The Newborn

Care Management: From Birth Through The First 2 Hours

Care begins immediately after birth and focuses on assessing and stabilizing the newborn’s condition. As part of Standard Precautions, gloves are worn when handling the newborn until blood and amniotic fluid are removed by bathing.

The nurse verifies that respirations have been established, dries the infant, and assesses temperature.

Identical identification bracelets are placed on the infant and the mother. In some settings the father or partner also wears an identification bracelet. Information on the bracelet includes name, sex, date and time of birth, and identification number. Infants are footprinted by using a form that includes the mother’s fingerprints, name, and date and time of birth. These identification procedures must be performed before the mother and infant are separated after birth.

The infant can be placed on the mother’s chest or abdomen to allow skin-to-skin contact, wrapped in a warm blanket and placed in the mother’s arms, given to the partner to hold, or kept partially undressed under a radiant warmer. The infant can be admitted to a nursery or remain with the parents throughout the hospital stay.

The initial examination of the newborn can occur while the nurse is drying and wrapping the infant, or observations can be made while the infant is lying on the mother’s chest or abdomen or in her arms immediately after birth. Interference in the initial parent-infant acquaintance process should be minimized.

Apgar Score

The nurse usually assigns the Apgar score at 1 and 5 minutes after birth. The Apgar score permits a rapid assessment of the newborn’s transition to extrauterine life based on five signs (Table 7-1). Scores of 0 to 3 indicate severe distress; scores of 4 to 6 indicate moderate difficulty; and scores of 7 to 10 indicate that the infant is having no difficulty adjusting to extrauterine life. If resuscitation is required, it should be initiated before the 1-minute Apgar score.

TABLE 7-1

Apgar Score

Sign	SCORE
Sign	0	1	2
Heart rate	Absent	Slow (<100 beats/min)	>100 beats/min
Respiratory effort	Absent	Slow, weak cry	Good cry
Muscle tone	Flaccid	Some flexion of extremities	Well flexed
Reflex irritability	No response	Grimace	Cry
Color	Blue, pale	Body pink, extremities blue	Completely pink

Initial Physical Assessment

If the infant is breathing effectively, is pink, and has no apparent life-threatening anomalies or risk factors requiring immediate attention (e.g., infant of a mother with diabetes), delay further examination until after the parents have had an opportunity to interact with the infant. Routine procedures and the admission process can be carried out in the mother’s room or in a separate nursery.

The initial physical assessment includes a brief review of systems:

1. External: Note skin color, general activity, and position; assess nasal patency by covering one nostril at a time while observing respirations; assess skin for peeling or lack of subcutaneous fat (dysmaturity or postterm); note meconium staining of cord, skin, fingernails, or amniotic fluid (staining can indicate fetal release of meconium, often related to hypoxia; offensive odor can indicate intrauterine infection); note length of nails and creases on soles of feet.

2. Chest: Auscultate apical heart for rate and rhythm, heart tones, and presence of abnormal sounds; note character of respirations and presence of crackles or other adventitious sounds; note equality of breath sounds by auscultation.

3. Abdomen: Observe characteristics of abdomen (rounded, flat, concave) and absence of anomalies; auscultate bowel sounds; note number of vessels in cord.

4. Neurologic: Check muscle tone; assess Moro and suck reflexes; palpate anterior fontanel; note by palpation the presence and size of the fontanels and sutures.

5. Genitourinary: Note external sex characteristics and any abnormality of genitalia; check anal patency and presence of meconium; note passage of urine.

6. Other observations: Note gross structural malformations obvious at birth that require immediate medical attention.

A gestational age assessment is done within 2 hours of birth using forms readily available in nurseries.

An assessment of newborn reflexes (Table 7-2) and a more comprehensive physical assessment (Table 7-3) are completed within 24 hours of birth.

