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Exam 1 - OB Newborn Assessment
Ob Newborn Asssessment
Course
Labor Law (LAW 771)
University
West Virginia University
Academic year: 2022/2023
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OB Newborn Assessment
Nursing Interventions: Immediate Newborn Period
- Maintaining airway patency
- ALWAYS suction mouth first, then suction nares - that way they can cry and won’t inhale
anything in airway
- They are obligatory nose breathers, so must keep nose and back of mouth clear
- If we don’t suction the mouth first then when the baby takes the first breath, that fluid on the
back of the throat will be inhaled into the lungs
- Ensuring proper identification
- Have hugs tags in place? If you move a baby close to an exit, the alarm will go off
- ID bands
- Dual numberings, mom and baby have numbers
- Administering prescribed medications
- Vitamin K - thickens blood, babies can bleed to death if they don’t get vit. K
- Eye prophylaxis - erythromycin eye ointment to eye
- Whether or not mom has not had an STD screening, treat infections before you know
they have one
- STDs are leading cause of blindness in babies
- “everybody lies”
- Maintaining thermoregulation
- Babies don’t regulate temperature until 24 hours after delivery, keep them swaddled, no baths
until temp is regulated
- The babies temp will be on the low end
- Have to protect the temperature
- Hat
- Swaddles
Initial Newborn Assessments:
- Signs indicating a problem:
- Nasal flaring - seen in newborns in severe distress
- Chest retractions- subcostal retractions, chest/sternum will look like sternum touches backbone
- Grunting on exhalation
- Labored breathing
- May hear fluid in the lungs in a C-section baby
- Generalized cyanosis - determine if it’s bc of compromised airway or if it’s normal
- Flaccid body posture- arms are jello/not moving
- Abnormal breath sounds
- Abnormal RR
- Normal: resting RR is 50-
- Abnormal HR
- Normal: 110-150 bpm
- Abnormal newborn size
- Apgar scoring
- Length and weight
- Vitals:
- Pulse
- Respirations
- Temp
- pulse ox
- BP not normally done if good
- Gestational age assessment
- Physical maturity
- skin texture
- lanugo
- plantar creases
- breast tissue
- eyes and ears
- genitals
- Neuromuscular maturity
- Posture
- square window
- arm recoil
- popliteal angle scarf sign
- heel to ear
- tells us if baby is at term or not
- Should be able to touch their heel to their ear
- if baby can’t get it up to ear, probably preterm baby
- If baby lays on face and can’t turn away and if elbow can’t be moved all the way across,
it’s a preterm baby
Apgar Scoring:
want to see the baby only progress (go up)
A= appearance (color)
P= pulse (HR)
G= grimace (reflex irritability)
A=activity (muscle tone)
R- respiratory (respiratory effort)
- Large for gestational age (LGA):
- Large for gestational age
- Weight more than 90th percentile (usually >9lbs)
- Seen in diabetic moms- excess glucose=packing on the pounds
- Babies start growing one lb per week after 35 weeks
Respirations:
- Normal rate:
- 30-60 breaths per min
- Rhythm:
- Slightly irregular
- May have transient apnea
- They forget to breathe because they didn’t have to in womb
- Shallow Depth:
- Unlabored:
- Moist lung sounds; fine crackles on inspiration, mainly C-section babies
- Vag babies don’t have as much of this problem bc the fluid in lungs is pushed out during birth
due to pressure on their chest from the vaginal canal
- Equal bilaterally
- Babies are obligatory nose breathers- ensure their nares are clear or their airway is gone!!
Heart:
- Rate: 110-160bpm
- Sinus arrhythmias are normal
- Murmurs not present at birth
- Listen to heart on front, lungs in back
Temperature:
- Average: 37C (99) (Celsius is always used on newborns)
- Warm, slightly cool to touch, lose heat easily
- Low temps are dangerous- temps less than 36 indicate possible infection
- Monitor for changing temperatures
- Drying the baby is the first thing to do, NO BATH until temp is stable!
- Keep them warm, swaddle and hats!
- Lose heat through conduction (touching things), convection (breeze), evaporation, radiation (through
air)
Head, Face, Neck:
- Head circumference: 13-15inches, 32-38 cm
- Obtain widest part of head! Page 639!
