Characteristic of Newborn

The end of your journey has come after 40 weeks. The fruit of your labour (literally) will soon be in your hands.
There are a few things you might want to know about your new arrival. Typically, a newborn baby has the following
characteristic appearance:
• Weight: Average 2.8 kg for Indian babies (range 2.5 – 3.2 kg). Babies below 2.5 kg at birth are considered
to be low birth weight and need special evaluation.
• Length: Approximately 50 cm. Remember, small women have small babies and many genetic factors also
play a role in determining the length of the baby.
• Head: Your baby’s head appears large for the body and may have an elongated shape or appear to have
some ‘bumps’. This is due to changes called molding, which occurs in labour and delivery. Small bumps
called ‘caput’ usually disappear in 1 – 2 days. Soon the head gets rounder. The head circumference is 33 –
35 cm.
• Soft spots or Fontanelles: There are 2 areas on the head where bone formation is incomplete at birth. The
larger one, in front of the head closes by 6 – 18 months. The smaller one at the back usually closes by 6
weeks.
• Hair: As all people vary, so does their hair. Your baby may have lots of hair or none at all! It depends on
familial and racial factors.
• Heart beats: Usually the heart rate is 120 – 140 beats per minute.
• Respiratory rate (breathing): It is faster than adults, usually 30 – 40 breaths / minute. Breathing may be
noisy or stop for many seconds. This is not uncommon.
• Colour: Depending on the parents, the skin colour of newborn varies. In general, newborn babies look
flushed and pink all over. However, the palms and soles of the feet may look dusky or little bluish soon
after birth.

Axillary temperature measurement. The thermometer should remain in place for 3 minutes. The nurse presses the
newborn’s arm tightly but gently against the thermometer and the newborn’s side, as illustrated

Proper Identification of the Newborn

 Proper Id is made in the delivery room before mother and baby are separated.
o Identification Band
o Footprints
o Others – fingerprints, crib card, bead bracelet
 Birth certificate
 final identification check of the mother and infant must be performed before the infant can be allowed to
leave the hospital upon discharge to ensure that the hospital is discharging the right infant.
Preventing Infection
Credes Prophylaxis – Dr. Crede
prevent opthalmia neonatorum or gonorrhoeal conjunctivitis
how transmitted – mom with gonorrhea
drug: erythromycin ophthalmic ointment- inner to outer

 It is part of the routine care of the NB to give prophylactic eye

treatment against gonorrheal conjunctivitis or ophthalmia
neonatorum within the first hour after delivery.
 Neisseria gonorrhea, the causative agent,maybe passed on to the
fetus when infected vaginal and cervical secretions enter the eyes as
the baby passes the vaginal canal during delivery. This practice was
introduced by Crede, German gynecologist in 1884. Silver Nitrate

Ophthalmia neonatorum
Any conjunctivitis with discharge occuring during the first two weeks of life. It typically appears 2-5 days
after birth, although it may appear as early as the first day or as late as the 13th.

silver nitrate (used before) – 2 drops lower conjunctiva (not used now)
Administering Erythromycin or Tetracycline Ophthalmic Ointment
 These ointments are the ones commonly used nowadays for eye prophylaxis because they do not cause eye
irritation and are more effective against Chlamydial conjunctivitis.
 Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes.
 Wipe excess ointment after one minute Č sterile cotton ball moistened Č sterile water.
Principles of cleanliness at birth: Handwashing
 Clean hands  Before entering the nursery or caring for a baby
 Clean perineum  In between newborn handling or after the care of
 Nothing unclean to be introduced into the vagina each baby
 Clean delivery surface  Before treating the cord
 Cleanliness in cutting the umbilical cord  After changing soiled diaper
 Cleanliness for cord care of the newborn baby  Before preparing milk formula.
Preventing Hemorrhage
 As a preventive measure, 0.5mg (preterm) to 1 mg (full term) Vit. K or Aquamephyton is injected IM in the
NB’s vastus lateralis (lateral anterior thigh)muscle
 Vit-K – to prevent hemorrhage R/T physiologic hypoprothrombinemia
 Aquamephyton, phytomenadione or konakion
 .1 ml term IM, vastus lateral or lateral ant thigh
 .05 ml preterm baby
 Vit K – synthesized by normal flora of intestine
 Vit K – meds is synthetic due intestine is sterile
Procedure for vitamin K injection. Cleanse area thoroughly with alcohol swab
and allow skin to dry. Bunch the tissue of the upper outer thigh (vastus
lateralis muscle) and quickly insert a 25-gauge 5/8-inch needle at a 90-degree
angle to the thigh. Aspirate, then slowly inject the solution to distribute the
medication evenly and minimize the baby’s discomfort. Remove the needle
and gently massage the site with an alcohol swab.

