Neonatal Examination and Assessment

1) History2) Examination: • In Delivery Room:a) Color: - Cyanosis

- Pallor - Acrocyanosis - Differential Cyanosis

b) Meconium- stainedc) Jaundiced) Respiration: - R.R, RDe) C.V.S : HR, peripheral pulse & Murmursf) Abdomeng) Genitaliah) Congenital anomaliesi) APGAR scoring (A = Appearance , P = Pulse , G = Grimace , A = Activity , R =

Respiration )

• Examination in the nursery: (Detailed)a)Monitoring of vital signs should be done every 30 min after

birth for 2 hr. or until stabilization.1- Temp.2- R.R3- HR + Peripheral pulses.4- BP

b)Anthropometric Measurement: wt, Ht, Hcc)Skin:

- Plethora- Jaundice- Hemangioma- Mongolian Spots- Milia- Hemorrhage- Mottling- Edema

4) Skull :- Overlapping Sutures- AF- Opened post Fontanel- Craniotabes- Caput Succedenum- Cephalhematoma

5)Face 6) Eye7) Ears 8) Mouth9) Nose 10) Neck11) Chest 12) Abdomen13) Genitalia 14) Anus and rectum15) Extremities 16) Back17) Neurological examination: Primitive Reflexes

a) Moro b) Rooting Suckling c) Palmar Grasp reflex d) Stepping

Assessment of Newborn Gestational Age- Physical and neurological examination

(Dubowitz scoring system and New Ballard Score)1)Neuromuscular Maturity: a) Posture

b) Square Windowc) Arm recoild) Popliteal angele) Scarf signf) Heel to Ear

2) Physical Maturity:a) Skinb) Lanugo hairc) Plantar surfaced) Breaste) Eye/Earf) Genitalia

New Ballard Score

Physical Maturity

Resuscitation of Newborn (ABC)1) Preparation2) Radiant heater3) Suction of airway4) Dry the infant5) Gentle tactile stimulation6) Apgar evaluation:

1) One minute Apgar score : Intrapartum asphyxia2) After 1 minute : adequacy resuscitation

Sequence of Resuscitation:1) No asphyxia : (Apgar 8-10)

- > 90% of NB- Dry , Warm- Suction

2) Mild asphyxia : (Apgar 5-7)- Stimulation- O2

3) Moderate asphyxia: (Apgar 3-4)- HR < 100/M despite O2

- PPV + 100% O2

- Bag + Mask (15-30 sec)

4) Severe asphyxia (Apgar 0-2)- need immediate vigorous resuscitation - O2 + PPV

- If no response ( HR < 60/M after 15-30 sec)

A) IntubationB) Circulation:

- After 15-30 sec of ventilation- Cardiac Massage

• Medications: if no response (HR < 60/M)a) Sod. Bicarbonate + Glucoseb) Epinephrinec) Volume expansiond) Dopamine or Dobutaminee) Narcosis (Naloxone Hydrochloride)

Duration : 15 – 20 Min

• Objectives:• 1-to know steps of examination of the neonate at birth

immediately(rapid) and during 24 hours(detailed) in ward.• 2-to define APGAR score as tool to asses birth asphyxia.• 3-to know how to asses gestational age.• 4- to determine steps of resuscitation in neonate. • 5- to know methods of nutrition of newborn(breastfeed,

bottle feed)• 6- to determine advantages and contraindications of

breastfeed.• 7- to know problems associated with breastfeeding.• 8- to define weaning, and steps of introduction of foods.