the nostrils occurs when the infant is receiving insufficient oxygen.

Vernix caseosa

A thick, white substance that resembles cream cheese, provides a protective covering for the fetal skin in utero.

Nevus simplex

Also called "salmon patch" "stork bite" or "telangectatic nevus". Flat, pink discoloration from dilated capillaries that occurs on the eyelids, just above the bridge of the nose or at the nape of the neck. Usually disappear by 2 years of age.

Caput Succedaneum

An area of localized edema that appears over the vertex of the newborn's head as a result of pressure against the mother's cervix during labor. It resolves quickly and generally disappears within 12-48 hours after birth.

Assess airway

Assess respirations at least once every 30 mins until the infant has been stable for 2 hours after birth. Normal respiratory rate is 30-60 breaths per min. Respirations should not be labored and the chest movements should be symmetric. Respirations should be counted for a full minute for accuracy.

Bilirubin

Assesses for jaundice at least every 8-12 hours. Jaundice becomes visible when the bilirubin is >5 mg/dL.

Blood Pressure

Average BP for full term newborn is 65-95 mm Hg / 30-60 mm Hg . Doppler ultrasonography or other electronic measurement techniques are used. Taking BP while infant is crying elevates BP.

Length

Average length of a full term newborn is 19-21 inches.

Cephalhematoma

Bleeding between the periosteum and the skull, results from pressure during birth. Swelling may not be present at birth but may develop within the first 24-48 hours. It has clear edges that end at the suture lines. May take 2-3 months to completely resolve. Affected infants are at greatest risk for jaundice.

Choanal Atresia

Blockage or narrowing of one or both nasal passages by bone or tissue. Bilateral choanal atresia causes severe respiratory distress and requires surgery.

Mongolian Spots

Bluish-gray marks that resemble bruises on the sacrum, buttocks, arms, shoulders and other areas. Occur most frequently in newborns with dark skin. Usually disappear after first few days of life, some continue into adulthood.

Pallor

Can indicate the infant is slightly hypoxic or anemic. Hemoglobin, Hematocrit or CBC could be ordered.

Molding

Changes in the shape of the head that allow it to pass through the birth canal.

Transient strabismus

Crossed eyes. Common for the first 3-4 months after birth because infants have poor control of their eye muscles.

Polydactyly

Extra digits.

Lanugo

Fine, soft hair that covers the fetus during intrauterine life.

Female genitalia

In full term infants, labia majora should be large and completely cover the clitoris and labia minora. Edema of the labia and white mucous vaginal discharge are normal.

Head circumference

Measured around the occiput just above the eyebrows. Normal range is 13-15 inches.

Chest circumference

Measured at the level of the nipples. Normal range is 12-14 inches.

Weight

Newborn's weight ranges between 5 lb,8 oz and 8lbs, 13 oz. They can be expected to lose up to 10% of their birth weight during the first week of life. Loss results from excretion of meconium, normal loss of extracellular fluid, and inadequate intake of calories during the first few days.

Blood glucose

Normal range for a term infant is 40-60 mg/dL during the first day of life and 50-90 mg/dL after.

Retractions

Occur when the soft tissue around the bones of the chest is drawn in with the effort of pulling air into the lungs.

Apnea

Pause in breathing lasting 20 seconds or more, or accompanied by cyanosis, pallor, bradycardia or decreased muscle tone.

Periodic Breathing

Pauses in breathing lasting 5-10 seconds without other changes followed by rapid respirations for 10-15 seconds.

Acrocyanosis

Peripheral cyanosis involving only the extremities.

Cafe-au-lait spots

Permanent, light brown areas that may occur anywhere on the body.

Craniosynostosis

Premature closure of the sutures. May impair brain growth and the shape of the head and requires surgery.

Cyanosis

Purplish blue discoloration indicating the infant is not getting enough oxygen. May be preceded by a dusky or gray hue to the skin. Central cyanosis involves the lips, tongue, mucous membranes and trunk.

Erythema Toxicum

Red, blotchy areas with white or yellow papules or vesicles in the center. Commonly called "flea bite rash" or "newborn rash". Resembles small bites or acne. Most common over face, back, shoulders and chest.

Tachypnea

Respiratory rate of more than 60 breaths per minute.

Ruddy Color

Ruddy or reddish skin color may indicate polycythemia (excessive # of RBCs). Hematocrit level >60% confirms polycythemia.

Male genitalia

Scrotum should be pendulous at term and may be dark brown from maternal hormones. Rugae (creases in the scrotum) are deep and cover the entire scrotum in full term infants. Palpation of the scrotum determines whether the testes have descended.

Brachial and Femoral Pulses

Should be present and equal bilaterally.

Abdomen

Should be soft, rounded and should protrude slightly, but should not be distended.

Umbilical Cord

Should contain 3 vessels, 2 arteries and a single vein. If the cord appears thin, the infant may have been poorly nourished in utero. A yellow-brown or green tinge indicates meconium was released prior to birth. No redness or discharge from the cord should be present.

Breath Sounds

Should present equally throughout. Crackles in the lungs during the first hour or two after birth is not unusual because fetal lung fluid has not been absorbed fully.

Thermoregulation

Temperature should be assessed at least once every 30 mins until the infant has been stable for 2 hours after birth. Most common method of taking temperature is axillary measurement. Normal range for axillary measurement is 97.7-99.5 degrees F.

Syndactyly

Webbing between the digits.

Milia

White cysts, 1-2 mm in size, that disappear without treatment. Occur on the face over the forehead, nose, cheeks and chin.

Point of Maximum Impulse

location of the apex of the heart. It is where the pulse is most easily felt and sound is the loudest.

Eyes

should be symmetric and of the same size. Iris is dark gray, blue or brown but may change color by 6 months of age. Sclera should be white or bluish white. Pupils should be equal in size and react equally to light.

Pseudomenstruation

small amount of vaginal bleeding that may occur from the sudden withdrawal of the mother's hormones at birth.

Cryptorchidism

undescended testes.