Newborn Assessment: Expected and Abnormal Findings

Introduction

• Speaker: Meris, Level Up RN
• Topic: Expected and abnormal findings in newborns following birth
• Resource: Maternity flashcards from leveluprn.com

Skin Findings

Expected Findings

• Pink Color: Normal
• Acrocyanosis: Pink trunk with bluish extremities, normal as newborn adjusts to extra-uterine life
• Vernix: Thick, creamy, white substance protecting skin in utero, normal in skin creases (e.g., armpits, neck rolls)
• Lanugo: Fine downy hair for warmth, normal in full-term newborns (e.g., sides of face, upper back, shoulders)

Abnormal Findings

• Jaundice within First 24 Hours: Always abnormal
• Green/Brown Skin Discoloration: May indicate meconium presence and fetal distress

Normal Variations

• Telangiectatic Nevi (Stork Bites): Pink discoloration on eyelids, between eyes, neck; disappear within 18 months
• Milia: Small white cysts on the face; disappear in a few weeks
• Mongolian Spots (Congenital Dermal Melanocytosis): Blue/purple pigmentation, common in darker skin; fades in a few years
• Nevus Flammeus (Port-Wine Stain): Purple/red discoloration; permanent
• Erythema Toxicum: Transient rash with papules, disappears in a few weeks

Head Findings

Expected Findings

• Fontanels: Anterior (diamond-shaped, larger), Posterior (triangular-shaped, smaller), should be soft, flat, and open
• Head Shape: Symmetric, round

Normal Variations

• Molding: Elongated head due to birth canal passage
• Caput Succedaneum: Soft tissue swelling, crosses suture line, resolves in ~3 days
• Cephalohematoma: Blood collection not crossing suture line, resolves in months

Physical Assessment

Face

• Blink Reflex: Should be intact
• Ear Alignment: Aligned with outer canthi of eyes
• Mucous Membranes: Pink and moist
• Epstein Pearls: Small white cysts on gums or palate; harmless

Neck and Clavicles

• Range of Motion: Full, no crepitus or tenderness

Umbilical Cord

• Structure: Contains two arteries and one vein (A-V-A)
• Pathology: Can be sent for further investigation

Hips

• Leg Length: Equal
• Symmetry: Gluteal and thigh creases
• Barlow and Ortolani Tests: Negative indicates no hip dysplasia

Quiz Questions

1. Is jaundice at 16 hours post-birth expected or abnormal?
2. What is the name for bluish pigmentation on a newborn's back, and is it concerning?
3. What is the name for localized swelling on one side of a newborn's head, and how long will it last?
4. How many arteries and veins should be in the umbilical cord?

• Call to Action: Subscribe to the Level Up RN channel for more nursing content.
• Engagement: Leave comments on findings or questions for interactive learning.