Definition of Newborn Anewbom infin, or neonate, is achikd under 28 days of age. During these first 28 days cf life. the child is at highest risk of dying. It & thus crucial that approprine feeding ond care are provided during tis period, both io improve the chill’s chances of survival and te bry the foundations for a heathy ie, Behavior: Tt may be defined as the way in which one acts or conducts oneself, espectally towards others It is the way in which an animal or person behaves in respome te a particular siustion or stimulus. Acad in cave of a newbom behavior may be defined the way it functions and atiains differem stages of gowth and development. Importance of Newborn Behavioral Assessment: Newbom, or neonatal, death: accoum for 45% of all death: among children under 5. ‘The mmjority of all neonatal deaths (75%) occur during the first week of li, and between 259% to 45% occur within the fist 24/hours.The main causes of newborn deaths we prematurity and low-binth-weight, infections, asphyxia (lack of oxygen at bith) and bith trauma. These causes account for nearly 80% of deaths in this age goup.Up to two tind of newborn deaths coukd be prevemed if skilled heath workers perform efféctive health measures. at birth and during the fast week of life ‘Thus assessment of the newborn is very vital While babies may not speak their first word for a year, they are born ready to communicaiz with arich vocabukary of body movements, cries and visual responses: all part of the complex languige of infant behaviour. All newborn babies are routinely exarined by a pedivrician within the first 24 hours of if and again prior to discharge to home. A general appraisal of the baby's color, cverall appearance, muscular activiy and response to handing are onde throughout the examination. A professional examination wil certailly include sensing tle sensing capacities of the newer Thus, special senses and behavioral pattems are assessed and evahnted in order to establish nomralty of the baby. If there are variances from the normal patterns, it's assessed acoordingly a response is devised and designed toaddress it What and how newborn Behavior Is assessed: ‘A professional assessment scheme must reveal the individuality of then newborn. By the end of the assestment, the examiner nust have a behavioural ‘perrait” of the infam, describing the babys strengths, adaptive respomes and postbk wiherabilities The examiner shares this portrait with parents (and other stke holders) to develop appropriate caregiving sualegies aimed atenhancing she earhest relationship between babies and parents and other stakehobers. ‘Though newborns seem vuberable, yet they are highly capable when they are bom "A newborn akeady has nine mouths of experience when she is bora," Dr. T. Berry Brazelion, the developer of the Neonatal Behavioural Assessmem Scab (NBAS) prochims. The newborn iscapabk of conroling his/her behaviour in order to respond to ber new envicnment. Babies "communicate" through their behaviour, which, although it may not always seem Eke it, is a rational nguage. Not only do infants respond to cues around them, lke their parents’ faces, but they also take steps to congol their environnert, such as crying to get a resporse fiom their caregivers. Newborns are socal organisms, individuak with ter own unique quites, ready to shape as well as be shaped by the caregiving environment. Thus professionals have developed standard procedures (e.g... scales) 10 assess the new! they need to be assessed zhysically and neurologically to porvait a picure af te pote S (or the absence of them) of the baby. The examiners are trained 1 get the best performance from the chill by doing everything possible to support the infant in ‘suoceeding." For example, ome pact of the exam boks alan infant's ability wo self-consok when she i upset. Some infants console themselves easily, whit others have amore difficult time. Ifthe infant cannot console here, the examiner takes measured steps to help her. Notonly do we learn how much support the infist may need at home, but ako how far along the chidd is at compkting ber developmental agenda By the end of the exam, the examiner has devebped a vibrant porta of the newborn, which can be twed to tailor caregiving to the baby's specific physical needs and behavioural style Does the baby lie io be handed? Is the baby receptive to social interaction? Does the baby easily calm herself? "These standard scales must give a peep irte the possible and, may be, a designer future of