RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

RESOURCE UNIT

Assessment of the Newborn

SUBMITTED BY: Cuesta, Angelie E.

Gajensan, Ren Mae N.
Ruben, Jun Carlo C.
Tumarong, Chuche S.
SUBMITTED TO: Mrs. Riza T. Abellanosa, RN, MSN.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

NEGROS ORIENTAL STATE UNIVERSITY

VISION: A dynamic, competitive, and globally responsive state university.

MISSION: The university shall provide excellent instruction, relevant and responsive research and extension services, and quality-assured production
through competent and highly motivated human capital.

GOALS: Negros Oriental State University strives to advance:

• National development through effective partnership

• Opportunity-laden educational access to poor but deserving students
• Research-based and competency-driven instruction
• Scholarship and innovation
• Unity in diversity of cultures

CORE VALUES:

S - spirituality
A - accountability
P - professionalism
P - patriotism
H - harmony
I - integrity
R - respect
E – excellence

QUALITY POLICY:

NORSU commits itself to the provision of quality instruction, research, extension services and production as well as compliance to applicable regulatory
requirements and continual improvement of its management system.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

CNPAHS VISION:

NORSU College of Nursing, Pharmacy and Allied Health Sciences (CNPAHS) is an educational institution to become the premier provider of health care education in the
country and across the world.

CNPAHS MISSION:

Provide excellent instruction thereby developing competent future health leaders and practitioners who are intellectually and humanely responsive, self-directing and
contributing members of the society.

CNPAHS GOALS:

• Develop innovative approaches towards achieving quality teaching, research, service, and practice goals.
• Contribute to the knowledge base of the discipline through an active program of health care and interdisciplinary research that are responsive to the changing health
needs of the population.
• Cultivate the attitudes and skills necessary to think critically, manage information and assume accountability for independent decisions.
• Maintain an awareness of the historical trends, legal, social, economic, political and trans-cultural issues related to total health care education and practice.

CNPAHS OBJECTIVES:

• To synthesize theoretical and empirical knowledge from the GEd subjects with professional subjects to produce competent graduates.
• To equip would-be-health leaders and workers with comprehensive knowledge and skills in administering health services in various health settings.
• To motivate the faculty and students to undertake cutting edge research that will enhance the quality of human life and contribute to national and global development.
• To maintain collaborative and cooperative partnership with the community through health care programs and extension services.
• To value every individual as a unique and adaptive person who has worth and dignity and who engages in dynamic and reciprocal interaction with the environment.
• To collaborate with health consumer and provides in promoting, maintaining and restoring health and facilitate the provision of accessible, cost-effective, quality health care.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

BACHELOR OF SCIENCE IN NURSING

PROGRAM OBJECTIVES:

The students shall be given opportunity to be exposed in the various levels of health care (health promotion, disease prevention, risk reduction, curative and
restoration of health) with values client groups (individual, family, population groups and community). These opportunities shall be given in graduated experiences
to ensure that the competencies per course, per level and for the whole program are developed. Before graduation, the student shall the competencies of a
professional nurse as they assume the various roles and responsibilities. For each year level the following shall achieved:

LEVEL II

At the end of second year, the student shall have acquired the holistic understanding of the human person as a bio-psycho cultural being focusing on the concept
of health and illness as it is related to the care of the mother and the child in varied settings. Specifically, the students shall:

• Describe the health care delivery system and nurse’s role in it.
• Demonstrate ethico-moral legal responsibilities in the care of individual, family and community.
• Demonstrate the beginning skill in the provision of the independent and collaborative nursing function.
• Discuss the role of economics as it impacts on health and illness.
• Relate the stages of growth and development in the care of the clients.
• Demonstrate beginning skills in the preparation of healthy and therapeutic diets in varied client cases.
• Explain the dynamics of the disease process caused by microbes and parasites, and the environment.
• Imbibe the core values cherished by the nursing profession such as love of God, caring, love and community and of people.
• Design a plan that will focus on health promotion and risk reduction clients.
• Utilize the nursing process in the care of the high-risk mother and child in the family and in the community.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

TOPIC TITLE Assessment of the Newborn

This topic deals with concepts related to assessment of the newborn. It tackles particularly on the
appearance of the newborn, assessment of fetal well-being that consists of the Apgar scoring and
TOPIC DESCRIPTION
the methods of assessing the gestational age, newborn screening, and hearing test for the
newborn.

TIME ALLOTMENT 1 hour, 20 minutes

PLACEMENT 1st Semester, SY 2021-2022
PARTICIPANTS BSN II Sec A Nursery Rotation Group 2
ROTATION Nursery

At the end of the 1 hr., 20 mins. discussion given various teaching-learning activities, the learners
GENERAL will be able to gain appropriate and substantial knowledge on the concepts related to assessment
OBJECTIVES of the newborn, develop beginning skills in the assessment of a newborn, and most importantly,
apply a positive attitude in the care of newborns.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

SPECIFIC TEACHING-
CONTENT OBJECTIVES TA LEARNING MATERIALS EVALUATION
ACTIVITIES
At the end of 1 hr.
and 20 mins, the
learners will be able
to:

INTRODUCTION Develop rapport with 3 mins Interactive Lecture Visual Aids (Through
the lecturers and Discussion through PowerPoint
A. Greetings familiarization of the Google Meet Presentation with
B. Introduction of Ward Class Presenters topics to be Graphics and Pictures)
C. Articulation of Major Topics and Concepts under each Major Topic discussed.