Care of the Cord

The cord is clamped and cut approx. within 30 sec after birth. In the
DR, the cord is clamped twice about 8 inches from the abdomen and
cut in between.
When the NB, is brought to the nursery, another clamp is applied . to 1 in from the abdomen and the
cord is cut a second time.
The cord and the area around it are cleansed w/ antiseptic solution.
The manner of cord care depends on hospital protocol or the discretion of the birth attendant in home
delivery, what is impt. Is that principles are followed.
Cord clamp is removed after 48 hours when the cord has dried. The cord stump usually dries and falls
off within 7-10 days leaving a granulating area that heals on the next 7-10 days.
Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and
seperates more rapidly if it is exposed to air.
Report any unusual signs & symptoms that indicate infection:
Foul odor in the cord
Presence of discharge
Redness around the cord
The cord remains wet and does not fall off within 7-10 days
Newborn fever

“Tetanus microorganism thrives in anaerobic environment so you actually prevent infection if

cord is exposed to air”.
3 cleans in community
clean hand
clean cord
clean surface
betadine or povidone iodine – to clean cord
check AVA, then draw 3 vessel cord

If 2 vessel cord- suspect kidney malformation

leave about 1” of cord
if BT or IV infusion – leave 8” of cord best access - no nerve
check cord every 15 min for 1st 6 hrs – bleeding .> 30 cc of blood bleeding of cord – Omphalagia –
suspect hemophilia
Cord turns black on 3rd day & fall 7 – 10 days
Faiture to fall after 2 weeks- Umbilical granulation
Mgt: silver nitrate or catheterization
clean with normal saline solution not alcohol
don’t use bigkis – air
persistent moisture-urine, suspect patent uracus – fistula bet bladder and normal umbilicus
dx: nitrazine paper test – yellow – urine
mgt: surgery

Bathing
• oil bath – initial
• to cleanse baby & spread vernix caseosa

Fx of vernix caseosa
1. insulator
2. bacterio- static
Babies of HIV + mom – immediately give full bath to lessen transmission of HIV
• 13 – 39% possibly of transmission of HIV