the newborn. A professional may stuly and assess the baby though (A) Special Senses and, (B) Refiexes avexphined below: (A) Special Senses and Beha viar Patterns Vision ‘The smucties necessary for vison are present and finctional at bith although immature, The baby is sensiive to bright Ights, which cause hinvher to fown or biti. The body demonstrates apreference for black and white patterns and the shape of huran face. The newborn's focusing diame is abou 15-20.cm which, allows hinvher to see the mother's face when being mesed He/She can tack a moving object briefly wihin the firs five days. ‘Hearing ‘The baby turns the eyes cowards scund, comforted by low-pitched sounds. High-pitched sounds ake bin uncormrable A sudden sound elicits a sare or blink reflex He/She prefers the sound of the human wire tw other sounds. The baby can discriminate between voices and prefers the mother's. This toc, prompics mpther-baby inicraction (De Casper and Fifer, 1987)‘Smell and Taste Babies prefer the smell of milk to that of other substances and show a preference for human milk, Within afew days, the baby can differestiate the smell ofhisMher mother’s mik, The baby tums away fom unpkasent smells. His/Her preference for sweet tasie is demonstrated by ‘vigorous. and strong sucking and a gimmcing resporme to biter, saly or sour substances (Bhekbun and Loper, 1992). Touch Infants are acutely semitive to touch, exjey skin-to-skin contact, immersion in water, stoking, culding and rocking movements (Blockbun and Loper, 1992). A pulf of air on the baby’s face induces. an inspiration or gasp refx. His curving response te touch and the gasp reflexes eshance hivher relationship with the mother. The baby withdraws from painful stimuli, bulges his brow and msolabial furrow and may cry vigorously (Rushforth and Levene, 1994) Sleeping and Waking Following the iniiation of respiration at birh, the baby remains alert and reactive for a period of approxinntely 1 hour after which the baby rebres and sleeps. The length of this frst skep varies fiom a few minules to several hours. Subsequeat skeping and waking rhyihas sbow marked variations and the baby takes some time to sere imo hivher individual pater Initially, waking periods ae zeied to hunger, but within a few weeks, the waking periods st longer and meet the need for social imeraction ‘Tvo skep states are identifiable: Deep sleep in which the baby's eyes are closed, respirations are reguker, no eye movements are resent, response to stimuli & delayed and is queckly suppressed. Jerky mmvemen's may occur at intervals, Light sleep in which eye movements couki be observed chrongh the closed eyelids Respirations are iegukr and sucking movements occur intermittently. Response to stimuli ‘occurs more readily and may result in aeration of sleep state. Random movernents are noted. Avakening states A wider range of awakening scames i observed, ranging from drowsiness to crying, Drowsy state: The baby's eyes may be open or closed with some futering of the eyekds. Smiling may occu. Lim movements are generally smooth, but are interspersed by startle responses (Quiet alert state: Moter activry is minimal the baby és alert to visual and auditory stintih. Active alert siate: The baby is generally active and reactive to the environme ri Active crying stzte: The baby cries vigorously and may be difficult to console. Muscular acliviy is considerabk, Remarks‘The amount of ime that the baby spends in which state varies and influences the way in which he responds to stimuli, whether visual auditory ortactie (Brazelon, 1984). ‘Crying Crying & the way in which the baby communicates discomfort and surmons assistance. With experieme, it is possble *o difkrentiate the cry and identify the need, which may be hunger, thirst, pain, general discomfort [fr example, warting a chmge of postion or fecing too coll or too warm), boredom, loneliness or a deste for physical or social comtact. The mother needs to kam how 10 comfort her baby. Rocking induces. sleep, and swaddling and upright position appear to be soothing (Downey and Bidder, 1990) Growth and Development Because of physical limitations, the baby is dependent on the mother (or other care Giver) for hisiher continued growth development and survival. ‘These will progress satisfactorily only if the baby is in asaie environment, the nutritional needs are met and the psychohgral devebpment is pmmoted by appropriate stimulation and loving care Abnormality of the baby’s body systems Inadequate moriien