A. Appearance of a Newborn Describe the different 20 Interactive Lecture Visual Aids (Through Applicable to all:
appearance of a mins Discussion through PowerPoint
✓ Eyes newborn. Google Meet Presentation with Visual Test Probe
- Newborns usually cry tearlessly, because their lacrimal ducts Graphics and Pictures)
do not fully mature until about 3 months of age. Determine and Question & Answer Active Participation
To inspect the eyes of a newborn, lay the newborn in a supine position contrast the normal (Verbal Feedback)
and lift the head. This maneuver will cause the baby to open the eyes. and abnormal (Question & Answer)
- A newborn’s eyes should appear clear, without redness or appearance of a
newborn.
purulent discharge.
It’s a white, yellow, or brown fluid and might be slightly thick in texture.
And if there, is it a sign of infection.
- The irises of the eyes of newborns are gray or blue; the sclera
may be blue because of its thinness.
Infant eyes assume their permanent color between 3 and 12 months
of age.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

- A newborn can only see well for 8 to 12 inches. The

newborn’s eyes may wander and seem crossed if an item is moved
beyond this range.
Your baby's eye muscles will grow to the point where he or she will be
able to concentrate both eyes on the same thing at the same time.
- Swelling around the eyes of the newborn is possible and this
will last for the first two or three days, until the newborn’s kidneys are
capable of evacuating fluid more efficiently.
- There will be a red spot on the sclera, usually on the inner
aspect of the eye, or as a red ring around the cornea.
Pressure during birth sometimes ruptures a conjunctival capillary of
the eye, resulting in a small subconjunctival hemorrhage. When a red
spot in the white region of the eye can be seen in certain newborns,
there is no need for treatment since this will go away in a few weeks.
You can reassure the parents that these hemorrhages are common in
newborn.
Occasionally, the administration of an antibiotic ointment such as
erythromycin given at birth, is to protect against Chlamydia infection
and ophthalmia neonatorum (gonorrheal conjunctivitis), has caused a
purulent discharge that lasts for the first 24 hours of life.

✓ Ears
- A newborn’s external ear is not as completely formed as it will
be eventually.
The pinna tends to bend easily. In the term newborn, the pinna should
be strong enough to recoil after bending.
- The level of the top part of the external ear should be on a
line drawn from the inner canthus to the outer canthus of the eye and
back across the side of the head.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

As you can see in the illustration, the first pic shows an abnormal ear
alignment and the second one as you can see the ears are set lower
than this are found in infants with certain chromosomal abnormalities,
particularly trisomy 18 and 13, this syndromes in which low-set ears
and other physical defects are coupled with varying degrees of
cognitive challenge.
- A small skin tag can occasionally be observed immediately in
front of an ear.
Although these tags may be linked to chromosomal abnormalities or
renal illness, they are generally minor results with no implications.
They can be ligated and removed as soon as the infant is one week
old.
Always inspect in front of newborns’ ears for pinpoint-size openings
that reveal these sinuses. A preauricular dermal sinus may be present
directly in front of the ear. These sinuses are usually small and can be
removed surgically without consequence when the child is near school
age.
Test a newborn’s hearing by ringing a bell held about 6 inches from
each ear. A hearing infant who is crying will stop momentarily at the
sound. If quiet, a newborn who can hear will blink the eyes, appear to
attend to the sound, and possibly startle and those are one of the
positive responses. Although this method of testing is not highly
accurate, a negative response is unusual. Infants with negative
responses should be retested later. In many health care facilities,
newborn hearing screening is the standard of care in which the primary
purpose of this is to identify newborns who are likely to have hearing
loss and who require further evaluation.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

✓ Nose
If you can observe that the newborn’s nose tends to appear large for
the face – it is normal. As the infant grows, the rest of the face grows
more than the nose does, and this discrepancy usually disappears.
Testing for choanal atresia (blockage at the rear of the nose) it is done
by closing the newborn’s mouth and compressing one naris or the
opening of the nose at a time with your fingers. Note any discomfort or
distress while breathing this way. Nasal flaring upon inspiration is
another indication of respiratory distress and occurs when the nostrils
widen while breathing. It is often a sign of trouble breathing that should
be further evaluated. Also record any evidence of milia on the nose.
These are tiny white bumps on a newborn’s nose.

✓ Mouth
- A newborn’s mouth should open evenly when he or she cries.
Cranial nerve injury is suggested if one side of the mouth moves more
than the other.
- A newborn’s tongue appears large and prominent in the
mouth.
The frenulum membrane is attached close to the tip of the tongue
that’s why it appears short, this create an impression that the infant is
“tongue tied.” At one time, there was this procedure to snip a
newborn’s frenulum membrane to lengthen it. This was considered
harmful, because it leaves a portal of entry for infection, risks
hemorrhage due to the low vitamin K levels found in most newborns,
and creates feeding difficulties by making the tongue itchy and
irritating. As the tongue grows, the frenulum recedes to its adult
placement, that’s why this procedure is unnecessary.
- The lips should be pink in color and symmetrical in shape.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

- Palate of the newborn should be intact and inspection is

necessary.
- Occasionally, Epstein’s pearls are present on the palate.
This is one or two small, round, glistening, well circumscribed cysts,
and this appearance is a result of extra calcium that was deposited in
utero. And as future nurses make sure to inform parents that these
pearl-like cysts are nothing to worry about, require no treatment, and
will disappear spontaneously within 1 week. Otherwise, a parent may
assume them for thrush, a Candida infection, which usually appears
on the tongue and sides of the cheeks as white or gray patches and
needs therapy with an antifungal drug this is according to
(Subramanian et al., 2008).
- The inside of the mouth should be pink, moist and the
mucous membranes intact.
Newborns delivered by cesarean birth usually have an increased
amount. When a newborn is laid on its side, mucus flows from the
mouth, causing little discomfort. A tracheoesophageal fistula is
suspected when a neonate's mouth is so full with mucus that he or she
seems to be blowing bubbles. Before the infant is fed, this must be
confirmed or ruled out; otherwise, formula can be aspirated into the
lungs due to an improperly formed esophagus.
- Benign inclusion cysts may be present on the gum margins
- These are small, white epithelial pearls.
No treatment is necessary for these.
It is unusual for a newborn to have teeth, but sometimes natal teeth
will have erupted this is usually one or two teeth. Any teeth that are
present must be evaluated for stability for prevention and safety of the
newborn. And if loose, they should be extracted to prevent possible
aspiration during feeding.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

