NEWBORN ASSESSMENT Thursday March 4 2021 1 PREPARED

NEWBORN ASSESSMENT Thursday, March 4, 2021 1

PREPARED BY Mrs. Benazeera Assistant. Professor Child Health Nursing Thursday, March 4, 2021 REVIEWED BY Dr. Priya Assistant Professor Child Health Nursing 2

Learning objectives 1. Understand the meaning of newborn assessment 2. List down the phases of Newborn Assessment 3. Explain in detail about Newborn assessment 4. Demonstrate the newborn assessment and reflex Thursday, March 4, 2021 3

Meaning Newborn assessment is the critical analysis and evaluation or judgment of the status of a newborn Thursday, March 4, 2021 4

PHASES 1. 2. 3. 4. Apgar scoring Assessment of gestational age Systematic physical examination Transitional assessment during the period of reactivity Thursday, March 4, 2021 5

A PGA R TEST Thursday, March 4, 2021 6

q. A test developed in 1952 by Dr. Virginia Apgar q. A baby’s first test q. Quick assessment of the newborn’s overall well-being q. Given one-minute after birth and five minutes after birth q. Rates 5 vital areas Thursday, March 4, 2021 7

WHYIS ITDONE To assess the baby’s vital signs quickly The score is helpful for later evaluations Thursday, March 4, 2021 8

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RESULTS 10 out of 10 is a perfect score The A higher the score, the better the condition score over 7 indicates good condition A score less than 7 may indicate some medical assistance Thursday, March 4, 2021 10

LIMITATIONS Quick assessment Does not necessarily indicate a baby’s long-term behavior Thursday, March 4, 2021 11

ASSESSMENT OF GESTATIONAL AGE Thursday, March 4, 2021 12

Ballard scale Simple examination to assess Gestational age Accurate to +/- 2 weeks Thursday, March 4, 2021 13

Takesin to account 2 things: 1. Neuromuscularmaturity 1. Posture 2. Square Window Test 3. Arm recoil 4. Popliteal angle 5. Scarf Sign 6. Heal to ear test 2. Physicalmaturity 1. Skin 2. Lanugo 3. Plantar surface 4. Breast 5. Eye/Ears 6. Genitals Neurological signs are more reliable than physical Thursday, March 4, 2021 14

NEURO MUSCULAR MATURITY: 1. POSTURE: (AT REST) • As maturation progresses increasing passive flexor tone • Increasing passive flexor tone -centripetal direction. Thursday, March 4, 2021 15

NEUROMUSCULARMATURITY: 1. POSTURE: Thursday, March 4, 2021 16

NEURO-MUSCULARMATURITY 2. SQUARE WINDOW TEST: • Tests wrist flexibility &/or resistance to extensor stretch. • At term and post term, the infant has maximum passive Flexor tone and minimum passive Extensor Thursday, March 4, 2021 17

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NEUROMUSCULARMATURITY: 3. ARM RECOIL: • Focuses on Passive Flexor Tone of biceps muscle • Briefly flex the elbow extend briefly Release Thursday, March 4, 2021 19

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NEURO MUSCULAR MATURITY: 4. POPLITEAL ANGLE: • This maneuver assesses maturation of passive flexor tone about the knee joint by testing for resistance to extension of the lower extremity. Thursday, March 4, 2021 21

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NEURO MUSCULAR MATURITY: 5. SCARF SIGN: • Tests the passive tone of the flexors about the shoulder girdle. • The point on the chest to which the elbow moves easily prior to significant resistance is noted. Thursday, March 4, 2021 23

NEUROMUSCULARMATURITY: 5. SCARFSIGN: • Landmarks noted in order of increasing maturity: – Full scarf at the level of the neck (-1) – Contralateral axillary line (0) – Contralateral nipple line (1) – Xyphoid process (2) – Ipsilateral nipple line (3) – ipsilateral axillary line (4) Thursday, March 4, 2021 24

