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.