TABLE 7-2

Assessment of Newborn’s Reflexes

Reflex	Eliciting the Reflex	Characteristic Response	Comments
Rooting and sucking	Touch infant’s lip, cheek, or corner of mouth with nipple	Infant turns head toward stimulus, opens mouth, takes hold, and sucks	Response difficult if not impossible to elicit after infant has been fed; if response weak or absent, consider prematurity or neurologic defect Parental guidance: avoid trying to turn head toward breast or nipple, allow infant to root; response disappears after 3-4 mo^∗ but can persist upto 1 yr
Swallowing	Feed infant; swallowing usually follows sucking and obtaining fluids	Swallowing usually coordinated with sucking and usually occurs without gagging, coughing, or vomiting	If response is weak or absent, may indicate prematurity or neurologic defect Sucking and swallowing often uncoordinated in preterm infant
Grasp:
Palmar	Place finger in palm of hand	Infant’s fingers curl around examiner’s fingers Toes curl downward	Palmar response lessens by 3-4 mo; parents enjoy this contact with infant; plantar response lessens by 8 mo
Plantar	Place finger at base of toes	Toes curl downward
Extrusion	Touch or depress tip of tongue	Newborn forces tongue outward	Response disappears about fourth mo of life
Glabellar (Myerson)	Tap over forehead, bridge of nose, or maxilla of newborn whose eyes are open	Newborn blinks for first four or five taps	Continued blinking with repeated taps consistent with extrapyramidal disorder
Tonic neck or “fencing”	With infant falling asleep or sleeping, turn head quickly to one side	With infant facing left side, arm and leg on that side extend; opposite arm and leg flex (turn head to right, and extremities assume opposite postures)	Responses in leg are more consistent Complete response disappears by 3-4 mo, incomplete response may be seen until third or fourth yr After 6 wk, persistent response is sign of possible cerebral palsy
Classic pose in spontaneous tonic neck reflex. (Courtesy Marjorie Pyle, RNC, Lifecircle, Costa Mesa, CA.)
Moro	Hold infant in semisitting position, allow head and trunk to fall backward to an angle of at least 30 degrees Place infant on flat surface, strike surface to startle infant	Symmetric abduction and extension of arms are seen; fingers fan out and form a C with thumb and forefinger; slight tremor may be noted; arms adducted in embracing motion and return to relaxed flexion and movement Legs may follow similar pattern of response Preterm infant does not complete “embrace”; instead, arms fall backward because of weakness	Response is present at birth; complete response may be seen until 8 wk; body jerk is seen only between 8 and 18 wk; response absent by 6 mo if neurologic maturation is not delayed; response may be incomplete if infant is deeply asleep; give parental guidance about normal response Asymmetric response may connote injury to brachial plexus, clavicle, or humerus Persistent response after 6 mo indicates possible brain damage
Moro reflex. (From Dickason, E., Silverman, B., & Kaplan, J. [1998]. Maternal-infant nursing care [3rd ed.]. St. Louis: Mosby.)
Stepping or “walking”	Hold infant vertically, allowing one foot to touch table surface	Infant will simulate walking, alternating flexion and extension of feet; term infants walk on soles of their feet, and preterm infants walk on their toes	Response normally present for 3-4 wk
Stepping reflex. (From Dickason, E., Silverman, B., & Kaplan, J. [1998]. Maternal-infant nursing care [3rd ed.]. St. Louis: Mosby.)
Crawling	Place newborn on abdomen	Newborn makes crawling movements with arms and legs	Response should disappear about 6 wk of age
Deep tendon	Use finger instead of percussion hammer to elicit patellar, or knee-jerk, reflex; newborn must be relaxed	Reflex jerk present; even with newborn relaxed, nonselective overall reaction can occur
Crossed extension	Infant should be supine; extend one leg, press knee downward, stimulate bottom of foot; observe opposite leg	Opposite leg flexes, adducts, and then extends as if attempting to push away stimulating agent	This reflex should be present during newborn period
Crossed extension reflex. (Courtesy Marjorie Pyle, RNC, Lifecircle, Costa Mesa, CA.)
Babinski (plantar)	On sole of foot, beginning at heel, stroke upward along lateral aspect of sole, then move finger across ball of foot	All toes hyperextend, with dorsiflexion of big toe; recorded as a positive sign	Absence requires neurologic evaluation, should disappear after 1 yr of age
Babinski reflex. (From Hockenberry, M., & Wilson, D. [2011]. Wong’s nursing care of infants and children [9th ed.]. St. Louis: Mosby.)
Pull-to-sit (traction)	Pull infant up by wrists from supine position with head in midline	Head will lag until infant is in upright position, then will be held in same plane with chest and shoulder momentarily before falling forward; infant will attempt to right head	Response depends on general muscle tone and maturity and condition of infant
Trunk incurvation (Galant)	Place infant prone on flat surface, run finger down back about 4-5 cm lateral to spine, first on one side and then down other	Trunk is flexed, and pelvis is swung toward stimulated side With transverse lesions of cord, no response below the level of the lesion is present	Response disappears by fourth wk Absence suggests general depression of nervous system Response can vary but should be obtainable in all infants, including preterm ones
Trunk incurvation reflex. (Courtesy Marjorie Pyle, RNC, Lifecircle, Costa Mesa, CA.)
Magnet	Place infant in supine position, partially flex both lower extremities, and apply pressure to soles of feet	Both lower limbs should extend against examiner’s pressure	Absence suggests damage to spinal cord or malformation Reflex can be weak or exaggerated after breech birth
Magnet reflex. (Courtesy Michael S. Clement, MD, Mesa, AZ.)
Additional newborn responses: yawn, stretch, burp, hiccup, sneeze	Spontaneous behaviors	Can be slightly depressed temporarily because of maternal analgesia or anesthesia, fetal hypoxia, or infection	Parental guidance: most of these behaviors are pleasurable to parents Parents need to be assured that behaviors are normal Sneeze is usually response to lint, etc., in nose and not an indicator of a cold No treatment needed for hiccups; sucking may help