- Measure with tape measure that doesn’t stretch
- May see molding/cone head babies from birth canal
- 2 variations in assessing head circumference:
- Caput succedaneum:
- Localized edema on the scalp that occurs from the pressure of the birth process (use of
forceps or pressure against presenting part) can cross suture line
- resolves within 3-4 days
- Cephalhematoma:
- Localized collection of blood between skull and periosteum
- Doesn’t cross the suture line (always confined by 1 cranial bone), takes a lot longer to
resolve- blood has to be reabsorbed (usually takes longer to resolve: 3-6 weeks)
- Fontanelles:
- Anterior fontanelle:
- ‘soft spot’: diamond shape 4-6 cm (largest diameter); top of head
- Soft, flat, and open (should close in 18-24 months)
- Posterior fontanelle:
- triangular 0-1 cm, soft, flat, and open, closes by 3 months, size of tip of finger; back of
head by the eyebrow line
- Shouldn’t be scaphoid (depressed): can indicate dehydration
- Shouldn’t be bulging: could indicate increased ICP or too much fluid
- Sutures:
- Frontal (metopic) suture
- Coronal suture
- Sagittal suture (follow sagittal back you run into posterior fontanelle)
- Lambdoid suture
- Purpose- allows head to compress for vaginal delivery, within 24 hours after birth you can feel
one parietal bone over the other (allows for vaginal delivery)
- Molding:
- Newborn head molding is an abnormal head shape that results from pressure on the baby's head
during childbirth. Newborn cranial deformation; Molding of the newborn's head
- Head Shape:
- Round, large in proportion to body, symmetric in appearance and movement
- A quarter of the size of our body
- Temperature loss
- Should see symmetry from head to toe, face symmetrical, eyebrows, eyes appropriately spaced,
center of lips midline
- If not, may indicate retinoblastoma (childhood cancer of eye): tx: eye removal
Nose:
- Small and narrow
- Midline
- Patent nares
- Intact septum
- Nose breathers
- Look for bulb syringe when you assess the nose! Ensure it is in reach to use
Mouth:
- Epstein pearls on hard palate- don’t have to take these out
- Lips intact with symmetric movement, midline, pink
- Tongue- free moving
- Should come out past lips, ensures baby can get a good latch for bottle or breast
- Protruding tongue- down syndrome
- Natal teeth- have to be removed, can fall out and baby aspirates
- Salivary glands don’t start working till 2-3 months (may think they are teething- but they aren’t)
- Extrusion reflex- spit it back out, use tongue to push things out of mouth, protects airway
Reflexes:
- Root reflex:
- Corner of baby’s mouth is stroked and baby turns head to follow and “root” in that direction,
helps baby find bottle to begin breastfeeding
- Suck reflex:
- Rooting helps baby become ready to suck, when roof of mouth is touched baby will suck
- Doesn’t begin until 32nd week of pregnancy and is not fully developed until about 36 weeks
- Premature babies may have a weak or immature sucking ability because of this
- They may lose weight due to the energy it takes to suck
- Babies have a hand to mouth reflex that goes with rooting and sucking and may suck on fingers
or hands
- To test this reflex:
- put pinky finger, pad up, into mouth and they will suck
- Moro reflex:
- Startle reflex, baby is startled by a loud sound or movement, in response to the sound, baby
throws back his or her head, extends out the arms and legs, cries, then pulls arms and legs back
in
- A baby’s own cry or fart can startle them, this reflex lasts about 5-6 months
- Grasp reflex:
- Stroking the palm of baby’s hand causes the baby to close his or her
fingers in a grasp, lasts 5-6 months of age
- Babinski:
- Sole of foot is firmly stroked, big toe bends back toward top of foot and other toes fan out;
normal up to 2 years old
- Toes will fan = postitive
- Step reflex:
- Walking/dancing reflex because baby appears to take steps or dance when held upright with his
or her feet touching a solid surface
- Sneezing, coughing
- swallowing (takes time to learn)
- Premature babies lose weight due to the energy it takes to suck
Ears:
- Soft, pliable, should recoil quickly and easily when folded and released
- Should be aligned with outer canthus of eyes
- Low set ears=down syndrome, renal anomalies
- Renal system and ears develop at same time, so when there is a problem with one there is a
problem with both
- Epicanthi folds
- Auditory reflux
- Turen toward sounds, startled with loud noises
Chest:
- 12-14 inches, 30-36 cm
- Clavicles intact (clavicle could be fractured from delivery)
- Relation to head circumference: 2-3 cm smaller than head circumference
- Barrel shaped, round, symmetric
- Breast: nipples may be engorged/edema and have white discharge
- Boys with engorged breasts/edema is due to mom’s hormones
- Little girls might have pseudomenstruation due to mom’s hormones
- Supernumerary nipple- extra nipple from axilla down
Abdomen:
- Circumference done only 1 time on normal newborn for baseline
- Different for neonatal ICU babies or with GI issues
- Necrotizing Enterocolitis: small intestine, r/t cold stress
Umbilical Cord:
- Purple dye
- No tub baths until cord falls off (keep dry!)