✓ Neck
- The neck of a newborn is short and often chubby, with
creased skin folds.
- The head should rotate freely on it.
- If there is rigidity of the neck, congenital torticollis might be
present.
Torticollis is a term derived from tortus (twisted) and collum (neck).
Torticollis (wry neck) occurs as a congenital anomaly when the
sternocleidomastoid muscle is injured and bleeds during birth. In
newborns whose membranes were ruptured more than 24 hours
before birth, nuchal rigidity suggests meningitis. Nuchal rigidity is an
inability to flex the neck forward due to rigidity of the neck muscles.
- In a sitting position, a new born should make a momentary
effort at head control.
Although the neck of a newborn is not strong enough to support the
total weight of the head.
When lying prone, infants may elevate their heads slightly, generally
enough to clear mucus or spit-up formula from their nose. The head
will lag behind significantly if they are dragged into a sitting position
from a supine position. They should, however, make an effort to control
and settle their heads when they sit down.
- The trachea may be prominent on the front of the neck, and
the thymus gland may be enlarged.
Because of the rapid growth of glandular tissue (in comparison with
other body tissues) early in life. The thymus gland will triple in size by
3 years of age; It maintains that size until the child reaches the age of
ten, after which it shrinks. Although a newborn's thymus may appear
to bulge, it is rarely the cause of respiratory problems, despite
appearances.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

✓ Chest
- The chest in some newborns looks small because the head
is large in proportion.
It is actually approximately 2 inches smaller in circumference than and
as wide in the anteroposterior diameter as it is across. Not until a child
is 2 years of age does the chest measurement exceed that of the head.
- The clavicles should be straight.
A crepitus or actual separation on one or the other clavicle may
indicate that a fracture occurred during birth and calcium is now being
deposited at that point. A lump on the clavicle caused by temporary
calcium overgrowth may be palpable while the area heals.
- A newborn's chest should be symmetrical from side to side.
- Respirations are normally rapid (30 to 60 breaths per minute)
but not distressed.
- A supernumerary nipple may be present.
(usually found below and in line with the normal nipples). If so, it may
be removed later for cosmetic purposes although this is not necessary.
- In both female and male infants, the breasts may be
engorged.
Occasionally, the breasts of newborn babies secrete a thin, watery
fluid popularly termed witch’s milk. The influence of the mother's
hormones causes engorgement to develop in utero. The engorgement
and any fluid present subside until the hormones have been cleared
from the infant's system (approximately 1 week). Fluid should never
be expressed from infants’ breasts, because the manipulation could
introduce bacteria and lead to mastitis.
- Retraction should not be present.
(drawing in of the chest wall with inspiration). A newborn with
retractions is pulling in the anterior chest muscle as he or she pulls air
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

into the respiratory tract with such force. Because a newborn’s lung
alveoli open slowly over the first 24 to 48 hours and the baby invariably
has mucus in the back of the throat, listening to lung sounds often
reveals the sounds of rhonchi—the harsh, innocent sound of air
passing over mucus.
- An abnormal sound, such as grunting, suggests respiratory
distress syndrome; a high, crowing sound on inspiration suggests
stridor or immature tracheal development.

✓ Abdomen
- The contour of a newborn abdomen looks slightly
protuberant.
A scaphoid or sunken appearance may indicate missing abdominal
contents or a diaphragmatic hernia (bowel positioned in the chest
instead of the abdomen).
- Bowel sounds should be present within 1 hour after birth.
- The edge of the liver is usually palpable 1 to 2 cm below the
right costal margin.
- The edge of the spleen may be palpable 1 to 2 cm below the
left costal margin.
Tenderness is difficult to determine in a newborn. Palpation, on the
other hand, might cause the newborn to cry, thrash around, or tension
the abdominal muscles in order to protect the abdomen.
- For the first hour after birth, the stump of the umbilical cord
appears as a white, gelatinous structure marked with the blue and red
streaks of the umbilical vein and arteries.
When the cord is first cut, the vessels are counted to be certain that
one vein and two arteries are present. In 0.5% of births (3.5% of twin
births), there is only a single umbilical artery, and in one-third of such
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

infants, this single artery is associated with a congenital heart or renal

abnormality. Because these heart and kidney abnormalities aren't
often obvious, any infant with a single umbilical artery should be
closely monitored and assessed until the anomalies are ruled out.
Inspect the cord clamp to be certain it is secure.
- After the first hour of life, the cord begins to dry and shrink,
and it turns brown like the dead end of a vine.
By the second or third day, it has turned black. It breaks free by day 6
to 10, leaving a granulating area a few centimeters wide that heals
during the following week.
- There should be no bleeding at the cord site.
Bleeding suggests that the cord clamp has become loosened or the
cord has been tugged loose by the friction of bedclothes.
- The base of the cord should appear dry.
A moist or odorous cord suggests infection. If infection is present, it
must be treated immediately, or it could enter a newborn's
bloodstream and cause septicemia.
- Moistness at the base of the cord also may indicate a patent
urachus.
Meaning there is an opening between the bladder and the belly button
(navel).
(a canal that connects the bladder and the umbilicus), which will drain
urine at the cord site until it is surgically repaired.
Always inspect the base of the cord to be certain that there are no
abdominal wall defects such as an umbilical hernia is present. If there
is a fascial (abdominal wall) defect smaller than 2 cm in diameter, it
usually closes on its own by school age; a larger defect will probably
require surgical correction.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Home remedies such as taping the cord or placing buttons or coins on