cremotional deprivation will compromise the baby's ability to grow and develop to hivher full potzatial. His rebtively immature orgin finctions and vulnerability to infections and hypotermia demand that care must be designed to meet the needs and capabilities. ‘B) Reflexes: ‘The baby's reflex responses are elicied in onder to establish normality of fe nervous system. ‘These are Rooting Reflex: It is a primitive reflex. Ifthe cheek is rubbed, the infimt will tum his head into. that direction of the stinuhs. Sucking reflex — i develops at 32-36 weeks of gestation, If sucking reflex is poor & indicates the baby & premature or there may be some difficulty in swallowing. Mom's reflexstartle reflex — it can be assessed in two ways: {The baby should be hell supine over the right hand and arm. The flexed head is suddenly allowed to drop by about 30°. A Positive response conss's of rapid abduction and extension of upper mis and opening of hands folowed by sbwer addiction and flexion or embrace equiak rr 1) Phoe newbom on a firm surface and ake a bul soud by banging the examination table. The limbs will extend and then flex. This reflex useful to evahale the aleriness, muck tone and hearing of the baby. This reflex should be assessed last, as the infant wil start crying,Stepping/dancing Reflex-Place the chil! in standing position near the ‘abl, the feet will touch the tab: and flex ahermiely by both kgs giving an appewance as if Oe buby is dancing. It disappears by 1-2 monits. Doll's eye Reflex — Turn the head of the infint. The eyes move in the opposte direction. It disappears once the Child is abk to focus. ‘Tonic neck reflex — When infant's; head is quickly tumed to one side, the extremities on that side extend and those on oppose side will flex, Grasping reflex—put your finge: near the clik!'s pukn; the chi closes its finger around it If finger is placed near the toe, they curl around the finger." Babinski reflex —when a stimulus is ghen to the plantar surface. Stroke the sole of the foot begiming at the heel Stoke wpward abng lateral aspect of the scle then move finger across ball of foot. ‘There is dorsiffexion of the large with faming of other, tes,NEWBORN ASSESSMENT INTRODUCTION- It is a detaied systemutic and whok body eximination of rewbom, Assessment of the newborn as soon as possible afler bith and subsequent assessment in the postnatal period are vital responsbity of the murses working in hospital or in the community. The assessment shoul inclide deaied history of prenacal and intrunmtal period and genetic history of family along wih head to toe examination. Assessment of the newbom must be examined thoroughly within 24 hours of birth. Before actual examination, the important maternal and perinatal history shoud be reviewed. DEFINITION. ‘A detailed and systenmtic whok body examination of a stabiled newbom baby during the early hours of Kf. PURPOSES: To determine the normaky of different body system for healthy adaptation to extra uterine We. To detect significant medical problem for immedinte assessnent, To detect any congenital probkm. To assess the need for resuscitation. Any disorder which may affect the well being of the baby. STEPS- Assessment of newborn can be divided into folowing steps 1. Immediate assessment with APGAR score 2. The vamitional aesessmem during period of reactivity 1. Immediate assessment. The intial assessment of neonate is a very important activty immediately after bith The most essential assessment is the first cry. Good cry helps in establishment of satisfactory breathing The respiration, heart rate , and skin cobbr are the basi: criteria which should be evaluated immediately to determine the need for Iie saving support, ie. resuscitation. For assessment of the baby immediately after bith, apgar scoring is done. Apgar score is a quintiative method of assessing the infant respiratory, circuhtory and neurobgical sais. It is done at 1 min and 5 min afer birth. The criteria are respiration, heart rate, musck tone, reflex iritability and skin cobur.APGAR Test Seong, Total score- 10 Appesrence No depression: 7-10 Pure Mill depression: 4-6 Severe depression-0-3 Grimace Boewwiry Respraton = © When score between 7-10 it imlicates that mwbom is easily adjust to extra uterine environment, The score between 4-6 indicates moderately difficulty to adjust exra uterine environment ‘The score between 3 Or below the neomtes is severe distress which must be treated immediately ‘Tramitional assessment- immedistely afler birth neomutes tres