CMCA-Lec

Ma’am Florendo
Physiologic Function and Appearance of the  Molding may result in a lower head
Newborn circumference measurement
1. Temperature 6. Chest Circumference
 Range from 36.5 to 37 axillary  30.5 to 33 cm
 Crying may elevate temperature  Head and chest circumference maybe equal
 Stabilizes in 8-10 hours after delivery for the first 24 – 48 hrs of life
Signs of Potential Distress:
 Temperature is no a reliable indicator of 7. Weight
infection  2500 – 4000 gms
 A temp of less than 36.5
8. Length
2. Heart Rate  48 – 53 cms
 Range from 120 to 160 beats per minute
 Range to 100 when sleeping and 180 when 9. Skin
crying  Reddish, smooth and puffy at birth
 Color pink wih acrocyanosis  At 24-36 hrs skin is flaky, dry and pink color
 Maybe irregular when crying  Edema around eyes, feet and genitals
Signs of Potential Distress:  Good skin turgor with good recoil
 Murmurs  Cord with 1 vein,2 arteries
 Deviation from range  Hair silky and soft with individual strands
 Faint heart sounds  Nipples present in expected locations
 Nails to end of fingers and often extend
3. Respirations slightly beyond
 30 – 60 breaths per minute  Presence of vernix caseosa
 Bilateral bronchial breath sounds  Presence of lanugo
 Moist breath sounds may be present shortly  May have acrocyanosis
after birth  Mongolian spots
Signs of Potential Distress:  Mottling
 asymmetrical chest movements  Physiologic jaundice
 apnea for more than 15 seconds  Milia
 diminished breath sounds  Erythema toxicum
 seesaw respirations  Petechia or bruises over presenting part
 grunting  Skin tags
 nasal flaring  Harlequin coloring
 retractions Signs of Potential Distress:
 deep sighing  Jaundice within 24 hours
 tachypnea  Forceps mark
 persistent irregular breathing  General cyanosis
 excessive mucus  Circumoral cyanosis between feedings
 excessive fine crackles, stridor  Petechiae or ecchymoses other than on
presenting part
4. Blood Pressure  All rashes with exeption of erythema toxicum
 Varies with change in activity level  Pigmented nevi
 Appropriate cuff size  Yellow vernix
 65/41 mmHg 1 to 3 days in both upper and  Hemangioma
lower extremities  Pallor
Signs of Potential Distress:
 Calf systolic pressure of 6-9 mmHg less than 10. Head
systolic pressure in upper extremities may be  Anterior fontanel diamond shaped
indicative of coarctation of the aorta.  Posterior fontanel triangularly shaped
 Fontanels: soft firm, and flat
5. Head Circumference  Sutures palpable with small separation in
 33 – 35 cm between
 Should be 2 – 3 cm larger than the chest  There may be caput succedaneum
 molding
CMCA-Lec
Ma’am Florendo
Signs of Potential Distress:  Minimal or absent salivation
 Cephalhematoma  Tongue moves freely and does not protrude
 Hydrocephalus  Well-developed fats pads on bilateral cheeks
 macrocephaly  Sucking reflex
 Rooting reflex
11. Eyes  Gag reflex
 Slate gray or blue eye color  Extrusion reflex
 No tears  Moist mucosa
 Fixation at times  High arched palate
 Red reflex  Epstein’s pearls on ridges of the gums
 Blink reflex Signs of Potential Distress:
 Distinct eyebrows  Cleft lip palate
 Cornea: bright and shiny  Circumoral pallor
 Pupils equal and reactive to light  Asymmetrical lip movement
 Edematous eyelids  Absent or incomplete reflexes
 May focus for a few seconds  Protruding tongue
 Uncoordinated movements  Diminished tongue movement
Signs of Potential Distress:  Candida albicans
 Discharges  Percocious teeth
 Opaque lenses
 Absence of red reflex 15. Neck
 Epicanthal folds in newborns not of oriented  Short and thick
descent  Turns easily on sides
 Reflexes absent  Clavicles intact
 Chemical conjunctivitis  Tonic neck reflex present
 Subconjunctival hemorrhage  Neck-righting reflex present
 Some head control
12. Ears Signs of Potential Distress:
 Loud noise elicits startle reflex  Torticollis stiff neck drawing head to one side
 Flexible pinna with cartilage present  Resistance to flexion
 Pinna top on horizontal line with outer  Webbing of neck
canthus of the eye  Large fat pad on back of the neck
 Skin tags on or around the ears  Palpable crepitus, movement with palpation
Signs of Potential Distress: of the clavicle
 Lower ear placement
 Clefts present 16. Chest
 Malformations  Evident xiphoid process
 Cartilage absent  Bilateral synchronous chest movement
 Preauricular sinus  Symmetrical nipples
 Equal anteroposterior and lateral diameter
13. Nose  Witch’s milk
• Nostrils patent bilaterally  Enlarge breasts
• Obligate nose breathers  Accessory nipples
• No nasal discharge Signs of Potential Distress:
• Sneezes to clear nostrils  Asymmetrical chest movements
• Bridge appears absent  Depressed sternum
• Thin white nasal mucus discharge  Marked retractions
Signs of Potential Distress:  Absent breast tissue
 Cloanal atresia and discharge  Flattened chest
 Malformation  Supernumerary nipples
 Nasal flaring beyond first few moments after  Nipples widely spaced
birth  Bowel sounds auscultated