Immediate Care of the Newborn • Signs of potential distress or deviations from

A irway expected findings
B ody temperature o Asymmetrical chest movements
C heck/ assess the newborn o Apnea >15 seconds
o Diminished breath sounds
D etermine identification
o Seesaw respirations
• Stimulate & dry infant
o Grunting
• Assess ABCs
o Nasal flaring
• Encourage skin-to-skin contact
o Retractions
• Assign APGAR scores o Deep sighing
• Give eye prophylaxis & Vit. K o Tachypnea - respirations > 60
• Keep newborn, mother, & partner together o Persistent irregular breathing
whenever o Excessive mucus
Newborn Assessment and Nursing Care o Persistant fine crackles
o Stridor
Physical Assessment
• Breathing ( ventilating the lungs)
• Temperature - range 36.5 to 37 axillary
o check for breathlessness
• Common variations
o if breathless, give 2 breaths- ambu bag
• Crying may elevate temperature o 1 yr old- mouth to mouth, pinch nose
o Stabilizes in 8 to 10 hours after o < 1 yr – mouth to nose
delivery o force – different between baby & child
o Temperature is not reliable indicator of
o infant – puff
infection a temperature less than 36.5
• Circulation
Temp: rectal- newborn
o Check for pulslessness :carotid- adult
• to rule out imperforate anus
¨ Brachial – infants
• take it once only , 1 inch insertion • CPR – breathless/pulseless
• Compression – inf – 1 finger breath below
Imperforate anus
1. atretic – no anal opening nipple line or 2 finger breaths or thumb
2. agenetialism – no genital • CPR inf 1:5
3. stenos – has opening • Adults 2:30
4. membranous – has opening • Blood Pressure
o not done routinely
Earliest sign: • Factors to consider
1. no mecomium o Varies with change in activity level
2. abd destention o Appropriate cuff size important for accurate
3. foul odor breath reading
4. vomitous of fecal matter o 65/41 mmHg
5. can aspirate – resp problem
General Measurements
Mgt: Surgery with temporary colostomy o Head circumference - 33 to 35 cm
o Expected findings
Heart Rate
o Head should be 2 to 3 cms larger than the chest
• range 120 to 160 beats per minute
o Abdominal circumference – 31-33 cm
• Common variations
o Weight range - 2500 - 4000 gms (5 lbs. 8oz. - 8
• Heart rate range to 100 when sleeping to 180 lbs. 13 oz.)
when crying o Length range - 46 to 54 cms (19 - 21 inches)
• Color pink with acrocyanosis
• Heart rate may be irregular with crying Anthropometic measurement
• Although murmurs may be due to transitional normal length- 19.5 – 21 inch or 47.5 – 53.75cm,
circulation-all murmurs should be followed-up average 50 cm
• and referred for medical evaluation head circumference 33- 35 cm or 13 – 14 “
• Deviation from range Hydrocephalus - >14”
• Faint sound Chest 31 – 33 cm or 12 – 13”
Abd 31 – 33 cm or 12 – 13”
Cardiac rate: 120 – 160 bpm newborn
Apical pulse – left lower nipple
Radial pulse – normally absent. If present PDA Signs of increased ICP
Femoral pulse – normal present. If absent- COA - 1.) abnormally large head
coartation of aorta 2.) bulging and tense fontanel
3.) increase BP and widening pulse pressure #3 & #4 are
Respiration Cushings triad of
4.) Decreased RR, decreased PR ICP
8
• range 30 to 60 breaths per minute
5.) projective vomiting- sure sign of cerebral irritation
 • Common variations
o Bilateral bronchial breath sounds
• Moist breath sounds may be present shortly
after birth
Skin
o Skin reddish in color, smooth and puffy at birth
o At 24 - 36 hours of age, skin flaky, dry and pink
in color
o Edema around eyes, feet, and genitals
o Venix Caseosa -whitish, cheese-like substance,
covers the fetus while in utero and lubricates
the skin of the NB. The skin of the term or
postterm nb has less vernix and is frequently
dry; peeling is common, esp. on the hands &
feet
o Lanugo -moderate in full term; more in
preterm; absent in postterm; shed after 2 weeks
in time of desquammation
o Turgor good with quick recoil
o Hair silky and soft with individual strands