will not help the defect close. Heavy taping, in fact, may aggravate the
condition by preventing the development of healthy abdominal wall
muscle tone and this also tends to keep the cord moist, making
infection more likely than when it is dry.
Placing one hand behind the infant while you palpate offers a firmer
base and helps when evaluating kidney size (newborn kidneys are
about the size of a walnut). An enlarged kidney suggests a polycystic
kidney or pooling of urine from a urethral obstruction.
Thorough palpation of the right and left abdomen within the first few
hours after delivery must be performed to confirm the presence of
kidneys. The intestines fill with air after this period, making palpation
more difficult. Because the right kidney is lower in the retroperitoneal
space than the left, it can typically be palpated easily; the left kidney is
more difficult to locate because the gut is bulkier, it is larger on the left
side and is higher in the retroperitoneal space. Regardless, make an
effort to find both of them.
Elicit an abdominal reflex to complete the abdominal examination.
When you stroke each quadrant of the abdomen, the umbilicus will
shift or "wink" in that direction. The T8–T10 spinal nerves are tested in
this superficial abdominal reflex. In newborns, the reflex may not be
seen until the tenth day of life.

✓ Anogenital Area
Okay, so let’s move to Anogenital Area.
- Inspect the anus of a newborn to be certain it is present,
patent, and not covered by a membrane (imperforate anus).
- Test for anal patency by gently inserting the tip of your gloved
and lubricated little finger.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Also note the time after birth at which the infant first passes meconium.
If a newborn does not do so in the first 24 hours, suspect imperforate
anus or meconium ileus. (Meconium ileus is a bowel obstruction that
occurs when the meconium in your child's intestine is even thicker and
stickier than normal meconium)
• Male Genitalia
- The scrotum in most male newborns is edematous, usually
pigmented and has rugae (folds in the skin).
It may be deeply pigmented in African American or dark-skinned
newborns.
- Testes are palpable in each scrotum.
- Both testes should be present in the scrotum.
Make a practice of pressing your nondominant hand against the
inguinal ring before palpating for testes, so they do not slip upward and
out of the scrotal sac as you palpate. If one or both testicles are not
present which is termed as cryptorchidism, referral is needed to
establish the extent of the problem.
This condition could be caused by:
- agenesis (absence of an organ)
- ectopic testes (the testes cannot enter the scrotum because the
opening to the scrotal sac is closed).
- or undescended testes (the vas deferens or artery is too short
to allow the testes to descend).
Because the testes and kidneys are derived from the same germ
tissue, newborns with agenesis of the testes are usually referred for
renal anomaly investigation. A test for the integrity of spinal nerves T8–
T10 is done by stroking the internal side of the thigh to elicit a
cremasteric reflex. The testis on that side moves perceptibly higher as
the skin is stroked. Just like the abdominal reflex which was discussed
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

earlier the response may be absent in newborns who are younger than
10 days.
- The penis of newborns appears small, approximately 2 cm
long.
If it is less than this, the newborn should be referred for evaluation by
an endocrinologist.
- Inspect the tip of the penis to see that the urethral opening is
at the tip of the glans.
Not on the dorsal surface (epispadias) or on the ventral surface
(hypospadias).
Today most male newborns are circumcised, the necessity for this
operation can be questioned unless it is for religious reasons, because
it is rare to find an infant who physically requires it (i.e., has a foreskin
so constricted that it interferes with voiding or circulation).
Furthermore, surgery at this age involves the risk of hemorrhage and
infection. If hypospadias or epispadias are present, circumcision
should be avoided since the surgeon may want to use the foreskin as
tissue while repairing these conditions.
• Female Genitalia
- The vulva in female newborns may be swollen because of the
effect of maternal hormones.
- Some female newborns have a mucus vaginal secretion,
which is sometimes blood-tinged (pseudomenstruation).
Again, this is caused by the action of maternal hormones. The
discharge disappears as soon as the infant’s system has cleared the
hormones. The discharge should not be mistaken for an infection or
taken as an indication that trauma has occurred.
✓ Back
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

- The spine of a newborn typically appears flat in the lumbar

and sacral areas.
Inspect the base of a newborn's spine for any pinpoint openings,
dimpling, or sinus tracts in the skin that might indicate a dermal sinus
or spinal bifida occulta.
- A newborn normally assumes the position maintained in
utero, with the back rounded and the arms and legs flexed on the
abdomen and chest.
- A child who was born in a frank breech position tends to
straighten the legs at the knee and bring their feet up next to the face.
- The position of a baby with a face presentation sometimes
simulates opisthotonos for the first week, because the curve of the
back is deeply concave.

✓ Extremities
- The arms and legs of a newborn appear short.
- The hands are plump and clenched into fists.
- Newborn fingernails are soft and smooth, and usually long
enough to extend over the fingertips.
Unflex the arms for around 5 seconds to test for muscular tone in the
upper extremities. When an arm is released, it should immediately
return to its flexed position if the tone is good. Hold the arms down by
the sides and note their length.
- The fingertips should reach the proximal thigh.
- Unusually short arms may signify achondroplastic dwarfism.
Observe for unusual curvature of the little finger, and inspect the palm
for a simian crease (a single palmar crease, in contrast to the three
creases normally seen in a palm).
- A newborn’s arms and legs should move symmetrically.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

(unless the infant is demonstrating a tonic neck reflex).