- Should fall off within 5-10 days
- 2 arteries and one vein in cord, the arteries carry deoxygenated blood and veins carry oxygenated blood,
vein is larger than the two arteries
- Urine need to void within 24 hours
- 1 cc/kg/hr
- Weigh diapers
- 6-8 diapers a day after the first week, at first they aren’t good at taking in fluids
- Imperforate anus? No opening
Femoral Pulses:
- Gross measurement checks for circulatory problems
- Coarctation of aorta (narrowing)
- Save checking this for last
Position:
- At rest- on back
- No sleeping with baby
- More SID and suffocation deaths when sleep with baby and lay on stomach
- When playing they can have tummy time
Skin: refer to slide 59 for pictures of some of these!
- Acrocyanosis:
- persistent cyanosis of fingers, hands, toes, and feet with mottled blue or red discoloration and
coldness
- May be seen during the 1st week of life in response to exposure to cold
- Normal and intermittent
- Vernix caseosa- a greasy deposit covering the skin of a baby at birth
- Stork bites/salmon patches
- Millia:
- tiny white bumps that commonly appear on a baby’s face
- Mongolian spots:
- dark spots, usually see in darker skinned people
- Erythema toxicum:
- flea bite rash
- Harlequin sign:
- cutaneous condition seen in newborns characterized by momentary red color changes of half the
child, sharply demarcated at the body’s midline
- Nevus flammeus:
- stork bite
- Nevus vasculosus:
- strawberry hemangioma
- Lanugo:
- fine, soft, downy hair, first hair produced by fetal hair follicles
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Exam 1 - OB Newborn Assessment
Course: Labor Law (LAW 771)
University: West Virginia University
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1
OB Newborn Assessment
Nursing Interventions: Immediate Newborn Period
- Maintaining airway patency
- ALWAYS suction mouth first, then suction nares - that way they can cry and won’t inhale
anything in airway
- They are obligatory nose breathers, so must keep nose and back of mouth clear
- If we don’t suction the mouth first then when the baby takes the first breath, that fluid on the
back of the throat will be inhaled into the lungs
- Ensuring proper identification
- Have hugs tags in place? If you move a baby close to an exit, the alarm will go off
- ID bands
- Dual numberings, mom and baby have numbers
- Administering prescribed medications
- Vitamin K - thickens blood, babies can bleed to death if they don’t get vit. K
- Eye prophylaxis - erythromycin eye ointment to eye
- Whether or not mom has not had an STD screening, treat infections before you know
they have one
- STDs are leading cause of blindness in babies
- “everybody lies”
- Maintaining thermoregulation
- Babies don’t regulate temperature until 24 hours after delivery, keep them swaddled, no baths
until temp is regulated
- The babies temp will be on the low end
- Have to protect the temperature
- Hat
- Swaddles
Initial Newborn Assessments:
- Signs indicating a problem:
- Nasal flaring - seen in newborns in severe distress
- Chest retractions- subcostal retractions, chest/sternum will look like sternum touches backbone
- Grunting on exhalation
- Labored breathing
- May hear fluid in the lungs in a C-section baby
- Generalized cyanosis - determine if it’s bc of compromised airway or if it’s normal
- Flaccid body posture- arms are jello/not moving
- Abnormal breath sounds
- Abnormal RR
- Normal: resting RR is 50-60
- Abnormal HR
- Normal: 110-150 bpm
- Abnormal newborn size
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