o Nipples present and in expected locations
o Cord with one vein and two arteries
o Cord clamp tight and cord drying
o Nails to end of fingers and often extend slightly
beyond
Skin color
White – edema Blue – cyanosis or hypoxia
Grey – infection Yellow – jaundice , carotene
Acrocyanosis
o Bluish discoloration of the hands and feet maybe
present in the first 2 to 6 hours after birth
o This condition is caused by poor peripheral
circulation, w/c results in vasomotor instability &
capillary stasis, esp. when the baby is exposed to
cold.
If the central circulation is adequate,
the blood supply should return quickly
when the skin is blanched with a
finger. Blue hands and nails are poor
indicator of oxygenation in NB. The
nurse should assess the face & mucus
membranes for pinkness reflecting
adequate oxygenation
Mongolian Spots
Patch of purple-black or blue-black
color distributed over coccygeal and
sacral regions of infants of African-
American or Asian descent. Not
malignant. Resolves in time. They
gradually fade during the first or
second year of life. They maybe
mistaken for bruises and should be
documented in the NB’s chart.
Mottling
lacy pattern of dilated blood vessels
under the skin
Occurs as a result of general
circulation fluctuations. It may last
several hours to several weeks or
may come and go periodically.
Mottling maybe related to chilling
or prolonged apnea.
Physiologic Jaundice
o Hyperbilirubinemia not associated with
hemolytic disease or other pathology in the
newborn. Jaundice that appears in full term
newborns 24 hours after birth and peaks at 72
hours. Bilirubin may reach 6 to 10 mg/dl and
6.) high deviation – diplopia – sign of ICP older child
4-6 months- normal eye deviation
>6 months- lazy eyes
7.) High pitch shrill cry-late sign of ICp
o Jaundice is first detectable on the face (where
skin overlies cartilage) and the mucus
membranes of the mouth and has a head-to-toe
progression.
o Evaluate it by blanching the tip of the nose, the
forehead, the sternum, or the gum line. This
procedure must be done with appropriate
lighting. Another are to assess is the sclera.
o Jaundice maybe related to breastfeeding,
hematomas, immature liver function, bruises
from forceps, blood incompatibility, oxytocin
induction or severe hemolysis process.
Nsg Resp:
1. cover eyes – prevent retinal damage
2. cover genitals – prevent priapism – painful continuous
erection
3. change position regularly – even exposed to light
4. increase fld intake – due prone to dehydration
5. monitor I&O – weigh baby
6. monitor V/S – avoid use of oil or lotion
due- heat at phototherapy
= bronze baby syndrometransient
S/E of phototherapy
Care of Newborn in Jaundice
Phototherapy
o Is the exposure of the NB to high intensity
light.
o Maybe used alone or in conjunction w/
exchange transfusion to reduce serum bilirubin
levels.
o Decreases serum bilirubin levels by changing
bilirubin from the non-water soluble form to
water-soluble by products that can be excreted.
Nursing Interventions:
1. Exposing as much of the NB’s skin as possible
however genitals are covered & the nurse monitors the
genitals area for
skin irritation
2. Eyes are covered with patches or eye shields and are
removed at least once per shift to inspect the eyes
3. Monitor temp. closely & ↑ fluids to compensate water
loss
4. NB is repositioned q 2° and stimulation is provided.
o NB will have loose green stools and green
colored urine.
Exchange Transfusion
o Is the withdrawal and replacement of newborn’s
blood with donor blood.
Milia which are exposed to
sebaceous glands, appear as
raised white spots on the face, esp.
across the nose. No treatment is
necessary, because they will
clear within first month.
Infants of African heritage have a
similar condition called transient
neonatal pustular melanosis.
 resolve in 5 to 7 days.
o If jaundice occurs within 2 days – pathologic
jaundice
o If jaundice occurs at 3rd-7th days of life –
physiologic jaundice

