Physical assessment - Neonate: Nursing

The physical assessment of a newborn is an ongoing process to monitor the newborn’s adaptation to extrauterine life, and to identify problems that need immediate intervention. At the same time, the assessment considers factors such as the prenatal history; any complications during the pregnancy, labor, and birth; the type of anesthesia or analgesia used during birth; if any neonatal resuscitation measures were needed; and the newborn’s gestational age.

Let’s start by looking at the newborn’s vital signs. First, the apical pulse is auscultated. It’s a good idea to assess this first, when the infant is in a quiet state, and before any other assessments which could agitate them. 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 infant is crying or drop as low as 80 to 90 beats per minute when in deep sleep. A consistently high or low heart rate should be investigated.

Next up is the newborn’s respirations. Respirations are usually irregular, and there may be occasional 5 to 20 second pauses; so they are counted for a full minute for accuracy. A normal respiratory rate is between 30 to 60 breaths per minute. You’ll notice that the abdomen will rise and fall with each respiration; this is normal, because newborns tend to use their diaphragm to breathe more than their intercostal muscles. A respiratory rate of more than 60 breaths per minute could signal problems like cold stress, congenital heart defects, or infection; while a respiratory rate less than 30 breaths per minute could be associated with central nervous system depression.

Then, the temperature is measured, which normally ranges between 97.7° F and 99.5° F, or 36.5° C and 37.5° C. The axillary temperature is the preferred method of measurement, because it is easily accessed and is a close estimate to the newborn’s core temperature