Newborn Assessment: Expected and Abnormal Findings

Introduction

• Presenter: Meris from Level Up RN
• Topic: Expected and abnormal findings in newborns post-birth.
• Resource: Maternity flashcards available at leveluprn.com

Skin Findings

Expected Findings

• Pink color or acrocyanosis:
  • Normal for trunk to be pink and extremities to be bluish.
  • Acrocyanosis can occur due to cold as newborns adjust to new circulatory functions.
• Vernix:
  • Thick, creamy, white substance; common in skin creases in full-term babies.
• Lanugo:
  • Fine downy hair aiding in warmth, present on face, upper back, and shoulders of full-term babies.

Abnormal Findings

• Jaundice:
  • Jaundice in the first 24 hours is abnormal.
  • Green or brown skin/nail discoloration may indicate meconium passage and fetal distress.

Normal Variations

• Stork Bites (Telangiectatic nevi):
  • Pink discoloration, often on eyelids, neck, etc., fades by 18 months.
• Milia:
  • White cysts on the face, disappear within weeks.
• Mongolian Spots:
  • Blue/purple pigmentation, common in darker-skinned infants, fades over years, document to avoid abuse concerns.
• Nevus Flammeus (Port-wine stain):
  • Permanent purple/red discoloration, usually on face or neck.
• Erythema Toxicum:
  • Transient rash, disappears in weeks.

Head Findings

Expected Findings

• Fontanels:
  • Anterior (diamond-shaped) and posterior (triangular-shaped) should be open, flat, soft, and symmetric.
• Head Shape:
  • Should be round due to molding from birth canal passage.

Normal Variations

• Molding:
  • Elongated head shape from birth canal passage.
• Caput Succedaneum:
  • Soft tissue swelling crossing suture line, resolves in 3 days.
• Cephalohematoma:
  • Blood collection not crossing suture line, may last months.

Physical Assessment

Face and Neck

• Face:
  • Intact blink reflex, ears aligned with eyes; low set ears may indicate Down syndrome.
  • Epstein Pearls: White cysts in the mouth, normal.

Clavicle

• Full range of motion, no crepitus or tenderness.
• Check for fractures in case of birth trauma.

Umbilical Cord

• A-V-A: Two arteries, one vein is normal.
• Pathology may be done on cords/placentas if needed.

Hips

• Ortolani and Barlow tests for hip dysplasia.
• Expect equal leg length and symmetrical gluteal/thigh creases.

Quiz Questions

• Assessing jaundice within 16 hours - is it abnormal?
• Bluish pigmentation on back - name and concern?
• Localized swelling on head - name and duration?
• Number of arteries and veins in umbilical cord?

Conclusion

• Encouragement to subscribe and engage with Level Up RN content.
• Invitation to share and discuss learning experiences.