to cope up with the extra uterine environment. Newbom during frst 24 hours gets various changes in the vial funetion such as heart rate, respiration, mptor activity, cobur and bowel activity, these changes occurs in orderly ‘mamer. It is known as period of reactivity. First period of reactivity- ater birth during first 6-8 hours, the newbom passess through the fest period of reactivity. During firs 30 minutes of period of reactivity. The neonates is alert, active, cres ant tus strong sucking reflex. This is the good time for breast feeding aml eye Wo eye contacts with mothers. Respiratory rate over 60 per minute and heart rate is 160 per minute. Bowel sounds are heard and mucus secretions are increased, and exyosure to environment should be avoided to maintain the vial signs. During this time following assessment is done- General examination Anthropometric assessment Head to toe examination Newobgic examination Reflexes Estimation of gestational age . Second period of reactivity. & sus when neonates awakes from fist sleep. It is a about 6-8 hours affer the birth It is for about 2-5 hours. In this period, the neomis again become art, active and responsive, respiration rate and heart rate wil also sligitly increase. During this period the stabilization of physilogical system wil occur.Assessment in this period incules- A. GENERAL EXAMINATION Posture- in fill term babies, generalved flexion is seen, The neck and extremities are flexed. Preterm babies may fe in fiog lke structure. Activity. normal neonates are alert and active. The baby muy be irritable or drowsy if having any newobgical problem. Cry- normal neonates cries when hungry or wet. Weak cry is seen in preterm or low bith weight baby. High pitch cry is seen in babies with raked intracranial pressure. Color- the entire body and extremities are pink If the baby is having respiratory distress extremities my be bbe Vital sign. TPR are checked, The temperature of newbam babies’ ranges between 35.5Ci 37.5 C. the bean rae should be ausculmted wih sethosoope when the baby is calm normally ranges from 120-140 beats/ min, the respiratory rates ranges fromm 40-60 breatity’ min ANTHROPOMETRIC ASSESSMENT ‘Weight- the body weigit of neonsies on an average is 2.5 to 3kg. the neonates boses about 10% ‘weight in the first ten days of life. There after babies gaim about 25-30 gms days. Lengthy the averages length of a neomtes is 45-50 om. Head circumferences- immediately afler birth, moulling of skull may give inaccurate measurement of head circumferences. So it should be measures afler 48 hours of bith the normal head circumferences & 33-3 cm. it may be brger in cases of hydrocephabs and smaller in microcephaly. Chest circumferences- it is abou 31-33cm. ts 2-3 cm kss thin head circumfere nees. a om eC. HEAD TO TOE EXAMINATION- ‘Skin the neonates skin i soft, smooth and puffy. At bith it is covered with whie cheesy substances known as vernix caseosa, Vernit caseosa act as a insulating byer and it have antibacterial or bacteriostatic power. Skin shoull be observed for cyanosis, jaundice, pallor. Chock the tir distibuinn er lamgoo hots, Mongolian spots on skin. Check skin turgor for dehydration Head- head of the neonates consists skull hones that are not close completely, dur to this skull easily moukled during the passage through the bith caml at the time of bith where the surire lines are joined they form the fontanelles. ‘Anterior fomanelle Posterior fontanelie Bounded by the paretal and ffomal bore It is diamond in shape Tris about 2.5 cm long and 4cm wide This closed at 12-18 month of age Itis also called bregma. Bounded by occipital and parietal bones Its wiangukr in shape Its about 2.5em wide & 2.5 cm long Itis closed in 2 month of ages Itis abo called Lambda Fontanelles Posterior fontanelle:If the suure are wie and fonianelles are bulged indicates increased intracranial presse which is commonly seen in hydrecephahs condition, When fontanele depressed it indicates dehydration We should ako observe the caput succedaneum and cephalohematoma, Face- examine the face for any asymmetry or malformations. Eyes- eyes of newborn should be checked for oedema, conjunctivitis, discharge. colour of sckra . yellow cobr inlicates jaundice. Position of eyes ami distance between inner canthus of both eyes should be checked, it should be 2 om in diameter. If it is more than 2 cm known as hypertelorism and if it is ess than 2 cm than known as hypotebrim. Neonates pupis are round in shape and react to the light. There is