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NEURO MUSCULAR MATURITY: 6. HEEL TO EAR: • Measures passive flexor tone about the pelvic girdle by testing for passive flexion or resistance to extension of posterior hip flexor muscles. Thursday, March 4, 2021 26

NEURO MUSCULAR MATURITY: 6. HEEL TO EAR: q. Note location of heel where significant resistance+ q. Landmarks noted in order of increasing maturity include resistance felt when the heel is at or near: – ear (-1) – nose (0) – chin level (1) – nipple line (2) – umbilical area (3) – femoral crease (4) Thursday, March 4, 2021 27

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PHYSICAL MATURITY 1. SKIN Thursday, March 4, 2021 30

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PHYSICAL MATURITY: • 2. LANUGO: Thursday, March 4, 2021 32

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PHYSICALMATURITY: 3. PLANTARSURFACE: • Very premature no detectable foot creases. • Measure the foot length or heel-toe distance. • Heel-toe distances: – less than 40 mm (-2) – between 40 and 50 mm (-1) Thursday, March 4, 2021 34

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PHYSICAL MATURITY: 4. BREAST: • The breast bud consists of: – breast tissue that is stimulated to grow by maternal estrogens – fatty tissue which is dependent upon fetal nutritional status. Thursday, March 4, 2021 36

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PHYSICAL MATURITY: 5. EYE / EAR: Thursday, March 4, 2021 38

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• PHYSICAL MATURITY: • 6. GENITALS: (MALE) Thursday, March 4, 2021 40

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Weight related to gestational age • AGA (Appropriate-for-gestational-age ) 10 th – 90 th percentiles on intrauterine growth curves • Small-for-date (SFD) or small-forth gestational age (SGA) - <10 percentile on intrauterine growth curves (= IUGR) • LGA (Large-for-gestational-age ) > 90 th percentile on intrauterine growth curves Thursday, March 4, 2021 43

Weight related to gestational age Thursday, March 4, 2021 44

Systematic physical assessment Thursday, March 4, 2021 45

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Transitional assessment Ist stage: Lasts for 6 hours , first 30 minutes awake, reaming hours baby will be sleeping. II STAGE: 6 to 12 hours observation should be made until the vital signs are stabilized. Thursday, March 4, 2021 51

Deep sleep Light sleep Crying Stages of sleep and activity Drowsy Active alert Quiet alert Thursday, March 4, 2021 52

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INTRODUCTION A REFLEX is defined as an involuntary, or automatic, action that your body does in response to something, without even having to think about it. Types of reflexes present at birth: 1. General body reflexes 2. Facial reflexes 3. Oral reflexes Thursday, March 4, 2021 54

GENERAL BODY REFLEXES Thursday, March 4, 2021 55

MORO REFLEXES • Any sudden movement of the neck initiates this reflex. • A way of eliciting the reflex is to pull the baby half-way to sitting position from supine and suddenly let head fall back to a short distance. • Reflex consists of rapid abduction and extension of arms with opening of hands. Thursday, March 4, 2021 56

CLINICAL SIGNIFICANCE Its nature gives an indication of the muscle tone. • The responses may be asymmetrical if muscle tone is unequal on two sides or there is a weakness of an arm or injury to humorous or clavicle. This reflex disappears in 2 -3 months. Thursday, March 4, 2021 57

• It is similar to moro reflex, but it is initiated by sudden noise or any other stimulus STARTLE REFLEX Thursday, March 4, 2021 58

WALKING/ STEPPING REFLEX • When the sole of the foot is pressed against couch, the baby tries to walk. • It persists as voluntary standing. Thursday, March 4, 2021 59

PALMER/ GRASP REFLEX • When the baby’s palm is stimulated, the hand closes. • There is also a corresponding planter reflex. • Both normally disappear by 24 months. Thursday, March 4, 2021 60

CLINICAL SIGNIFICANCE • An exceptionally strong grasp reflex may be found in the spastic form of cerebral palsy and in kernicterus. • It may be asymmetrical in hemiplegia and in cases of cerebral damage. • It should have disappeared in 2 -3 months and persistence may indicate the spastic form of cerebral palsy. Thursday, March 4, 2021 61

