| 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 rate | 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 gm (7½ lbs); range: 5 lb 8 oz–8 lb 13 oz | Birth weight <2500 gm: preterm or SGA infant; >4000 gm: LGA infant, evaluate mother for gestational diabetes |
| Length | 50 cm (20 inches); range: 18–22 inches | |
| Chest circumference | 2 cm (¾ inch) 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 physiological jaundice; petechiae (over presenting part), milia, mongolian spotting, lanugo, and vernix caseosa |
|
| Head | Molding of fontanels and suture spaces; one fourth of body length | Cephalohematoma, caput succedaneum, 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, hairline; 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 pearlson 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; thrush; 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 synchronously; nipples symmetrical | Flattened, funnel-chested, asynchronous movement; lack of breast tissue; fracture of clavicle(s); supernumerary or widely spaced nipples; bowel sounds |
| Abdomen | Dome shaped, abdominal respirations, soft; may have small umbilical hernia; umbilical cord well formed, containing three 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 | ||
| 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 |
| 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 | Synchronized movements, freely movable through 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; bottle-fed: formed, light yellow (see Table 4-17. Infant Stool Characteristics ) | 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 gm/dL | Evaluate for anemia and persistent polycythemia |
| Serum bilirubin | 2–6 mg/dL | Hyperbilirubinemia ( term: 15 mg or more; preterm: 10 mg or more) |
| Blood glucose | 40 mg/dL for term; >30 mg/dL for preterm | Identify hypoglycemia before overt or asymptomatic hypoglycemia—do Dextrostix on all suspected infants (LGA or SGA neonates, or neonates of mothers who are diabetic) |
| Neurological Examination* | Specific to gestational age and state of wakefulness | |
| 1. Behavioral patterns | ||
| a. Feeding |
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| b. Social |
|
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| c. Sleep-wakefulness |
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| d. Elimination |
| See Stools Diminished number: dehydration |
| 2. Reflex response | Bilateral, symmetrical response (see Table 4-15. Assessment: Normal Newborn Reflexes ) | Absent, hyperactive, incomplete, asynchronous |
| 3. Sensory capabilities | ||
| a. Vision |
| Absence of these responses may be due to absence of or diminished acuity or to sensory deprivation |
| b. Hearing |
| Absence of response: deafness |
| c. Touch |
| Unable to be comforted: possible drug dependence |
| d. Smell |
| Newborns who are cocaine-addicted avoid eye contact |
| e. Taste |
| |
| f. Motor |
| Absence |
* Based on Brazelton's method.