no tear formation in the neonates, Ear it should be examined for sie and shape. The ear cartiag: ‘8 full term infant is fully develped and ear returns its shape. Observe the startle reflex by the bud noise which indicates audbility of the neonates, Nase- it is examined for potency, depression or bw msal bridge, assess for nasal discharge, devised nasal septum, masal flaring. Press the masal tip and check for color, if it is yeRowish color for long duration i indicate jaundice. Mouth & throat- it can be examined when the neonates is yawning or crying Mouth should be assessed for cleft pabte. Observe the natal teeth Assess oral thrush white patches on oral cavity dur to fingal infection. Neck neck of the newbom is short and having varinw folds. It should be checked for mbilty, any fracture of clavick bone, observe any muss and webbing neck etc (Chest- observe shape and size of chest, Normally chest is burel simped. Observe the nipple and breast tissues, observe witch's milk which is milky discharge due to efféct of mmiemal hormones. Parerts of baby should not be worry because i will be resohed sbbwly and there is no treatment for it, Check the rate and rhythm of respimtinn, neonate’s abdomen rises and falls during each breathe, Abdomen. it should be observed for shape and distention. Check bowel sounds, liver of newbom. can be palpated at 1-3cm below from the costal margin, the spken tip is also palpated on kit side. the kidney bwer pok may be palpable observe the umbilical cord for infection any discharge, redness and observe two arteries and one vein. Check for any hernia or any anomalies Abdomen should feel soft during palpation Genitalia- in ful erm female neonates the labia majora cover the bia minora and cltors is vibe on separating Urethral opering shoukl be bebw the clioris, Pink red mucow, vagim discharge may be found during first week due to suiden decrease of maternal harmooes, which is known as pseudomenstruationMale neonates should be inspected for testes descend, scrotum appears pigmented and wrinkled with rugae. Penk should be impected for urethral opening, Check for hytrocele and inguinal hhemia. The absence of testes in the scrotum my be seen in premature baby, ful term baby usunlly have both testes in serotal sac. Back & Spine- back should be checked for abnormal spinal curvature, hair on skin, depression in the spine, spina bifida, meningocele, meringomyelocele etc. should be observed. Buttocks- butocks should be observed for my mass. Periamal area should be checked for anal opening, anal fissure or any other abnormalities. Extremities- extremities are examined for nay ffacture, range of motion, check the reflexes and muse tone. Fingers and toes should be observed for increased or decreased in rumber. Check for chi foot, chib mils ete. D. NEUROLOGICAL ASSESSMENT It is very important in meonates, Neurological mechanism are immature by both anaiomically and physbbgealy, which results in disturbances of temperature reguhtion, umoordimated movements and bck of control over musculature The rewobgical ascescment is based on four fundamental observations- “Muscle tone- this is assessod by tree parameter pasture, passive tore, active tone Joint mobility. in preterm baby the joints ae relatively stif so the degree of flexion at ankle and wrk is limited. In term baby joints are more flexible and relaxed Automatic reflexes. the presence of certain automatic reflexes such as moro's reflex, pupilary reflex, blinking reflex, grasp, rooting & sucking reflex, help in establishing neurological heath of the monates, These reflexes disappear afier maturity of the nervous system. Body movements- the neomies if not skeping is active and abn. The baby moves exvemities actively. E. ASSESSMENT OF REFLEXES- Behavioral Respomse ] Age OF ‘Apperance ‘When we expose the eyes off neomites 10 the bright light or approach of any objects towards eyes, then neonaes protect. the eyes by rapid cbse of the eyelidPupikconsinits when bright ig fal on ft ‘When we tum the neonates ead to right and left side, the eyes do not adjust inmediately 10 the new position of the head, they hg behind, same Bke a dols eye Spontaneous responses of nasal ‘passage to any irritant When we tap the ghbella (he meeting point of forehead and nose) the neomies react by chsure of eyes are blinking. ‘When we touch the cheek albng the side of the mouth the neomte will tum his head townrds the same side, to find out the food. When we touch the roof of the neomies mouth wih breast nippk or with