Assessment of the Newborn

The newborn assessment is an ongoing process to monitor the newborn’s adaptation to extrauterine life, and to identify problems that need immediate intervention.

A focused assessment occurs immediately after birth, followed by a more comprehensive admission assessment. Some of the assessments you will do include the cardiovascular and respiratory systems, thermoregulation, and measurements.

To assess the newborn’s respiratory and cardiovascular systems, begin by observing their respirations. You’ll notice that their abdomen will rise and fall with each respiration; this is normal, because newborns primarily use their diaphragm to breathe, which tends to push their abdomen up with each breath.

Be sure to count their respirations for a full minute, since they’re usually irregular, with occasional 5 to 10 second pauses.

Normally, newborns have unlabored respirations of around 30 to 60 breaths per minute. Upon auscultation, soft, low pitched vesicular lung sounds should be noted throughout the lung fields, though fine crackles could be noted immediately after birth as fetal lung fluid is still being cleared.

Some assessment findings associated with respiratory problems include apnea, or a pause in breathing lasting 20 seconds or longer, and tachypnea, or a respiratory rate more than 60 breaths per minute.

Other concerning assessment findings include substernal or intercostal retractions and nasal flaring during inspiration, as the newborn works hard to bring in air during inspiration; and during expiration, grunting, which increases pressure within the alveoli to promote gas exchange.

Next, auscultate the apical heart for a full minute, assessing for rate and rhythm. It’s a good idea to assess this when the newborn is in a quiet state.

A newborn’s heart rate normally varies between 120 and 160 beats per minute, but it can rise to 180 beats per minute when the newborn is crying or drop as low as 80 to 90 beats per minute when in deep sleep.

Also, keep in mind that it’s not uncommon for newborns to have a murmur during the first 48 hours of life, as the ductus arteriosus closes.

You’ll also assess perfusion by palpating pulses, inspecting skin color, and testing capillary refill. The brachial and femoral pulses should be equal bilaterally.

When assessing skin color, keep the newborn’s natural skin variations in mind. For example, the skin and mucous membranes of newborns with lighter skin should appear pink.

For newborns with darker skin, you’ll look for pink coloring in their mucous membranes, like the area around their lips or eyes.

To test capillary refill in newborns with lighter skin, gently press down on their forehead or chest until the area blanches, and then release it.

In newborns with darker skin, capillary refill can be assessed on the palms of the hands or soles of the feet. Normally, color should return within 3 seconds.

Next, you’ll assess the newborn’s thermoregulation, which is the ability to balance between heat loss and heat production with the goal of maintaining a steady core temperature.

Establishing independent thermoregulation is a challenge, as the newborn leaves the cozy warm uterus and enters a cooler, drafty outside world.

Heat is lost as the newborn’s body heat is transferred to the environment by air currents, and as amniotic fluid evaporates and turns to vapor.

You’ll take steps to prevent excessive heat loss by drying the newborn off immediately, wrapping them in a warm blanket, and placing a hat on their head.

Then, you’ll measure their axillary temperature at regular intervals to ensure it stays within the normal range of 97.7 to 99.5 degrees °F, or 36.5 to 37.5 degrees °C.

Next, take the newborn’s measurements including weight, length, and head and chest circumference and compare them with expected measurements for their gestational age.

Term newborns typically range from 2500 to 4000 grams, or 5 pounds 8 ounces to 8 pounds 13 ounces. Their length, measured from the top of their head to the heel of their outstretched leg, should range from 48 to 53 centimeters, or 19 to 21 inches.

Measure the circumference of their head by wrapping your measuring tape around the occipital protuberance in the back and then just above the newborn’s eyebrows in the front.

Typically, the measurement should be anywhere from 32 to 38 centimeters, or 13 to 15 inches. Then, measure their chest circumference at the level of the nipples, which should range from 30 to 36 centimeters, or 12 to 14 inches.

Note that the chest circumference should be smaller than the head circumference. Alright, as a quick recap...

The newborn assessment is an ongoing process to monitor the newborn’s adaptation to extrauterine life, and to identify problems that need immediate intervention.

A focused assessment occurs immediately after birth, followed by a more comprehensive admission assessment. Your assessments will include the cardiovascular and respiratory systems,