- An arm that hangs limp and unmoving suggests possible birth
injury, such as injury to a clavicle or to the brachial or cervical plexus
or fracture of a long bone.
Assess for webbing (syndactyly), extra toes or fingers (polydactyly), or
irregular toe spacing, especially between the big and little toes (this
finding is present in certain chromosomal disorders, although it is also
a normal finding in some families).
Test to see whether the toenails fill immediately after blanching from
pressure.
- Normally, newborn legs are bowed as well as short.
- The sole of the foot appears flat because of an extra pad of
fat in the longitudinal arch.
The foot of a term newborn has many crisscrossed lines on the sole,
covering approximately two thirds of the foot. Immaturity is suspected
if these creases cover less than two-thirds of the foot or are absent.
Move the ankle through a range of motion to evaluate whether the heel
cord is unusually tight.
Check for ankle clonus by supporting the lower leg in one hand and
dorsiflexing the foot sharply two or three times by pressure on the sole
of the foot with the other hand.
- Upon checking for ankle clonus and after the dorsiflexion, one
or two continued movements are normal. Neurologic involvement is
suggested when rapid alternating contraction and relaxation (clonus)
is abnormal.
- The feet of many newborns turn in (varus deviation) because
of their former intrauterine position.
This simple deviation needs no correction if the feet can be brought
into the midline position by easy manipulation.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

- When the infant begins to bear weight, the feet will align
themselves.
A talipes deformity (clubfoot) is present when a foot does not align
easily (will not turn to a definite midline position). This situation needs
further examination, as congenital abnormalities of this type are best
treated in the immediate newborn period.
- With a newborn in a supine position, both hips can be flexed
and abducted to such an extent (180 degrees) that the knees touch or
nearly touch the surface of the bed.
According to McCarthy & MacEwen, 2007, if the hip joint seems to lock
short of this distance (160 to 170 degrees), hip subluxation (a shallow
and poorly formed acetabulum) is suggested. Subluxation can be
elicited by holding the infant’s leg with the fingers on the greater and
lesser trochanter and then abducting the hip;
- If subluxation is present, there is an Ortolani’s sign. It is a
“clunk” of the femur head striking the shallow acetabulum can be
heard.
- If the hip can be felt to actually slip in the socket, this is
Barlow’s sign.
- Subluxated hip may be bilateral but is usually unilateral.
It's important to identify hip subluxation as soon as possible, because
early diagnosis is more likely to be successful.
- Newborns are capable of bringing their arms and legs
underneath them and raising their stomach off the bed high enough for
a hand to be slipped underneath.
This ability helps to prevent pressure or rubbing at the cord site,
because the cord does not actually touch the bedding when the
newborn is lying on the abdomen. An indication of maturity is when the
preterm newborn does not have this ability.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

II. Assessment of Fetal Well-being

There are a number of traditional standardized assessments to
evaluate a newborn quickly at birth.

A. Apgar Scoring- an assessment scale used as a standard since Identify the five 20 Interactive Lecture Visual Aids (Through
1958. components of mins Discussion through PowerPoint
➢ A newborn whose total score is less than 4 is in serious APGAR scoring that Google Meet Presentation with
danger and needs resuscitation. should be observed Graphics and Pictures)
➢ 4 to 6 means that the infant’s condition is guarded and the in the assessment. 4 Pics 1 Word
baby may need clearing of the airway and supplementary
oxygen.
➢ 7 to 10 is considered good, indicating that the infant scored
as high as 70% to 90% of all infants at 1 to 5 minutes after
birth.
• Heart Rate
Auscultating a newborn heart with a stethoscope is the best way
to determine heart rate.
• Respiratory Effort
Respirations are counted by watching respiratory movements. A
mature newborn usually cries and aerates the lungs
spontaneously at about 30 seconds after birth. By 1 minute, he or
she maintains regular, although rapid, respirations.
• Muscle Tone
Muscle tone is tested by observing their resistance to any effort to
extend their extremities.
• Reflex Irritability
One of two possible cues is used to evaluate reflex irritability in a
newborn: response to a suction catheter in the nostrils and
response to having the soles of the feet slapped.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

• Color
All infants appear cyanotic at the moment of birth. They grow pink
with or shortly after the first breath, which makes the color of
newborns correspond to how well they are breathing.
Acrocyanosis (cyanosis of the hands and feet) is so common in
newborns that a score of 1 in this category can be thought of as
normal.

✓ Respiratory Evaluation Define the five criteria

For this assessment, a newborn is observed and then scored on each of features to be
of five criteria. Each item is given a value of 0, 1, or 2; the values are observed during the
then added. assessment.
➢ A total score of 0 indicates no respiratory distress.
➢ Scores of 4 to 6 indicate moderate distress.
➢ Scores of 7 to 10 indicate severe distress.
• Chest movement
• Intercostal retraction
• Xiphoid retraction
• Nares dilatation
• Expiratory grunt

✓ Physical Examination (1) Use learned

A newborn is given a preliminary physical examination immediately knowledge in proper
after birth, to establish gestational age and to detect any observable assessing of newborn
condition such as difficulty breathing, a congenital heart anomaly, infant and determine
meningocele, cleft lip or palate, hydrocephalus, a birthmark, the observable
imperforate anus, tracheoesophageal atresia, or bowel obstruction. condition after birth.
(2) Explain the
importance of
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

• Height and Weight laboratory tests for

Assuming newborns are breathing well, they are weighed the newborn in
nude and without a blanket soon after birth in the birthing identifying diseases,
room. Measurements such as body length and head, chest, disorders, and how
and abdominal circumferences can be obtained later. does heel-stick reveal
conditions.
• Laboratory Studies
➢ Hematocrit and hemoglobin determinations are done
to detect newborn anemia, because it is difficult to
appreciate that anemia is present by clinical observation
alone.
➢ Anemia can be caused by hypovolemia due to bleeding
from placenta previa or abruption placentae or by a
cesarean birth that involved incision into the placenta.
➢ Hypoglycemia may also produce few symptoms, so it is
determined by a heel-stick glucose measurement. If a
blood glucose heel-stick reading is less than 40 mg/100
mL of blood (30 mg/100 mL in the first 3 days of life),
hypoglycemia is present. To correct this condition, the
infant is prescribed oral glucose or infant formula to be
given immediately.