any other object, neomtes produce sucking movenrent to take it inside. The gag reflex, ako known as the pharyngeal reflex or hryngeal spasm, Ba contraction of the back of tethroat triggered by an object touhing the roof of your mouth, the back of your tongue, the area around your tonsib, or the back of your throat, The refx helps prevent choking, as well a8 helping 10 moderate the ‘vansiton fiom lipid to sold foods during infancy. When we touch ie tonge of| the neomle, then he bis to foe it out ward. When the oxygen evel 6 decreased, the neonate inspires bhrge amount of air by opening the mouth widely. Palmar grasp tellex- when we place any objects in| reonates palm, neonates bolls it by closing all tie fnger around the cbject, it meas whok palm and fingers are used. . Planter gasp reflex. when we plce any object at phnter surfice near to the foes eg. finger, the new bom reacts by fexion of all toes to grasp the objects. When we stroke the outer aspect of the sob of the neonate foot from the heel to the hase of] the toes by a firm object likedorsiflexion of the big toe and hyper extended toes. When we hoki the baby in supine position by supporting upper back and head with om hand and lower back with] another hand, then neonates head is suddenly alowed to drop down backward, due to sulden bck of support in neomite’s head causes sudden eatension and abduction of the extremities, with fanning of| fingers. Then folbwed by flexion and abduction of | extremities. When we produce a sudden bud sound rear to neonates, then neonates react. by abduction of arms and flexion of elbows, hand remains clenched. When infint & prone on a fim| surface, thumb & pressed abng spine ftom sacrum to neck, infart responds by crying, flexing extremities. «and. ekvating pelvis and head and ordosis of spine.When we hold the infant from axilla with both hands in a) vettical direction and touching the feet to a hard surface there 8 a fxn and extemion off legs, showing walking activity, When we pce the bahy on abdomen, baby makes crawling’ movements with arms and legs. When we suddenly bwer te neonates. From a short distance in venral suspension, itis felbwed by extension of arms, hands and fingers, same like a parachute, When the neomite & suspended in prone postion wih te examiner hand under tte abdomen, he responds by emension of head, munk and dips. On flexing the head, trunk and hip also shows flexion F. ASSESSMENT OF GESTATIONAL AGE: - ‘The assessment of gestational age of baby can be dom using New Bulkrds Scak. Il asigs a score to various criteria, the sum of all of which is then extrapolated to the gestational age of the fetus. These criteria are divided into Physical and Neurobgical criteria This scoring albws for the estimtion of ag: in the range of 20 weeks-44 week of gestation, with accuracy to+ 2 weeks.. The neuromuscular criteria ‘These are: Pasture Assess posture for the degee of fexion of the extremes AL term, a newborn's kes and arms are moderately flexed at rest. Preterm newborns show lesser degrees of flexion the younger the gesiatiomal age, the ss flexion the newborn demonstrate Squmre window Assess squire window by gasping the newbom's forearm and gemly flexing the wrist toward the ier arm. Do not albw rotation of the wrist, Measure Ge angk that forms where the hand meets the wrist At term, the hand should touch the wrist, resubing in a O-degree angle. Preterm newborns show greater angks of flexion at the wrist: the younger the gestational age, the kss fexbility at the wrst. Very preterm newboms have an angk of wrist flexion of 90 degrees or nnre, Arm recoil- Measure arm recoil by first flexing and holding both forearms for 5 seconds, then extending the arms and hands filly at the newbom’s side. Next, release the hands and albw the arms to recoil {retum to flexion). Term newborns demonstrate full recoil to a position of flexion while preterm newboms show less flexion. Measure the angk of flexion at the ebow to determinePopliteal angle: With the newbom’s thigh pressed against bis abdomen, measure the popliteal ange by moving the foot genily toward the head utd you meet resistance. At this point, measure the angle bebind the knee in the popliteal area. Term newborns are less flexible, with about a 90- degree ange. With very Scarf sign- assess the scarf sign by grasping the newborn's hand and attempting to crass the arm over his body at the neck. The arms of term newborns meet resistance befure crossing midline, while preterm newborns cross the ebow past