^∗All durations for persistence of reflexes are based on time elapsed after 40 wk of gestation; that is, if this newborn was born at 36 wk of gestation, add 1 mo to all time limits given.

TABLE 7-3

Physical Assessment of Newborn

Area Assessed	Normal Findings	Deviations From Normal Range	Etiology
POSTURE
Inspect newborn before disturbing	Arms, legs in moderate flexion; fists clenched	Hypotonia	Prematurity or hypoxia in utero, maternal medications
	Normal spontaneous movement bilaterally; asynchronous but equal extension in all extremities	Hypertonia	Drug dependence, central nervous system (CNS) disorder
		Opisthotonos	CNS disturbance
		Frank breech: legs straighter and stiff
		Limitation of motion in any of extremities
VITAL SIGNS
Heart rate and pulses: Inspection Palpation Auscultation	Visible pulsations in left midclavicular line, fifth intercostal space Apical pulse, fourth intercostal space, 110-160 beats/min (listen for 1 full min); 80-100 beats/min (sleeping) to 180 beats/min (crying) Quality: first sound (closure of mitral and tricuspid valves) and second sound (closure of aortic and pulmonic valves) sharp and clear Possible murmur	Tachycardia: persistent, >180 beats/min Bradycardia: persistent, <80 beats/min Murmurs (if present, note other signs of cardiovascular dysfunction, such as tachypnea, tachycardia, pallor, cyanosis, absence of peripheral pulses, or poor perfusion) Arrhythmias: irregular rate (irregular heart rate not attributed to changes in activity or respiratory pattern should be further evaluated)	Respiratory distress syndrome (RDS) Congenital heart block, maternal lupus Possibly functional
		Sounds distant, poor quality, extra	Pneumomediastinum
		Heart on right side of chest	Dextrocardia, often accompanied by reversal of intestines
Peripheral pulses: femoral, brachial, popliteal, posterior tibial	Peripheral pulses equal and strong Femoral pulses equal and strong	Weak or absent peripheral pulses; unequal pulses Weak or absent femoral pulses	Decreased cardiac output, thrombus Hip dysplasia, coarctation of aorta if weak on left and strong on right, thrombophlebitis
Temperature: axillary method of choice	Axillary: 36.5°-37.2° C	Subnormal	Prematurity, infection, low environmental temperature, inadequate clothing, dehydration
		Increased	Infection, high environmental temperature, excessive clothing, proximity to heating unit or in direct sunshine, drug addiction, diarrhea and dehydration
	Temperature stabilized by 8-10 hr of age	Temperature not stabilized by 6-8 hr after birth	If mother received magnesium sulfate, maternal analgesics
Check respiratory rate and effort when infant is at rest Count respirations for full min	30-60 breaths/min Shallow and irregular in rate, rhythm, and depth when infant is awake	Apneic episodes: >15 sec	Preterm infant: “periodic breathing,” rapid warming or cooling of infant
	Subnormal	Bradypnea: <25/min	Maternal narcosis from analgesics or anesthetics, birth trauma
	Breath sounds loud, clear	Tachypnea: >60/min	Narrowing of bronchi, RDS, congenital diaphragmatic hernia, transient tachypnea of the newborn
	Crackles may be heard after birth	Crackles, rhonchi, wheezes Expiratory grunt Distress evidenced by nasal flaring, retractions, chin tug, labored breathing	Fluid in lungs
