Baby care and Apgar scoring

Done by:
Boraq ahmed
Ahmed asad khan
Zahraa monaf
Abbas bilal
Supervised by dr. hadeer maitham
 Assessment of the newborn
A newborn should have a thorough evaluation performed within
24 hours of birth to identify any abnormality that would alter the
normal newborn course or identify a medical condition that
should be addressed (eg, anomalies, birth injuries, jaundice, or
cardiopulmonary disorders).
assessment includes review of the maternal, family, and prenatal
history and a complete examination. Depending upon the length
of stay, another examination should be performed within 24
hours before discharge from the hospital.
Details of this history should include the following information,
which will guide further evaluation and management in the
newborn period.
• Maternal medical conditions
• Previous maternal reproductive problems: stillbirth,
prematurity, blood group sensitization
• Events occurring in the present pregnancy.
• labor, fetal assessments, vaginal bleeding, acute illness,
duration of rupture of membranes).
• Description of the labor (duration, fetal presentation, fetal
distress, fever) and delivery (cesarean section, anesthesia or
sedation, use of forceps, Apgar scores, need for resuscitation).
This information, combined with clinical assessment of the
newborn, will determine risk for clinical deterioration and need
for further monitoring and intervention.
 Essential newborn care includes:
• Immediate care at birth (delayed cord clamping,
thorough drying, assessment of breathing, skin-
to-skin contact, early initiation of breastfeeding)
• Thermal care
• Resuscitation when needed
• Support for breast milk feeding
• Nurturing care
• Infection prevention
• Assessment of health problems
• Recognition and response to danger signs
• Timely and safe referral when needed
 Delivery Room Care
• Newborn should be placed head downward
immediately after delivery to clear the mouth, nose
and pharynx from fluids, mucus, meconium or blood by
gentle suction.
• Full-term, vigorous infants may initially be placed on
the mother’s abdomen after delivery.
• During which time delayed clamping of the umbilical
cord (30-60 sec) is recommended to improve
transitional circulation and increase neonatal red blood
cell (RBC) volume.
• Gentle wiping of the face, nose, and mouth with a soft
cloth will help clear the mouth and nares of secretions.
• Spontaneously breathing neonates without distress
require no assisted method to clear their airway only
gentle tactile stimulation to enhance respiration.
 Antiseptic Skin and Umbilical Cord
Care
• Careful removal of blood from the skin of newborn
may reduce risk of blood born infection.
• The entire skin and umbilical cord should be cleansed
with warm water or mild soap solution and then rinsed
with water. Then the newborn is dried and should be
wrapped in sterile blanket.
• Umbilical cord may be treated with bactericidal or
antimicrobial agents.
• Chlorhexidine washing of the skin should be avoided
because it may induce neurotoxicity.
• Rigidly enforcing hand to elbow washing of the nursery
personnel with iodophor containing antiseptic soap or
chlorhexidine before caring each newborn.
 Other Measures
• Vitamin K should be given as a prophylaxis to all
newborn 1mg (IM) for full term and 0.5mg for preterm,
to prevent hemorrhagic disease of newborn
• Then if the newborn in a satisfactory condition, is given
to his mother for immediate bonding and feeding.
• Hepatitis B immunization before discharge from the
nursery is recommended for newborns with weight >2
kg, irrespective of maternal hepatitis status.
• Neonatal screening is available for various genetic,
metabolic, hematologic, and endocrine disorders.
 Healthy newborn
• A healthy infant born at term b/w 38-42 wks.
should have average birth weight
• crying immediately following birth.
• establishes independent rhythmic respiration.
• quickly adapts to the changed environment.
 Gestational age assessment
Physical maturity
• Eyes and ears
• Skin texture
• Lanugo
• Breast
• Genitalia
• Planter creases
 General Examination
General Look:
• Posture.
• Gross abnormalities.
• Distress or not.
• Spontaneous movements.
Growth Parameters:
• OFC
• Weight
• Length
Vital Signs:
• Pulse rate >> 120-140
• Respiratory rate >> 40-
60
• Temperature (measure
rectal temperature and
subtract 0.5 degree) >>
36.5-37.5 C
• Blood pressure.
Skin Examination
• Cyanosis (lips & tongue).
• Jaundice (tip of nose)
• Edema
• Acrocyanosis (of the feet and hands) which
is normal in full term and premature infants
in the first day after delivery.
• Vernix caseosa, a soft white cream layer
covering the skin of term infants (not
present in preterm).
• Capillary and cavernous hemangiomas may
be seen and usually resolves 1-4 years of
age.
• Hair tufts over the lumbosacral spines
suggest spinal cord defects.
• Sclerema: it is a form of hardening of the
skin and subcutaneous tissues, it is a sign of
septicemia.
• Mild edema may be present in premature
infants but may suggest hydrops fetalis,
hypoalbuminemia, or Turner syndrome.
Head examination
1. Shape of the head (contour): Always compare it with family members
before assuming its abnormal.
2. Presence of caput or cephalohematoma
3. Texture and distribution of the hair (easily removed hair, any baldness).
4. Fontanelles (child must be sitting and quit during the examination):
• State of the anterior fontanelle: Flat (normal). Tense. Depressed
(dehydration). Measure the size in 2 dimensions.
• State of the posterior fontanelle (closed or opened): Must be closed at
birth but it can be opened in 3% of
• neonates (normal variant closes at 2-4 months of age
5. Eyes: inspection + fundoscopy
• Epicanthic folds & hypertelorism.
• Subconjunctival hemorrhage.
• Congenital cataract.
• Congenital glaucoma.
• Fair children with blue eyes may indicate phenylketonuria (PKU).
• Blue eyes may indicate osteogenesis imperfecta.
6. Ear: Shape and position (normal or low-sitting: Examined by following an
imaginary line running between the eyes and through the ear. Normally the
imaginary line should cross 1/3 or more of the ear height).
7. Nose: Shape and if there is any deformity (e.g., saddle nose,
depressed nasal bridge). Compare the shape with the family
members.