Babinski reflex When the sole of the foot https: //www. youtube. com /watch? v=b 2 QKXOz. D 8 s is firmly stroked, the big A toe bends back toward the top of the foot and the other toes fan out. This is a normal reflex up to about 2 years of age. Thursday, March 4, 2021 62

ASYMMETRIC TONIC NECK REFLEX • When the baby is at rest and not crying, he lies at intervals with his head on one side, the arm extended to the same side, and often with a flexion of the contra lateral knee. • This reflex normally disappears after 2 or 3 months, but may persist in spastic children. Thursday, March 4, 2021 63

PARACHUTE REFLEX It appears at about 6 -9 months and persists thereafter. The reflex is elicited by holding the child in ventral suspension and suddenly lowering him to couch. The arms extend as defensive a defensive reaction. In children with cerebral palsy, the reflex may be absent or abnormal. It would be asymmetrical in spastic hemiplegia. Thursday, March 4, 2021 64

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Perez reflex • While infant is prone on firm surface and thumb is pressed along spine from sacrum to neck. § infant responds by crying, flexing extremities , elevating pelvis and head and spine , defecation and urination may Occur q disappears by age 4 -5 mo Thursday, March 4, 2021 67

FACIAL REFLEX Thursday, March 4, 2021 68

Doll’s eye reflex • Passive turning of the head of the newborn leaves the eye “behind” • A distinct time lag occurs before the eyes move to a new position. • Disappears at within a week or two of birth Thursday, March 4, 2021 69

NASAL REFLEX Thursday, March 4, 2021 70

CORNEAL REFLEX PUPIL REFLEX • Consists of blinking when cornea is touched • Pupil reacts to light, but in preterm baby and some full term babies the duration of exposure to the light may have to be prolonged to elicit the reflex. Thursday, March 4, 2021 71

ORAL REFLEXES Thursday, March 4, 2021 72

ROOTING REFLEX • When the infant’s cheek contacts the mother’s breast, the baby’s mouth results in vigorous sucking movements resulting in baby rooting for milk. • When the corner of mouth is touched, the lower lip is lowered, the tongue moves towards the point stimulated. • When the finger slides away, the head turns to follow it. Thursday, March 4, 2021 73

SUCKING Onset~ 28 weeks iu Wellestablised~ 32 -34 weeks iu Disappear~ around 12 months Elicited by~ introducing a finger into the mouth Thursday, March 4, 2021 74

Onset is 28 weeks IU Wellestablised by 32 -34 weeks IU Thursday, March 4, 2021 Disappears by 3 -4 months 75

SWALLOWING • Begins around 12 and half weeks IU life. • Full swallowing and sucking is established by 32 -36 weeks of IU life. • Their absence in full-term baby would suggest a developmental defect. Thursday, March 4, 2021 76

GAG REFLEX Seen at 18 and half weeks of IU life. Touching here elicits a gag reflex, a protective reflex. Thursday, March 4, 2021 77

CRY It is a nonconditioned reflex which accounts for its lack of individual character and is of sporadic nature. Starts as early as 21 -29 weeks IU life. Thursday, March 4, 2021 78

ACTIVITY …………. Thursday, March 4, 2021 79

NAME THE REFLEXE Thursday, March 4, 2021 80

• D. C. Dutta (2011), Text book of Obstetrics, 7 th edition, New Central Book Agency (P) Limited. • Meharban Singh (2004), Care of the Newborn, 6 th edition, Sagar Publications. • B. T. Basavanthappa (2006), Textbook of Midwifery and Reproductive Health Nursing, 1 st edition, Jaypee Publications. • Susan Scott Ricci, Terri Kyle (2009), Maternity and Pediatric Nursing, 1 st edition, Lippincott Williams and Wilkins. Thursday, March 4, 2021 81

Thank you…………………. Thursday, March 4, 2021 82