• Congenital Anomaly Appraisal

B. Assessment of Gestational Age Identify the different

Specific findings on physical assessment provide clues to a newborn’s quick criteria that can
gestational age. These quick criteria can be used for assessment of all be used for the
newborns. assessment of all
1. Dubowitz Maturing Scale/ Ballard Assessment newborns.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Dubowitz/Ballard assessment can help determine whether a

newborn needs immediate high-risk nursery intervention. The
assessment consists of two portions: physical maturity
and neuromuscular maturity. The first is a series of
observations about skin texture, color, lanugo, foot creases,
genitalia, ear, and breast maturity. Each designated body part
is inspected and given a score of 0 to 5. Second, is the
neuromuscular maturity assessment criteria: posture, square
window(wrist), arm recoil, popliteal angle, scarf sign, and heel
to ear.
2. Brazelton Neonatal Behavioral Assessment Scale
- Use to evaluate a newborn’s behavioral capacity or ability
to respond to set stimuli.
Six major categories of behavior:
1. Habituation
2. Orientation
3. motor maturity
4. variation
5. self-quieting ability
social behavior

III. Newborn Screening Recognize the 27 Interactive Lecture Visual Aids (Through
Every newborn is tested for a group of health disorders that aren't purpose, procedure, mins Discussion through PowerPoint
otherwise found at birth. Through newborn screening, doctors can and expectancy of Google Meet Presentation with
check for rare genetic, hormone-related, and metabolic conditions that results of newborn Graphics and Pictures)
can cause serious health problems. It allows doctors diagnose babies screening, and the Feelin’ the Blanks:
quickly and start treatment as soon as possible. problems that can be Fill in the Blanks
discovered through
newborn screening.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

A. Newborn Screening Procedure

A small blood sample taken by pricking the baby's heel is tested. This
happens before the baby leaves the hospital, usually at 1 or 2 days of
age. The blood sample should be taken after the first 24 hours of life.
Some babies are tested within the first 24 hours, though, because
sometimes moms and newborns are discharged within 1 day. If this
happens, experts recommend taking a repeat sample no more than 1
to 2 weeks later. If the baby was not born at the hospital, coordinate
with the hospital and have the baby tested.

B. Screening Tests
Tests offered can change as technology advances and treatments
improve. Although there are national recommendations for newborn
screening, it is up to each state/ institution to decide which tests to
include. However, newborn screening usually includes tests to identify
problems with metabolism, hormone, hemoglobin, and others.
1. Metabolic Problems

• phenylketonuria (PKU)
Description: Also called PKU, is a metabolic disorder caused by a
defect in the enzyme that breaks down the amino acid
phenylalanine.
Signs and Symptoms:
✓ Brain damage (developmental delays and permanent
intellectual disability)
Phenylalanine is necessary for normal growth and normal
protein production, but too much buildup of it in the body can
affect the brain, thus, when untreated can lead to
developmental delays and permanent intellectual disability.
✓ Affects Melanin
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Phenylalanine affects melanin, the pigment responsible

for hair color and skin color.
Characteristics: fair skin, light hair, and blue eyes
✓ Others
Seizures, growth problems, behavioral problems, skin
rashes, and a musty odor to the breath, skin, or urine
(pee) from too much phenylalanine in the body.

• methylmalonic acidemia
Description: An inherited disorder in which the body is unable to
process certain proteins and fats (lipids) properly.
Signs and Symptoms:
Usually appear in early infancy and vary from mild to life-threatening.

✓ Vomiting, dehydration, weak muscle tone (hypotonia),

developmental delay, excessive tiredness (lethargy), an
enlarged liver (hepatomegaly), and failure to gain weight
and grow at the expected rate (failure to thrive).
✓ Long-term complications: feeding problems, intellectual
disability, chronic kidney disease, and inflammation of
the pancreas (pancreatitis).
✓ Leads to coma and death in some cases

• maple syrup urine disease (MSUD)

Description: Caused by a defect in the enzymes that break down
the amino acids: leucine, isoleucine, and valine. These amino acids
and their byproducts then build up in the blood, damaging the brain
and other organs.
Signs and Symptoms:
✓ Pee or earwax that smells like maple syrup (sweet)
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

✓ Infants: feeding problems, vomiting, irritability, high-pitched

cry, and low energy level (be very sleepy)
✓ Baby/Child: failure to thrive, unusual muscle movements and
muscle tightness, developmental delays, and seizures

• tyrosinemia
Description: A condition in which there is deficiency of
fumarylacetoacetate hydrolase (FAH) enzyme which is needed for
the breakdown of the amino acid tyrosine.

3 Types of Tyrosinemia:
1. Tyrosinemia Type 1
Most severe; leads to kidney and liver failure; and is infant-onset.
Signs and Symptoms: Difficulty gaining weight, a cabbage-like odor,,
frequent nosebleeds, and yellowing of the skin and whites of the eyes
(jaundice).
2. Tyrosinemia Type 2
Affects the eyes, skin, and mental development and is child-onset.
Signs and Symptoms: Eye pain, painful skin, and mental disability
3. Tyrosinemia Type 3:
Rarest
Signs and Symptoms: Intellectual disability, seizures, and
intermittent loss of balance and coordination (ataxia)

• citrullinemia
Description: An inherited disorder that causes ammonia and other
toxic substances to accumulate in the blood.

