Flashcards in Examination Of A Newborn Deck (34)
What are the two components to assessing the baby at birth?
1) The APGAR score
2) Top to toe physical examination
Why is the APGAR score carried out?
Apgar should be recorded routinely for all births (NICE)
So that the midwife can determine how well the baby is adjusting from intrauterine to extrauterine life.
Why do we carry out a top to toe physical examination?
-It looks to confirm normality and detect any deviations from the normal so that a referral can be made.
-To reassure parents
According to NICE 2014 midwives undertake the APGAR and top to toe as part of the care of the baby at birth.
When is the APGAR assessed?
It is assessed at:
Although these can be repeated at different time frames and are based on whether the baby is breathing effectively at birth.
The scores are given out of 10
What does APGAR stand for?
A- Appearance (Colour)
P- Pulse (Heart rate)
G- Grimace (Response to stimuli)
A- Activity (Muscle tone)
R- Respiratory effort
What is the scoring system for APGAR?
0,1 and 2 with a total score out of 10.
What is the procedure to carrying out the APGAR score?
1) Ensure good effective lighting, as this will give a good visualisation of colour of the baby
2) Note the time of delivery, wait 1 minute then undertake the first assessment assessing the five variables quickly and simultaneously, totally the score and recovering the baby
3) Act promptly and appropriately according to the score e.g a baby scoring 0-3 requires immediate resuscitation
4) Repeat at 5 minutes, the score should increase if previously eight or below
5) Document findings and act accordingly
When should the birth examination take place?
Within the first 72 hours of birth
How many wet nappies should a newborn have within 24 hours?
Why do we offer an IM injection of vitamin K to newborns?
Babies do not get enough Vitamin K from their mothers during pregnancy or when breastfeeding. vitamin K decreases the risk of a vitamin K deficiency bleeding. This is also known as Haemorrhagic Disease of the Newborn.
What is jaundice and why is it so common?
Jaundice is caused by the (completely normal) buildup of bilirubin in the blood.
Jaundice is common in newborn babies because babies have a high number if red blood cells in their blood which are broken down and frequently replaced.
Also, a newborn baby’s liver is not fully developed, so it’s less effective at removing the bilirubin from the blood.
When conducting the top to toe check, what are you looking for when examining the neck and clavicles?
Clavicles- Inability to move arms/irritability/symmetry/pain
Why do we treat babies with a high level of jaundice?
This is because there’s a small risk the bilirubin could pass into the brain and cause brain damage.
When conducting the top to toe check, what are you looking for when examining the face, eyes and mouth?
Mouth- tongue tie, lips and palate (formed correctly?) sucking reflex, teeth, signs of thrush (redness, white spots or white coating)
Eyes- symmetry, stickiness, redness, discharge, swelling, cataracts, heamorrhages
Face- symmetry, any deformities or abnormalities
When conducting the top to toe check, what are you looking for when examining the cord and abdomen?
Chest- symmetrical, two nipples
Cord- intact, knots, clamped (unless lotus birth)
When conducting the top to toe check what are you looking for when examining the spine?
-Gaps in the vertebrae
-Dense tufts of hair
-Ensure sacral dimple is skin lined
When conducting the top to toe check what are you looking for when examining the hands and feet?
-Ensure there is x10 fingers and toes
-Single palmar crease (sign of Down’s syndrome)
-Polydactyly (extra digits)
What is vernix?
A bio-film layer consisting of anti-microbial proteins and fatty acids. It provides a layer of protection.
When conducting the top to toe check what are you looking for when examining the head?
-Shape (Excessive moulding)
-Symmetry to the rest of the body
-Bruises/trauma (particularly in an assisted delivery)
What is the size of the head in a full term infant?
When conducting the top to toe check what are you looking for when examining the genitals?
-Check the sex of the baby
-Check boys testicles have descended into the scrotum
-Ensure urethra is open in and in the correct place
-Vaginal skin tags
When conducting the top to toe check what are you looking for when examining the anus and stool?
-Ensure anus is present and ensure the stool comes from the correct place
-Document the colour of the stool
What is the correct procedure for carrying out a top to toe check on the newborn?
1) Wash hands and don PPE
2) Confirm infants name and DOB
3) Obtain informed consent from parents
4) Ensure at least one parent is present at the assessment
5) Adequately expose infant for assessment (down to the nappy)
6) Work systematically from top to toe checking each feature
7) Wash hands and document findings
What percentage of a babies weight can we expect them to lose in the first few days of birth?
10% of their total birth weight
When should we conduct a newborn blood spot test?
What conditions does the newborn blood spot test screen for?
-Sickle cell disease
-Inherited metabolic diseases
How long is the neonatal period?
From birth to 28 days
What key issues should be considered before carrying out the examination?
History-antenatal, medical and intrapartum.
Birth outcome- mode of delivery
Informed consent-ensuring enough info is given to parents to make informed decisions
Room temp- needs to be ambient, 26 degrees. This is because babies loose heat through conduction, convection, evaporation and radiation
What temperature would we want a babies to be?