Measure blood pressure (BP) using oscillometric monitor BP cuff; palpate Check electronic monitor BP cuff: BP cuff width affects readings, use appropriate size and palpate brachial, popliteal, or posterior tibial pulse (depending on measurement site)	80-90/40-50 (mm Hg)	Difference between upper and lower extremity pressures	Coarctation of aorta
		Hypotension	Sepsis, hypovolemia
		Hypertension	Coarctation of aorta, renal involvement, thrombus
WEIGHT^∗
Weigh at same time each day	2500–4000 g Acceptable weight loss: <10%	Weight <2500 g	Prematurity, small for gestational age, rubella syndrome
	Second baby weighs more than first	Weight ≥4000 g	Large for gestational age, maternal diabetes, heredity—normal for these parents
	Birth weight regained within first 2 wk	Weight loss >10%-15%	Dehydration
Weighing the infant. The scale is covered to protect against cross-infection. The nurse never leaves the infant alone on the scale. (Courtesy Wendy and Marwood Larson-Harris, Roanoke, VA.)
LENGTH
Length from top of head to heel	45-55 cm	<45 cm or >55 cm	Chromosomal abnormality, heredity—normal for these parents
Length, crown to rump. To determine total length, include length of legs. If measurements are taken before the infant’s initial bath, wear gloves. (Courtesy Marjorie Pyle, RNC, Lifecircle, Costa Mesa, CA.)
HEAD CIRCUMFERENCE
Occipito-frontal circumference	32-36.8 cm Circumference of head and chest approximately the same for first 1 or 2 days after birth	Small head, <32 cm: microcephalyHydrocephaly: sutures widely separated, circumference ≥4 cm more than chest circumference	Prematurely, maternal rubella, toxoplasmosis, cytomegalic inclusion disease, fused cranial sutures (craniosynostosis)
			Maldevelopment, infection
		Increased intracranial pressure	Hemorrhage, space-occupying lesion
Head circumference. (Courtesy Marjorie Pyle, RNC, Lifecircle, Costa Mesa, CA.)
CHEST CIRCUMFERENCE
Measure at nipple line	2-3 cm less than head circumference, averages between 30 and 33 cm	<30 cm	Prematurity
Chest circumference. (Courtesy Marjorie Pyle, RNC, Lifecircle, Costa Mesa, CA.)
SKIN
Color	Generally pink	Dark red	Prematurity, polycythemia
	Varying with ethnic origin	Gray	Hypotension, poor perfusion
	Acrocyanosis, especially if chilled Mottling Harlequin sign Plethora	Pallor	Cardiovascular problem, CNS damage, blood dyscrasia, blood loss, twin-to-twin transfusion, nosocomial infection
	Telangiectasia (“stork bite” or capillary hemangioma) Erythema toxicum or neonatorum (“newborn rash”) Milia	Cyanosis	Hypothermia; infection; hypoglycemia; cardiopulmonary diseases; cardiac, neurologic, or respiratory malformations
	Petechiae over presenting part	Petechiae over any other area	Clotting factor deficiency, infection
	Ecchymoses from forceps in vertex births or over buttocks, genitalia, and legs in breech births	Ecchymoses in any other area	Hemorrhagic disease, traumatic birth
Jaundice	None at birth	Jaundice within first 24 hr	Increased hemolysis, Rh isoimmunization, ABO incompatibility
		Physiologic jaundice in up to 50% of term infants in first wk of life
Birthmarks	Mongolian spots: Infants of African-American, Asian, and Native-American origin: 70%-85% Infants of Caucasian origin: 5%-13%	Hemangiomas Nevus flammeus: port-wine stain Nevus vasculosus: strawberry mark Cavernous hemangiomas
Check condition	No skin edema	Edema on hands, feet; pitting over tibia	Overhydration
	Opacity: few large blood vessels visible indistinctly over abdomen	Texture thin, smooth, or of medium thickness; rash or superficial peeling visible	Prematurity, postmaturity