Erythema toxicum
o Is an eruption of lesions in the
area surrounding a hair follicle
that are firm, vary in size from
1-3 mm, and consist of a
white or pale yellow papule or
pustule w/ an erythematous
base.
o It is often called “newborn rash” or “fleabite”
dermatitis
o The rash may appear suddenly, usually over
o the trunk and diaper area and is frequently
widespread.
o The lesions do not appear on the palms of the
hands or soles of the feet.
o The peak incidence is 24-48 hours of life.
o Cause is unknown and no treatment
Harlequin Sign
o The color of the newborn's body appears to be
half red and half pale. This condition is
transitory and usually occurs with lusty crying.
Harlequin Coloring may be associated with to
an immature vasomotor reflex system.
BIRTH MARKS
Telangiectatic nevi (stork bites)
• Appear as pale pink or red spots and are
frequently found on the eyelids, nose, lower
occipital bone and nape of the neck
• These lesions are common in NB w/ light
complexions and are more noticeable during
periods ofcrying.
3 types Hemangiomas
a.) Nevus Flammeus – port wine stain – macular purple
or dark red lesions seen on face or thigh. NEVER
disappear. Can be removed surgically
b.) Strawberry hemangiomas – nevus vasculosus –
dilated capillaries in the entire dermal or subdermal
area. Enlarges, disappears at 10 yo.
c.) Cavernous hemangiomas – communication network
of venules in SQ tissue that never disappear
with age.
• The size & shape vary, but it commonly appears
on the face. It does not grow in size, does not
fade in time and does not blanch. The birthmark
maybe concealed by using an opaque cosmetic
cream.
• If convulsions and other neurologic problem
accompany the nevus flammeus,----5th
cranial nerve involvement.
Nevus vasculosus (strawberry mark)
• A capillary hemangioma,
consists of newly formed and
enlarged capillaries in the
dermal and subdermal layers.
• It is a raised,clearly delineated,
dark-red, rough-surfaced
birthmark commonly found in
the head region.
• Such marks usually grow starting the second or
third week of life and may not reach their
fullest size for 1 to 3 months; disappears at the
age of 1 yr. but as the baby grows it enlarges.
• Birthmarks frequently worry parents. The
mother maybe especially anxious, fearing that
she is to blame (“Is my baby marked because of
something I did?”) Guilt feelings are common
when parents have misconceptions about the
cause. Identify and explain them to the parents.
• Providing appropriate information about the
cause and course of birthmarks often relieves
the fears and anxieties of the family. Note any
bruises, abrasions,or birthmarks seen on
admission to the nursery.
HEAD
• Head circumference should be 2 cm greater
than chest circumference
• Assess fontanelles and sutures - observe for
signs of hydrocephalus and evaluate neurologic
status
• Craniosynostosis
• Microcephaly
• Macrocephaly

