Newborn Assessment & Care Notes
3 stages of life of a newborn transitioning to extrauterine world ✅1st stage of reactivity, decrease
response stage, and 2nd stage of reactivity
1st stage of reactivity ✅(FIRST 30 minutes after birth), HR increases 160-180 bpm and *returns* to
baseline; alert, startles, cries and moves head (APGAR score)
decreased response stage ✅(60-100 minutes after birth), RR ~60 and shallow, pink color and sleeps
2nd stage of reactivity ✅(2-8 hours after birth), tachycardia and tachypnea, improved muscle tone and
*passes meconium*
after baseline is established ✅thermoregulation is critical since babies have lower SQ fat and larger
body surface to body weight ratio
heat loss occurs: ✅convection - from body to room air
radiation - body to items in close proximity
evaporation - moisture loss from skin
conduction - body surfaces in direct contact
thermogenesis ✅metabolism of brown fat for heat production
cold stress ✅can lead to metabolic acidosis and hypoglycemia
hyperthermia ✅usually environmental; if septic then *hands/feet are cold EVEN WITH an elevated
temperature*
, newborn physical assessment ✅complete h-t assessment is done within 12 hours of birth, post-bonding
time; ideal time to educate parents
vital signs of newborn ✅apical HR (120-160 bpm)
RR ( 30-60 bpm) / abdominal breathers, nares open
temperature via axillary (97.7 - 99.5 degrees F)
*BP NOT DONE*
growth measurements (length, weight, head circumference) and foot printing is also completed
when do you wear gloves when caring for a newborn ✅every time up until their first bath
variations in physical assessment: HEAD ✅assess *fontanels (softspots)*
- posterior: fingertip sized, back of head
- anterior: varied size, top/front of head
assess for *molding or head bruising* or birth-related trauma
*caput succedanum* ✅edema *crosses suture line*, resolves quickly
*cephalohematoma* ✅edema does *NOT* cross suture line, gets larger on day 2, resolves in several
weeks
*subgaleal hemorrhage* ✅risk with *vacuum extractors use*; boggy head, increasing head size, covers
large area
variations in physical assessment: circulatory system ✅*acrocyanosis* is normal for day 1&2 after birth
> assess capillary refill in fingers/toes
assess pulses: brachial, femoral, and posterior tibial/pedal
central blueness in baby? ✅not good; blue hands/feet are WNL for a short amount of time
3 stages of life of a newborn transitioning to extrauterine world ✅1st stage of reactivity, decrease
response stage, and 2nd stage of reactivity
1st stage of reactivity ✅(FIRST 30 minutes after birth), HR increases 160-180 bpm and *returns* to
baseline; alert, startles, cries and moves head (APGAR score)
decreased response stage ✅(60-100 minutes after birth), RR ~60 and shallow, pink color and sleeps
2nd stage of reactivity ✅(2-8 hours after birth), tachycardia and tachypnea, improved muscle tone and
*passes meconium*
after baseline is established ✅thermoregulation is critical since babies have lower SQ fat and larger
body surface to body weight ratio
heat loss occurs: ✅convection - from body to room air
radiation - body to items in close proximity
evaporation - moisture loss from skin
conduction - body surfaces in direct contact
thermogenesis ✅metabolism of brown fat for heat production
cold stress ✅can lead to metabolic acidosis and hypoglycemia
hyperthermia ✅usually environmental; if septic then *hands/feet are cold EVEN WITH an elevated
temperature*
, newborn physical assessment ✅complete h-t assessment is done within 12 hours of birth, post-bonding
time; ideal time to educate parents
vital signs of newborn ✅apical HR (120-160 bpm)
RR ( 30-60 bpm) / abdominal breathers, nares open
temperature via axillary (97.7 - 99.5 degrees F)
*BP NOT DONE*
growth measurements (length, weight, head circumference) and foot printing is also completed
when do you wear gloves when caring for a newborn ✅every time up until their first bath
variations in physical assessment: HEAD ✅assess *fontanels (softspots)*
- posterior: fingertip sized, back of head
- anterior: varied size, top/front of head
assess for *molding or head bruising* or birth-related trauma
*caput succedanum* ✅edema *crosses suture line*, resolves quickly
*cephalohematoma* ✅edema does *NOT* cross suture line, gets larger on day 2, resolves in several
weeks
*subgaleal hemorrhage* ✅risk with *vacuum extractors use*; boggy head, increasing head size, covers
large area
variations in physical assessment: circulatory system ✅*acrocyanosis* is normal for day 1&2 after birth
> assess capillary refill in fingers/toes
assess pulses: brachial, femoral, and posterior tibial/pedal
central blueness in baby? ✅not good; blue hands/feet are WNL for a short amount of time