2 Types of Citrullinemia:
1. Type I citrullinemia (classic citrullinemia)
Evident in the first few days of life.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Signs and Symptoms: Affected infants typically appear normal at

birth, but as ammonia builds up, they experience a progressive lack of
energy (lethargy), poor feeding, vomiting, seizures, and loss of
consciousness, liver problems for some.
2. Type II citrullinemia
Chiefly affects the nervous system and is adult-onset.
Signs and Symptoms: Confusion, restlessness, memory loss,
abnormal behaviors (aggression, irritability, and hyperactivity),
seizures, and coma

• medium chain acyl CoA dehydrogenase (MCAD) deficiency

Description: A condition wherein the CAD enzyme in the body is
not enough to break down certain fats called medium-chain and
convert them to energy. MCAD deficiency is present from birth and is
a lifelong condition.
Signs and Symptoms:
✓ Hypoglycemia (dangerously dropping of blood sugar level)
and low energy.
✓ Left untreated, hypoglycemia can lead to seizures, breathing
difficulties, coma and other serious health problems.

2. Hormone Problems
• congenital hypothyroidism
Description: Previously known as cretinism, is a severe deficiency of
thyroid hormone in newborns.
Cause: Problem with the baby’s thyroid gland, or a lack of iodine in
the mother’s body during pregnancy
A baby’s body needs iodine to make thyroid hormones. These
hormones are essential for healthy growth, brain, and nervous system
development.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Signs and Symptoms: Impaired neurological function, stunted

growth, and physical deformities

• congenital adrenal hyperplasia

Description: Abbreviated CAH, refers to a group of genetic disorders
that affect the adrenal glands, a pair of walnut-sized organs above the
kidneys.
Important hormones produced by the adrenal glands:
✓ Cortisol- regulates the body's response to illness or stress.
✓ Mineralocorticoids, such as aldosterone- regulate sodium
and potassium levels.
✓ Androgens, such as testosterone (male sex hormones)
In people who have CAH, a genetic problem results in a lack of one of
the enzymes needed to make these hormones, most commonly the
21-hydroxylase.

3. Hemoglobin Problems
• sickle cell disease
Description: A group of disorders that affects hemoglobin, the
molecule in red blood cells that delivers oxygen to cells throughout the
body, resulting the formation of hemoglobin S, which can distort RBCs
into a sickle, or crescent, shape.
Signs and Symptoms:
✓ Usually start at 5 months or early childhood
✓ Anemia (low RBC number), repeated infections, and
episodes of pain

• hemoglobin SC disease
Description: A type of sickle cell disease (affects shape of RBCs and
their ability to carry oxygen). People with hemoglobin SC disease have
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

red blood cells that are differently shaped and therefore do not carry
oxygen as effectively.
Symptoms:
✓ Anemia, fatigue, and extreme pain (vaso-occlusive crisis)
✓ When the anemia becomes severe, blood transfusion may be
required.

• beta thalassemia
Description: A blood disorder that reduces the production of
hemoglobin.
Cause: Mutations in the HBB gene (needed to make beta-globin, a
component of Hemoglobin)
Hemoglobin typically two subunits of beta-globin and two subunits of
another protein called alpha-globin.
Symptoms: Anemia: pale skin and fatigue, and risk of abnormal blood
clots
2 Types
(1) thalassemia major (Cooley's anemia) – more severe and happens
within the first 2 yrs
(2) thalassemia intermedia- happens at early childhood or later in life
Bone abnormalities is a common finding in the 2 types.

4. Other Problems
• galactosemia
Other Names: galactose-1-phosphate uridylyl transferase deficiency
/ transferase deficiency galactosemia / GALT deficiency
Description: A disorder of carbohydrate metabolism that affects the
body’s ability to convert galactose (found in mother’s milk) to glucose.
Cause: Deficiency of enzyme: galactose-1-phosphate uridylyl
transferase (GALT)
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Signs and Symptoms: Brain damage, anorexia and vomiting (after

few days or weeks), jaundice, liver failure, accumulation of fluid in the
abdominal cavity (ascites), abdominal edema, bacterial infection,
ovarian failure and infertility, and cataracts with late treatment.
Galactokinase deficiency is associated with cataracts, increased blood
concentration of galactose and increased concentration of galactitol in
the urine. Galactitol accumulates in the lens of the eye where it causes
lens swelling and protein precipitation and, subsequently, cataract.
Treatment: Lactose-restricted diet
Children treated with this special diet usually show satisfactory general
health and growth. They can make reasonable, though often not
optimal, intellectual progress.

• biotinidase deficiency
Description: A disease where there is inability of the body to recycle
the vitamin biotin.
Cause: Mutations in the BTD gene cause biotinidase deficiency.
Biotinidase recycles biotin, a B vitamin found in foods such as liver,
egg yolks, and milk. It removes biotin that is bound to proteins in food,
leaving the vitamin in its free (unbound) state.
Types:
✓ Profound biotinidase deficiency, more severe form of the
condition
Effects: Seizures, weak muscle tone (hypotonia), breathing
problems, hearing and vision loss, problems with movement and
balance (ataxia), skin rashes, hair loss (alopecia), and fungal
infection (candidiasis).
✓ Partial biotinidase deficiency- milder

• cystic fibrosis
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Description: Disease in which the body makes very thick, sticky

mucus, which causes problems in the lungs, pancreas, and other
organs.
Meconium ileus or intestinal blockage – 1st sign a baby might have
CF
Symptoms: Lung infections/pneumonia, cough with thick mucus,
wheezing, constipation/diarrhea, and salty sweat

• severe combined immunodeficiency (SCID)

Description: A "combined" immunodeficiency because it affects
both B-cells and T-cells. In SCID, the child's body has too few
lymphocytes or lymphocytes that don't work properly. Lymphocytes
are cells responsible in fighting infections. T cells identify, attack, and
kill "invaders." B cells make antibodies that "remember" an infection
and are ready in case the body is exposed to it again.
Cause: Problem in a gene found on the X chromosome (affects only
males), or lack of enzyme needed for lymphocyte development.
Signs and Symptoms: Infections (e.g., acute otitis media, sinusitis,
meningitis, etc.)

