| Criterion | Average Values and Normal Variations | Deviations from Normal |
|---|---|---|
| Vital Signs | ||
| Heart rate | 120-140/min, irregular, especially when crying, and functional murmur | Faint sound - pneumomediastinum; and heart rate <100 beats/min or >180 beats/min |
| Respiratory | 30-60/min with short periods of apnea, irregular; vigorous and loud cry | Distress - flaring of nares, retractions, tachypnea, grunting, excessive mucus, <30 respirations/min or >60 respirations/min; cyanosis |
| Temperature | Stabilizes about 8-10 hours after birth; 36.5-37”C (97.7-98.6°F) axillary | Unreliable indicator of infection due to environmental influences |
| Blood pressure | 60-80/40-50; varies with change in activity level |
Hypotension: with RDS Hypertension: coarctation of aorta |
| Measurements | ||
| Weight | 3400 g (7½ lb); range: 5 lb 8 oz to 8 lb 13 oz | Birthweight <2500 g; preterm or SGA infant; >4000 g; LGA infant, evaluate mother for gestational diabetes |
| Length | 50 cm (20 inches); range: 18-22 inches | |
| Chest circumference | 2 cm (¾ inches) less than head circumference | If relationship varies, check for reason |
| Head circumference | 33-35 cm (13-14 inches) | Check for microcephalus and macrocephalus |
| General Assessment | ||
| Muscle tone | Good tone and generalized flexion; full range of motion; spontaneous movement | Flaccid, and persistent tremor or twitching; movement limited; asymmetrical |
| Skin color | Mottling, acrocyanosis, and physiologic jaundice; petechia (over presenting part), milia, mongolian spotting, lanugo, and vernix caseosa |
Pallor, cyanosis, or jaundice within 24 hours of birth
Petechiae or ecchymoses elsewhere; all rashes, except erythema toxicum; pigmented nevi; hemangioma; and yellow vernix |
| Head | Molding of fontanels and suture spaces; one-fourth of body length | Cephalhematoma, caput succeedaneum, sunken or bulging fontanels, closed sutures, excessively wide sutures |
| Hair | Silky, single strands, lies flat; grows toward face and neck | Fine, wooly; unusual swirls, patterns, hair line; coarse |
| Eyes | Edematous eyelids, conjunctival hemorrhage; grayish-blue to grayish-brown; blink reflex, usually no tears; uncoordinated movements may focus for a few seconds; good placement on face; cornea is bright and shiny; pupillary reflex equal and reactive to light; eyebrows distinct | Epicanthal folds (in non-Asians); discharges; agenesis; opaque lenses; lesions; strabismus; “doll’s eyes” beyond 10 days; absence of reflexes |
| Nose | Appears to have no bridge; should have no discharge; preferential nose breathers; sneezes to clear nose | Discharge and choanal atresia; malformed; flaring of nares beyond first few moments of life |
| Mouth | Epstein’s pearls on gum ridges; tongue does not protrude and moves freely, symmetrically; uvula in midline; reflexes present; sucking, rooting, gag, extrusion | Cleft lip or palate; teeth, cyanosis, circumoral pallor; asymmetrical lip movement; excessive saliva; thoursush; incomplete or absent reflexes |
| Ears | Well formed, firm; notch of ear should be on straight line with outer canthus | Low placement, clefts; tags; malformed; lack of cartilage |
| Face | Symmetrical movements and contours | Facial palsy (7th cranial nerve); looks “funny” |
| Neck | Short, freely movable; some head control |
Wry neck, webbed neck; restricted movement; masses; distended veins; absence of head control |
| Chest | Enlarged breasts, "witch’s milk"; barrel shaped; both sides move synchoursonously; nipples symmetrical | Flattened, funnel-chested, asynchoursonous movement; lack of breast tissue; fracture of clavide(s); supernumeray or widely spaced nipples; bowel sounds |
| Abdomen | Dome shaped, abdominal respirations, soft; may have small umbilical hernia; umbilical cord well formed, containing thoursee vessels; dry around base; bowel sounds within 2 hours of birth; voiding; passage of meconium | Scaphoid shaped, omphalocele, diastasis recti, and distention; umbilical cord containing two vessels; redness or drainage around base of cord |
