Abnormal respiratory rates (tachypnea, more than 60 breaths/min; bradypnea, less than 25 breaths/min)
Flaccid body posture
abnormal heart rates (tachycardia, more than 160 bpm; bradycardia, less than 100 bpm)
Abnormal newborn size: small or large for gestational age
Used to evaluate newborns at 1 min and 5 min after birth
P- pulse (heart rate)
G- grimace (reflex irritability)
A- activity (muscle tone)
R- respiratory (respiratory effort)
When the newborn experiences physiologic depression, the apgar score characteristics disappear in what order?
1 the pink coloration is lost
2 the respiratory effort
3 the tone
4 reflex irritability
5 heart rate
What is the expected length of a full term newborn ?
48-53 cm (19-21 inches)
What is the typical newborn birth weight?
2,700 to 4,000 g (6-9 lbs.)
less than 10% or more than 90% outside of normal range requires further investigation
Newborns classified by birthweight regardless on gestational age.
Low birthweight: <2,500g (<5.5 lb)
Very low birthweight: <1,500g (<3.4 lb)
Extremely low birthweight: <1,000g (<2.5 lb.)
How often is HR and RR assessed in the newborn?
Q30 min until stable for 2 hours. Once stable, Q8 hours
How often is temp assessed in the newborn?
Q30 mins until stable for 2 hours. Then Q8 hours until discharge.
If blood pressure needs to be assessed what equipment is used and what is the typical range for a newborn?
Oscillometer (Dinamap) and range is 50-75 mm Hg (systolic) and 30-45 mmHg (diastolic).
Crying, moving, and late clamping of the umbilical cord will increase systolic pressure.
What tool is used to determine the gestational age of a newborn?
Dubowitz/Ballard or New Ballard Score system
low score of -1 point or -2 points for extreme immaturity to 4 or 5 points for postmaturity
Physical maturity examination is done how soon after birth?
within the first 2 hours
The areas assessed on the physical maturity examination include:
skin texture- sticky to transparent to smooth, peeling and cracking, parchmentlike or leathery with significant cracking and wrinkling.
Lanugo- soft downy hair on body
Plantar creases-greater number on creases the greater maturity
Breast tissue- thickness and size of breast tissue and areola
Eyes and ears- lids fused or open and ear cartilage and stiffness determine the degree of maturity
genitals- males, testicular descent and appearance of scrotum (from smooth to rugae covered); females, appearance and size of clitoris and labia (prominant clitoris w/ flat labia suggests prematurity, clitoris covered by labia suggests greater maturity)
Neuromuscular maturity assessment is completed within 24 hours of birth and includes:
Posture- greater degree of flexion, greater degree of maturity
Square window- degree the hands can be flexed towards the wrists, as angle decreases, maturity increases
Arm recoil-degree of arm flexion and the strength of recoil
Popliteal angle- extended knees; an angle less than 90 degrees indicates greater maturity
Scarf sign-elbows movement across chest; an albow that does not reach midline indicates greater maturity
Heel to ear-can feet be moved to the ears; the lesser the ability, the greater the maturity
Preterm or premature- born before 37 weeks gestation, regardless of birthweight
Term - born between 38 and 42 weeks' gestation
Postterm or Postdates - born after completion of week 42 of gestation
Postmature - born after 42 and demonstrating signs of placental aging
Nursing intervention for helping infant transition.
maintaining airway patency
ensuring proper identification
administering prescribed medications
How soon after birth should a picture be taken of the newborn for safety reasons?