Flammeus (port-wine stain)

• A capillary angioma directly below the
epidermis, is a non-elevated, sharply
demarcated, red-to-purple area of dense
capillaries.
• Macular purple
Face, Mouth, Eyes, and Ears
• Assess and record symmetry
• Assess for signs of Down syndrome.
• Low set ears
• Assess history for risk factors of hearing loss
• Test for Moro reflex- elicited by a loud noise or
lifted slightly above the crib and then suddenly
lowered. In response, the NB straightens arms
and hands outward while the knees flexed.
Slowly the arm returns to the chest as in
embrace. The fingers spread, forming a C and
the newborn may cry. This lasts up to 6 months
of age.
• Check for presence of gag, swallowing
reflexes, coordinated with sucking reflex
• Check for clefts in either hard or soft palates
• Check for excessive drooling
• Check tongue for deviation, white cheesy
coating
Eyes
• Assess for PERLA (pupils equal and reactive
to light and accommodation)
• Assess cornea and blink reflex
• Note true eye color does not occur before 6
months
• May have blocked tear duct
Heart and Lungs
• Assess and maintain airway
• Assess heart rate, rhythm - evaluate murmur:
location, timing, and duration
o Examine appearance and size of chest
o Note if there is funnel chest, barrel
chest, unequal chest expansion
• Assess breath sounds and respiratory efforts -
evaluate color for pallor or cyanosis
• Breasts are flat with symmetric nipples - note
lack of breast tissue or discharge
Abdomen
• Abdomen appears large in relation to pelvis
o Note increase or decrease in peristalsis
o Note protrusion of umbilicus
• Measure umbilical hernia by palpating the
opening and record
o Note any discharge or oozing from
cord
o Note appearance and amount of
vessels
• Auscultate and percuss abdomen
o Assess for signs of dehydration
o Assess femoral pulses
o Note bulges in inguinal area
o Percuss bladder 1 to 4 cm above
symphysis
o Voids within 3 hours of birth or at time
of birth
Genitals
• Pseudomenstruation: the discharge w/c can
• Epispadias: if the opening is at the dorsal
surface
• Hydrocele – swelling due to accumulation of
serous fluid in the tunica vaginalis of the testis
or in the spermatic cord
Anus
• Inspect anal area to verify that it is patent and
has no fissure
• Digital exam by physician or nurse practitioner
if needed
• Note passage of meconium
Extremities
• Tic dwarfism : very short arms
• Amelia : absence of arms
• Phocomelia : absence of long arm
• Polydactilism: more fingers; extra digits on
either hands or feet
• Syndactilism: webbing; fusion of fingers or
toes
• Inspect the hands for normal palmar creases. A
single palmar crease called SIMIAN line is
frequently present in Down’s syndrome
• Adactyl : no foot
• Down’s syndrome: inward rotation of little
fingers
• Clubfoot/ talipes deformity – inward rotation
of foot fingers.
• Erb-Duchenne paralysis (Erb’s palsy) :
resulting from injury to the 5th and 6th cervical
roots of the brachial plexus; usually from a
difficult birth; it occurs commonly when strong
traction is exerted on the head of the NB in an
attempt to free a shoulder lodged behind the
symphysis pubis in the presence of shoulder
dystocia
A. The asymmetry of gluteal
and thigh fat folds see
B. Barlow's (dislocation)
maneuver. Baby's thigh is
grasped and adducted
(placed together) with
gentle downward
 become tinged w/ blood and is caused by
withdrawal of C, Dislocation is palpable
• maternal hormones as femoral head slips out of
acetabulum.
• Smegma: a white cheeselike substance is often
present between labia. Removing it may
traumatize tender
• tissue
D, Ortolani's maneuver puts
• Phimosis : tight foreskin or prepuce; w/c downward pressure on the hip and
sometimes lead to early circumcision then inward rotation. If the hip is
• Cryptoorchidism: undescended testes ;if the dislocated, this
testes did not go down maneuver forces the femoral head
over the acetabular rim
• Orchidopexy: repair of undescended testes
before 2 y/o Clubfoot
• Penis: urethra should be at the tip of the penis o Nurse examines feet for evidence of talipes deformity
• Hypospadias : if the opening is at the ventral (clubfoot)
surface o Intrauterine positions can cause feet to appear to turn
inward - "positional" clubfoot
o To determine presence of clubfoot, nurse moves foot to
midline - if resists, it is true clubfoot
TALIPES – “clubfoot”
a.) Equinos – plantar flexion –horsefoot Babinski reflex - When the
b.) Calcaneous – dorsiflexion –heal lower that sole of the foot is firmly
foot anterior posterior of foot flexed towards stroked, the big toe bends
anterior leg back toward the top of the
c.) Varus- foot turns in foot and the other toes fan
d.) Valgus- foot turns out out. This is a normal reflex
Equino varus- most common up to about 2 years of age.

Tonic neck reflex - When a

baby's head is turned to one
side, the arm on that side
stretches out and the opposite
arm bends
up at the elbow. This is often
called the "fencing" position.
Nursing Role The tonic neck reflex lasts
Be knowledgeable about normal newborn about six to seven months.
variations and responses that indicate further
investigation
o Respiratory distress
o Central cyanosis Grasp reflex - Stroking the
o Thermoregulation problems palm of a baby's
o Dehydration hand causes the baby to
o Teaching close his/her fingers in
a grasp. The grasp reflex
During physical and behavioral assessment,
lasts only a couple of
identify family's need for teaching
months and is stronger in
o Involve family early in care of infant
premature babies.
o Process establishes uniqueness and
Palmar & Plantar
allays concern
Teaching
o Feeding cues Palmar & Plantar Grasp Reflex
o Alert state
o Cord care
o Sleeping