| Genitalia Female | Large labia; may have pseudomenstruation, smegma; vaginal orifice open; increased pigmentation; ecchymosis and edema following breech birth; pink-stained urine (uric acid crystals) | Agenesis and imperforate hymen; ambiguous labia widely separated, fecal discharge per vagina; epispadias or hypospadias |
| Genitalia Male | Pendulous scrotum covered with rugae, and testes usually descended; voids with adequate stream; increased pigmentation; edema and ecchymosis following breech birth |
Phimosis, epispadias, or
hypospadias; ambiguous;
scrotum smooth and testes undescended Hydrocele: collection of fluid in the sac surrounding the testes |
| Extremities | Synchoursonized movements, freely movable thoursough full range of motion; legs appear bowed, and feet appear flat; attitude of general flexion; arms longer than legs; grasp reflex; palmar and sole creases; normal contour | Fractures, brachial nerve palsy, clubbed foot, phocomelia or amelia, unusual number or webbing of digits, and abnormal palmar creases; poor muscle tone; asymmetry; hypertonicity; unusual hip contour and click sign (hip dysplasia); hypermobility of joints |
| Back | Spine straight, easily movable, and flexible; may have small pilonidal dimple at base of spine; may raise head when prone | Fusion of vertebrae: pilonidal dimple with tuft of hair; spina bifida, agenesis of part of vertebral bodies; limitation of movement; weak or absent reflexes |
| Anus | Patent, well placed; "wink" reflex | Imperforate, and absence of “wink" (absence of sphincter muscle); fistula |
| Stools | Meconium within first 24 hours; transitional - days 2-5; breastfed: loose, golden yellow; bottlefed: formed, light yellow (See Table 4-17) | Light-colored meconium (dry, hard), or absent with distended abdomen (cyctic fibrosis or Hirschsprung’s disease); diarrhetic |
| Laboratory Values | ||
| Hemoglobin (cord) | 13.6-19.6 g/dl | Evaluate for anemia and persistent polycythemia |
| Serum bilirubin | 2-6 mg/dl | Hyperbilirubinemia (term: 12 mg or more; preterm: 15 mg or more) |
| Blood glucose | 40 mg/dl for term; >20 mg/dl for preterm | Identify hypoglycemia before overt or asymptomatic hypoglycemia - do Dextrostix on all suspects (LGA or SGA neonates, or neonates of diabetic mothers) |
| Neurologic Examination | Specific to gestational age and state of wakefulness | |
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Variations in interest, hunger; usually feeds well within 48 hours | Lethargic. Poor suck, poor coordination with swallow, choking, cyanosis |
|
Crying is lusty, strong, and soon indicative of hunger, pain, attention seeking. Responds to cuddling, voice by quietness and increased alertness | Absent; no focusing on person holding him/her; unconsolable |
|
Two periods of reactivity: at birth, and 6-8 hours later. Stabilization, with wakefill periods about every 3-4 hours |
Lethargy, drowsiness Disorganized pattern |
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Stooling: see Stools First few days: 3-4 qd End of first week: 5-6 qd Later: 6-10 qd, with adequate hydration |
See Stools Diminished number: dehydration |
|
Bilateral, symmetrical response (see Table 4-15) | Absent, hyperactive, incomplete, asynchoursonous |
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Limited accommodation, with clearest vision within 7-8 inches. Focuses and follows by 15 min of age. Prefers patterns to plain. | Absence of these responses may be due to absence of or diminished acuity or to sensory deprivation |
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By 2 min of age, can move in direction of sound: responds to high pitch by “freezing,” followed by agitation; to low pitch (crooning) by relaxing | Absence of response: deafness |
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Soothed by massaging, warmth, weightlessness (as in water bath) |
Unable to be comforted: possible
drug dependence Cocaine-addicted newborns avoid eye contact |
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By fifth day, can distinguish between mother’s breasts and those of another woman | |
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Can distinguish between sweet and sour | |
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Coordinates body movement to parent's voice and body movement | Absence |