• Pompe disease (glycogen storage disease type II)

Description: Also called acid maltase deficiency disease and
glycogen storage disease type II. It occurs due to ineffective
breakdown of glycogen; thus, glycogen builds up in the body's cells.
This stops the cells — especially those in the body's muscles, including
the heart — from working as they should.
Cause: Mutation in a gene that helps make the enzyme alpha-
glucosidase. This enzyme breaks down glycogen.
Signs and Symptoms: heart problems, muscle weakness (that can
make it hard to walk), and breathing problems
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

• mucopolysaccharidosis type 1
Description: A condition that affects many different parts of the body
and is considered a lysosomal storage disorder.
Cause: Mutations in the IDUA gene (breakdown of
glycosaminoglycans)
The IDUA gene provides instructions for producing an enzyme that is
involved in the breakdown of large sugar molecules called
glycosaminoglycans (GAGs)
Signs and Symptoms:
Soft out-pouching around the belly-button (umbilical hernia)
or lower abdomen (inguinal hernia)
Large head (macrocephaly)
Distinctive facial features that appear “coarse”
Varying degrees of developmental delay and learning
disabilities
Swollen abdomen (due to enlarged liver and spleen)
Clouding of the eye (corneal clouding)
Hearing loss
Frequent “runny nose"

• X-linked adrenoleukodystrophy
Description: A genetic disorder that mainly affects the nervous
system and the adrenal glands. In this disorder, the fatty covering
(myelin) that insulates nerves in the brain and spinal cord tends to
deteriorate (a condition called demyelination). The loss of myelin
reduces the ability of the nerves to relay information to the brain.
Signs and Symptoms: Difficulty reading, writing, understanding
speech, and comprehending written material, vision problems
Damage to the outer layer of the adrenal glands (adrenal cortex)
causes a shortage of certain hormones (adrenocortical insufficiency).
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

Adrenocortical insufficiency may cause weakness, weight loss, skin

changes, vomiting, and coma.

• spinal muscle atrophy (SMA)

Description: A genetic condition that causes muscle weakness and
atrophy (when muscles get smaller).
Cause: Most are caused by a problem with the SMN1 gene (protein
synthesis for motor neurons) motor neurons break down and can't
send signals to the muscles.
Signs and Symptoms:
✓ SMA can affect a child's ability to crawl, walk, sit up, and
control head movements.
✓ Severe SMA can damage the muscles used for breathing and
swallowing.

C. Availability of Newborn Screening Results

Blood test results usually are ready by the time a baby is 5–7 days old.
Often, parents won't hear about results if screening tests were normal.
They are contacted if a test was positive for a condition. A positive
newborn screening test does not mean a child definitely has the
medical condition. Doctors order more tests to confirm or rule out the
diagnosis.

D. Hearing Test for Newborn Identify what are the 10 Interactive Lecture Visual Aids (Through
required test in the mins Discussion through PowerPoint
• Auditory Brainstem Response (ABR) Test auditory perception of Google Meet Presentation with
This test evaluates the auditory brain stem (the part of the nerve a newborn. Graphics and Pictures)
that carries sound from the ear to the brain) and the brain’s Picture Identification
response to sound. During this test, miniature earphones are
placed in the ear and sounds are played. Band-Aid-like electrodes
are placed along your baby’s head to detect the brain’s response
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

to the sounds. If your baby’s brain does not respond to all the
sounds, your baby could have hearing trouble.
• Otoacoustic Emissions (OAE) Test
This test determines if certain parts of your baby’s ear respond
appropriately to sound. During the test, a miniature earphone and
microphone are placed in the ear and sounds are played. When a
baby has normal hearing, an echo will reflect back into the ear
canal. This echo is measured by the microphone. If the
microphone doesn’t receive the echo, your child may have
hearing loss.
• Brain Audiometry Evaluation
This test evaluates if all parts of the ear are working correctly. The
audiologist will play a sound in your baby’s ear and then watch for
changes in your baby’s behavior. A baby with full hearing will
generally respond by sucking a pacifier, quieting, or searching for
the sound.
 RA 9299 Republic of the Philippines June 25, 2004

Negros Oriental State University

NOPS (1907) NOTS (1927) EVSAT (1956) CVPC (1983)
Kagawasan Ave., Dumaguete City, Negros Oriental, Philippines 6200
COLLEGE OF NURSING, PHARMACY, AND ALLIED HEALTH SCIENCES

References:

Non-Printed:
Celluci, M. (2019, July). Newborn Screening Tests. Nemours KidsHealth. Retrieved November 26, 2021 from

https://kidshealth.org/en/parents/newborn-screening-tests.html

(n.d.). Newborn screening information for hearing loss | Baby’s First Test | Newborn Screening | Baby Health. Baby’s First Test. Retrieved November

25, 2021 from https://www.babysfirsttest.org/newborn-screening/conditions/hearing-loss

Pillitteri, A. (2009). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family (Maternal and Child Health Nursing) (6th ed.).

Lippincott Williams & Wilkins