14. Mouth and Throat 17. Abdomen

 Uvula midline • Dome-shaped abdomen
CMCA-Lec
Ma’am Florendo
• Abdominal respirations  Scrotum smooth
• Soft to palpation  Ambiguous genitalia
• Well-formed umbilical cord 20. Back and Rectum
• Three vessels in cord  Intact spine without masses or openings
• Cord dry at the base  Trunk incurvature reflex
• Liver palpable 2-3 cm below the right costal  Potential anal opening
margin  Wink reflex present
• Bilaterally equal femoral pulses Signs of Potential Distress:
• Bowel sounds auscultated within two hours of  Limitation of movement
birth  Fusion of vertebrae
• Voiding within 24-48 hours of birth  Spina bifida
• Small umbilical hernia  Tuft of hair
Signs of Potential Distress:  Imperforate anus
 absent bowel sounds  Anal fissures
 visible peristaltic waves  Pilonidal cyst
 abdominal distention
 palpable masses 21. Neuromuscular System
 scaphoid shaped abdomen  Maintains position of flexion
 omphalocele  When prone, turns head side to side
 base of cord with redness or drainage  Holds head and back in horizontal plane when
 cord with two vessels only held prone
 Ability to hold head momentarily erect
18. Female Genitalia Normal Newborn Reflexes
 Edematous labia and clitoris  Blink reflex
 Labia majora are larger and surrounding labia  Rooting reflex
minora  Sucking reflex
 Vernix between labia  Swallowing reflex
 Hymental tag  Extrusion reflex
 Pseudomenstruation  Palmar grasp reflex
 Smegma-sebaceous secretion  Step-in-place reflex
 Increased pigmentation  Placing reflex
 Ecchymosis and edema after breech birth  Plantar grasp reflex
 Red, brick pink-stained urine  Tonic-neck reflex
Signs of Potential Distress:  Moro reflex
 Labia fused  Babinski reflex
 Fecal discharge from vaginal opening  Magnet reflex
 Inperforate hymen  Crossed extension reflex
 Ambiguous genitalia  Trunk Incurvation reflex
 Widely separated labia  Landau reflex
 Deep tendon reflex
19. Male Genitalia Signs of Potential Distress:
 Urinary meatus at the tip of the glans penis  Hypotonia- low muscle tone
 Palpable testes in scrotum  Quivering
 Large, edematous, pendulous scrotum, with  Limp extremities or strainghtening of
rugae-(fold) extremities
 Smegma beneath the prepuce  Clonic jerling
 Stream adequate on voiding  paralyis
 Prepuce covering urinary meatus
 Erections 22. Cardiovascular System
 Increased pigmentation • Functional closure of the ductus arteriosus,
 Edema and ecchymosis after breech delivery foramen ovale , ductus venosus and umbilical
Signs of Potential Distress: artery
 Non palpable testes • Blood volume is 80-100ml/kgBW or total of
 Hypospadias 300 ml
 Epispadias • High ESR, hgb and WBC count
CMCA-Lec
Ma’am Florendo
• Prolonged coagulation or prothrombin time  Do not suction unless mouth/nose are
blocked with secretions/other material.
23. Respiratory System
 Onset of breathing occurs as air replaces that a.1. If after 30 seconds of thorough drying, NB is
fluid that filled the lungs during the not breathing.
intrauterine life.  Reposition
 Suction
24. Gastrointestinal System  Ventilate
 Sterile at birth  Clamp and cut the cord
 Limited ability to digest fats immediately
 Immature cardiac sphincter between the  Call for help
stomach and the esophagus  Transfer to warm, firm surface
 Immature liver functions  Inform mother
 Meconium to transitional stool  Start resuscitation
a.2 If after 30 seconds of thorough drying, NB is
25. Urinary System/Renal breathing or crying
 Voids within 24 hours after birth  Do skin-to-skin contact
 System does not fully mature until after the  Place NB prone on mother’s abdomen
first year of life  Cover NB’s back with blanket and head
with bonnet
26. Immune System  Place identification band on ankle
 Difficulty of antibody formation Don’ts:
 Don’t separate the NB from mother
unless in distress
Essential Newborn Care  Do not put NB on cold/wet surface
 Do not wipe off vernix if present
 Do not bathe earlier than 6 hours of life
 Do not do footprinting
b. 1-3 minutes- do delayed, not immediate cord
clamping
 Remove first set of gloves
 Clamp and cut cord after pulsations have
stopped (1-3 minutes)
 put ties around the cord at 2 cm
and 5 cm from NBs abdomen
 cut between ties with sterile
instrument
 Observe oozing blood
1. Immediate Newborn Care c. Within 90 minutes of age- provide support
 Starts at perineal bulging with presenting part for initiation of breathing
visible (2nd stage of labor) Actions:
 Prepare for delivery  make sure gloves re removed
 Ensure area is draft free  leave NB on mother’s chest in skin-to-skin
 Temperature is 25 – 28 degrees contact
 Wash hands with clean water and  Observe NB
soap Cues:
 Opening of mouth
 Double gloving
 Tonguing
a. Within First 30 seconds- call out the time of
 Licking
delivery
 Rooting
 Dry and provide warmth.
 Do quick check of NB breathing.
2. From 90 minutes to 6 hours
 Do not ventilate unless baby is
 Give vitamin K prophylaxis
floppy/limp and not breathing.
 Inject Hepa B and BCG vaccines
CMCA-Lec
Ma’am Florendo
 Thoroughly examine body, check for birth
injuries or defects
 Weigh and record