Prophylaxis with erythromycin ointment to both eyes and injection of hepatitis B vaccine are recommendations, while the baby has skin-to-skin with the mother. Within 1 hour of birth, intramuscular vitamin K should be administered. It is essential to interact with the newborn and to observe the responses to light and touch. The most common are primitive reflexes like the Moro, sucking, rooting, palmar and plantar grasp. Neurologic development is evaluated by eliciting reflexes and assessing tone. Examination of the skin looks for color, macules, spots, birthmarks or trauma that might have occurred at birth or caused by medical equipment like scalp monitors, ensuring documentation of each finding. Skin findings in the newborn are prevalent. When it comes to inspecting the back, centralization of the spine is assessed to identify any abnormal deviations as well as the presence of sacral dimples or hair tuff. All extremities are examined for symmetry, pulses, the range of motion and any deformities. The femoral pulses are palpated for intensity and symmetry and examination of the hips using the Ortolani and Barlow maneuvers to assess for the presence of clicks suggesting developmental dysplasia of the hip should follow. Examine the umbilical stump for normal vessels and hernias. While examining the abdomen evaluate for asymmetry or malformations, auscultate to assess peristalsis and palpate for the presence of masses or organomegaly (the liver edge is normally at 1cm below the costal margin). Lung fields are then auscultated for identification of adventitious sounds and air entry. While examining the chest, evaluate for symmetry and location of nipples in relationship to the clavicular midline.Īuscultation of the heart identifies rhythm and the presence of murmurs if any. The clavicles should also undergo palpation to assure continuity and to rule out fractures. Neck palpation checks for masses and range of motion. The ears are examined for size, patency of ear canals, malformations, skin tags or pits. In the mouth, the hard and soft palate are palpated and examined to rule out cleft palate or any other abnormalities, as well as an assessment of the sucking reflex.

Examination of the nose looks for patency and symmetry of nares. For the eyes, symmetry and size should be assessed as well as any subconjunctival hemorrhage, and the red reflexes should be elicited before discharging the baby home. Starting with the head, look for the presence of hematomas, subcutaneous swelling, overriding of sutures, and patency of anterior and posterior fontanelles. A head to toe approach is the preferred method. If the gestational age or due date is unknown, Dubowitz/Ballard maturational assessments can be used to take into consideration the infant's neuromuscular tone and reflexes as well as physical maturation.Ī full physical exam is done to assess for any abnormalities. These measurements can be plotted on a growth curve, and patient results fall into 3 categories:ġ) Small for gestational age (SGA) which is also 90 percentile, based on weight and gestational age. Boys are usually heavier than girls, but the average weight is around 3500 grams, length, and head circumference are an average of 50cm or 20 inches and 35cm or 14 inches +/- 2 inches, respectively. The values vary depending on sex, socioeconomic status, and race. Growth parameters are considered at the moment of examination: weight, length, head circumference, and abdominal and chest circumference. This scoring system takes into consideration five components with values from 0 to 2, and it includes respiratory effort, color, heart rate, and reflex irritability and muscle tone.

The Apgar score at 1 and 5 minutes of life is used to assess for the need for resuscitation. A team with knowledge of the equipment, training, and resources is in charge of assessing and attending any resuscitation efforts needed by the newborn at the moment of birth. The Neonatal Resuscitation Guidelines are useful to guide resuscitation if necessary. A pediatrician or nurse practitioner examines the newborn in the first twenty-four hours of life. In the setting of a normal spontaneous vaginal delivery or a Cesarean section with no complications, the examination is deferred until one hour of age after skin to skin contact with mother is established and breastfeeding is started if appropriate and desired.

Growth parameters and behavior are assessed at the moment of birth.

Daily routine for a newborn