midline. Heel To ear Assess heel to car by mising the newbom's eel toward his head in an atempt 10 bring the foot to the ear. Do not raise the newbom's buttocks off of the examination surface. Stop when you meet resistance and measure the degree of extersion of the leg. With preterm newboms, you'll come close to touching the heel to the ear, while you'll meet resistance almost immediately with term newborns;2. ‘The physical criteria ‘These are: Skin- The skin ranges from transtucert and ffiabk in preterm newborns to leathery, cracked, and wrinkled in post-term newborn, Assess the skin for transparency, eracks, vein, peeling, and Eaveye- The eye/ear assessment is an analsis of the ear cartibge and shape of the pina. The pinm is less curved in preterm newboms whik term newborms have a well-cuned pina with fim cartibg, Determine ear recoil by folding the pima down and assessing how quickly it reurs to its previous postion Ako, very preterm newborns may have fissed eyelids. You'll score ‘the degree of fitsinn for these newborns.‘© Lammgo hair Lamgo is very fine body hair, Extremely premiture newboms have none. During the middle of the third trimester, most femises have plentiful lug. Closer to term, this body hair ‘begins to thin, Terms newborns have very fie, and it is mearly absent in post-tecm newbores. + Plantar surane= EEport UEP col Geaies. Term newborns have creases ‘over the entre photar surface, whi the creases of a preterm newborn range from absent to. faint zed markings, Preterm infant at 28 weeks" Tem gestation, Note gestation. Note the flat the multiple creases smooth sole. 2 + Breast bud- Inspect the breast to assess the sie of the breast bud in mifimeters and the development of the. ares, Preterm newborns lick develbped breast tissue, Term newborns have a sased to a full areokt with breast buds that are 3 to 10 millimeters in diameter,Genitals Observe the genital for physical maturity. With males, the testes usualy descend near term and rugae (ridges or folds) are visible on the scrotum. Palpate the testes to determine if they have descended and note the rugse. With extreme prematurity, the scrotum is ft and smooth, With female oewboms at term, the bia majora are burger than the clioris and the labia mimora, Preterm newboms have a prominent clitoris and small bbia minora, Base your scores on the degree of development of the bia. Based ongestational age, each neonate is dassified as Premaure: <34 wk Late preterm: 34 to< 37 wk Early term: 37 O/T wk through 38 6/7 wie Full term: 39 0/7 wk through 40 6/7 wk Law ter 41 0/7 wk through 41 6/7 wk Postterm: 42.07 wk and beyond Postmatuwe: > 42 wkBOOK SOURCES- Parul Dawa, Pediauic Nursing, Second Edition Jaypee Brother an! Medical Publisher (P) Lid, New Delhi, Pp. 67-71 . Rimpe Sharma, Essentak of Pediatric Nursing, First Edition Jaypee Brother and Medical Publsher (P) Lid, Haryam, Pp 150-165 Manoj Yadav, A Text Book of Chili Heath Nursing 2011 Edition, S Vikas & Company ‘(Medical Publisher) India, Pp- 298-305 NET SOURCES- 1. Physical examination of the newbom - UTMB.edu hnps/Avww.utnb.edw/pedi_ed/oore/neomtology/page_11.htm . Ballard Manrational Assessmert - Wikipedia, the free encyclopedia ups/fen.wikipedia.org/wiki/Ba llr Maturationa | Assessmen Reflex Testing - A Practical Guide to Clinical Medicine lntps/fmeded.usd.edufclinicalmed/neuro3.htm |. Apgar score: MedinePlus Medical Encyclopedia medineplus gov » Medical EncycbpediASYMMETRICAL TONIC NECK REFLEX It is characterized by extension of the upper and lower extremities on the side to which the head and neck is turned with flexion of the contralateral upper extremity (fencing posture).SYMMETRICAL TONIC NECK REFLEX * Placing the child in quadruped position on the floor and passively flexing the head forward and then extend it backwards. Head extension causes arm extension and leg flexesTONIC LABYRINTHINE REFLEX * Movement of the head Toric Labyirtre Rtas any dimensions, stimulate the labyrinth to produce the appropriate responses * Arms &legs extend when head moves back ward, will curl in when the head moves forward APPEARS AT | MONTH DISAPPEARS AROUND 4 iNECK RIGHTING REFLEX + Neck Righting Reflex: With the infant supine, turning the head to one side causes the infant to turn his shoulders and trunk to the same side. It appears when the tonic neck reflex disappears NECK RIGHTING REFLEXTRUNK INCURVATION/GALANT REFLEX ¢ Stroking one side of the spinal column when baby is on abdomen causes > Crawling motion with legs > Lift the head from surface