Neurological Status
Assessment begins with period of observation
Observe behaviors - note:
o State of alertness
o Resting posture
o Cry The Moro reflex is often called a
o Quality of muscle tone startle reflex because it usually occurs
o Motor activity when a baby is startled by a loud
sound or movement. In response to
Jitteriness – feeling of extreme nervousness the sound, the baby throws back
Differentiate causative factors his/her head,
Examine for symmetry and strength of extends out the arms and legs, cries,
then pulls the arms and legs back in.
movements A baby's own cry can startle him/her
Note head lag of less than 45 degrees and begin this reflex. This reflex lasts
Assess ability to hold head erect briefly about five to six months.
 Immature central nervous system (CNS) of
newborn is characterized by variety of reflexes
o Some reflexes are protective, some aid Step reflex This reflex is also
in feeding, others stimulate interaction called the walking or dance
o Assess for CNS integration reflex because a baby appears to
take steps or dance when held
Protective reflexes are blinking, yawning, upright with his/her feet touching
coughing, sneezing, drawing back from pain a solid
Rooting and sucking reflexes assist with surface.
feeding
“What reflexes should be present in a newborn? Reflexes are
involuntary movements or actions. Some movements are spontaneous,
occurring as part of the baby's usual activity. Others are responses to
certain actions. Reflexes help identify normal brain and nerve activity.
Some reflexes occur only in specific periods of development. The
following are some of the normal reflexes seen in newborn babies”

Root reflex - This reflex begins when B, The clitoris is still

the corner of the baby's mouth is visible.The labia minora
stroked or touched. The baby will turn are now covered by the
his/her head and open his/her mouth to larger labia majora. Score
follow and 2. The gestational age is
"root" in the direction of the stroking. 36 to 40 weeks.
This helps the baby find the breast or
bottle to begin feeding.

Suck reflex Rooting helps the

baby become ready to C, The term newborn has
suck. When the roof of the baby's well-developed, large
mouth is labia majora that cover
touched, the baby will begin to both clitoris and labia
suck. This reflex does not begin minora. Score 3.
until about the 32nd
week of pregnancy and is not
fully developed until about 36
weeks. Premature babies may
have a weak or immature sucking Neuromuscular Components
ability because of this. Babies also
have a hand-to mouth reflex that
goes with rooting and sucking and
Square window sign
may suck on fingers or hands. A, This angle is 90
degrees and suggests an
immature
newborn of 28 to 32
ASSESSMENT OF PHYSICAL MATURITY
weeks’ gestation. Score
CHARACTERISTICS OF NEWBORN
0.
Observable characteristics of newborn should
be evaluated while not disturbing baby
Gestational assessment tools examine the
following physical characteristics
o Resting posture B, A 30- to 40-degree
o Skin angle is commonly found
o Lanugo from 39 to 40 weeks’
o Sole (planar) creases gestation. Score 2-3.
o Breast tissue
o Ear form and cartilage distribution
o Evaluation of genitals

Male genitals C, A 0-degree angle can

occur from 40 to 42 weeks.
Score 4. (C) Used with
permission from
V.Dubowitz, MD,
Hammersmith Hospital,
London, England.

A, Preterm newborn’s testes are not within the scrotum.

The scrotal surface has few rugae. score 2.
Signs of Preterm Babies

B, Term newborn’s testes are generally fully descended.
The entire surface of the scrotum is covered by rugae.
Score 3.
Female genitals
A, Newborn has a prominent
clitoris. The labia majora are
widely separated, and the
labia minora, viewed
laterally, would protrude
beyond the labia majora.
Score 1. The gestational age
is 30 to 35 weeks.
o Born after 20 weeks, after 37 weeks
o frog leg or laxed positon
o hypotonic muscle tone- prone resp problem
o scarf sign – elbow passes midline pos.
o square window wrist – 90 degree angle of wrist
o heal to ear signabundant lanugo-
Signs of Post term babies:
> 42 weeks
o classic sign – old man’s face
o desquamation – peeling of skin
o long brittle finger nails
o wide & alert eyes
Babies with special needs
Some babies may need some extra attention from you and the doctor
after birth. These include:
o Low birth weight babies (less than 2.5kg).
o Babies born too early (premature).
o Babies with pathological jaundice.
o Babies with infection.
o Those needing an operation soon after birth.
o Those with low blood sugar.
o Babies of diabetic mothers.