8. Mouth (cleft lip & palate):

Signs of cleft palate (sub-mucosal):
a. Bifid uvula.
b. Groove on palpation with the little finger.

9. Use NG tube to rule out choanal atresia and TE-fistula.

10.Look for hypoplasia of the mandible (micrognathia):

Examined by viewing the face laterally (the mandible must be in
line with the supraorbital ridge).
 Neck and Chest Examination
1.Deformity
• Webbed neck (examined from posterior).
• Torticollis (caused by sternocleidomastoid
muscle fibrosis because of trauma or
tumor).

2. Mass: Single or multiple. Site. Size.

Attachment to the skin. Cystic or solid. Tender
or not. Cystic hygroma (lateral in location).
Thyroglossal cyst (central in location).

3.Thyroid (goiter).

4.Tracheal position: can be slightly deviated to

the right in
• normal situations.
• ** In case of multiple masses, ask about the
criteria of the largest & smallest masses, and
the remaining are in between
 Chest examination
1. Signs of respiratory
distress.
2. Scar of previous
surgery.
3. Visible apical pulsation.
4. Heart thrill
5. Heart auscultation.
6. Breathing type thoracic
or thoracic abdominal
 Abdomen and Umbilical Stump
Examination
• Shape of the umbilicus if there is any
bleeding
• (umbilical stump).
• Umbilical hernia.
• Shape (scaphoid or distended).
• Symmetry.
• Movement with respiration.
• Visible veins.
• Masses
• Organo-megaly.
• Ascites.
• Auscultation (bowel sounds & bruits).
• Inspection: Erythema.
• Discharge. Swelling.
Blood vessels (2 arteries
and 1 vein):
a. Vein is slit-like, with
blood crust.
b. Artery is circular with
no blood crust.
• Palpation: Tenderness
 Genitalia and Hip Examination
1. Developmental dysplasia of the
hip (DDH): • < 2 month of age
diagnosis:
a.Barlow test.
b. Ortolani test.
c. Ultrasound.
• >2 month of age diagnosis:
a. Shortening of the leg.
b.Limitation of abduction.
c.Difficulties in applying the napkin.
2. Femoral artery palpation: Radio-
femoral delay or absent femoral
pulse (aortic coaortacation).
 Extremities and Back Examination
• Polydactyly.
• Syndactyly.
• Simian crease (down
syndrome).
• Pitting edema.
• Lymphedema (non-pitting
edema).
• Foot deformity (club
foot).
• Lower limb power (if
paralysis look for spina
bifida).
 Primitive reflexes

Primitive reflexes are reflex actions originating in the central

nervous system that are exhibited by normal infants, but not
neurologically intact adults, in response to particular stimuli.
These reflexes are suppressed by the development of the frontal
lobes as a child transitions normally into child development.
 The Apgar score
The Apgar score is an assessment done on newborn infants.
Medical practitioners conduct this test a minute after babies are
born to see if they handled the birthing process well and after 5
minutes to see if they are adjusting to the environment outside
the mother’s womb without much difficulty.

-The Apgar score comprises 5 criteria :

• 1) Appearance ( skin , color )
• 2) Pulse ( heart rate )
• 3) Grimace ( response to stimuli)
• 4) Activity ( muscle tone )
• 5) Respiration
Monitoring & Preparing for Discharge
• Newborn assessment and vital sign monitoring may vary by
hospital but generally decreases in frequency after the 1st 1-2
hrs. after birth. For well-appearing newborns, a reasonable
interval between assessments is 4 hrs. during the 1st 2-3 days
of life and 8 hrs. thereafter. The infant’s temperature should
be taken by axillary measurement, with a normal range of
36.5-37.4°C (97.7- 99.3°F). Weighing at birth and daily
thereafter is sufficient.
• As for discharge criteria:
1-Feeding well (suckling effectively) at least 8 times in 24 hours
2. No danger signs (what are they?)
3. Mother is confident to take care of baby
4. Understands the need for follow up and danger signs when to
report early 5. For small baby below 2500g: feeding well and
gaining weight adequately
 Calculate the Apgar Score:
• Case 1:
• A full-term newborn is born with good muscle
tone, a strong cry, pink color all over the body,
heart rate over 100 beats per minute, and
good respiratory effort.
• Case 2:
• A preterm newborn is born at 32 weeks
gestation. The baby has some flexion in limbs,
a weak cry, bluish extremities, heart rate
around 90 beats per minute, and irregular
breathing.
• Case 3:
• A full-term newborn is born limp, pale, with a
weak cry, heart rate under 80 beats per
minute, and shallow breathing.
Thank you!