		Numerous vessels very visible over abdomen	Prematurity
		Texture thick, parchment-like; cracking, peeling Skin tags, webbing	Postmaturity
		Papules, pustules, vesicles, ulcers, maceration	Impetigo, candidiasis, herpes, diaper rash
Gently pinch skin between thumb and forefinger over abdomen and inner thigh to check for turgor	After pinch released, skin returns to original state immediately	Dehydration: loss of weight best indicator Loose, wrinkled skin	Prematurity, postmaturity, dehydration: fold of skin persisting after release of pinch
		Tense, tight, shiny skin	Edema, extreme cold, shock, infection
	Normal weight loss after birth: 7 to 10% of birth weight	Lack of subcutaneous fat, prominence of clavicle or ribs	Prematurity, malnutrition
	Possibly puffy
Vernix caseosa: color and odor	Whitish, cheesy, odorless; usually more found in creases, folds	Absent or minimal	Postmaturity
		Excessive	Prematurity
		Green color	Possible in utero release of meconium or presence of bilirubin
		Odor	Possible intrauterine infection
Lanugo	Over shoulders, pinnae of ears, forehead	Absent	Postmaturity
		Excessive	Prematurity, especially if lanugo abundant and long and thick over back
HEAD
Inspect palpate	Making up one fourth of body length Molding Caput succedaneum, possibly showing some ecchymosis	Cephalhematoma Indentation Severe molding	Birth trauma Fracture from trauma
Fontanels: open vs. closed	Anterior fontanel 5-cm diamond, increasing as molding resolves	Full, bulging	Tumor, hemorrhage, infection
		Large, flat, soft	Malnutrition, hydrocephaly, retarded bone age, hypothyroidism
	Posterior fontanel triangle, smaller than anterior
Sutures	Palpable and unjoined sutures Possible overlap of sutures with molding	Depressed Widely spaced Premature closure	Dehydration Hydrocephaly Craniosynostosis
Hair	Silky, single strands lying flat; growth pattern toward face and neck, variation in amount	Fine, woolly	Prematurity
		Unusual swirls, patterns, or hairline or coarse, brittle	Endocrine or genetic disorders
EYES
Eyeballs	Both present and of equal size, both round, firm	Agenesis or absence of one or both eyeballs
	Eyes and space between eyes each one third the distance from outer-to-outer canthus Epicanthal folds: normal racial characteristic	Epicanthal folds when present with other signs	Chromosomal disorders, such as Down, cri du chat syndromes
	Symmetric in size, shape	Small eyeball	Rubella syndrome
	Blink reflex	Lens opacity or absence of red reflex	Congenital cataracts, possibly from rubella
	No discharge No tears	Discharge (purulent) Chemical conjunctivitis	Infection Eye medication (requires no treatment)
	Subconjunctival hemorrhage	Lesions: coloboma (absence of part of iris)
		Pink color of iris	Albinism
		Jaundiced sclera	Hyperbilirubinemia
Eyes. In pseudostrabismus, inner epicanthal folds cause the eyes to appear misaligned; however, corneal light reflexes are perfectly symmetric. Eyes are symmetric in size and shape and are well placed.
Pupils	Present, equal in size, reactive to light	Pupils: unequal, constricted, dilated, fixed	Intracranial pressure, medications, tumors
Eyeball movement	Random, jerky, uneven, focus possible briefly, following to midline Transient strabismus or nystagmus until third or fourth month	Persistent strabismus Doll’s eyes	Increased intracranial pressure
		Sunset	Increased intracranial pressure
Eyebrows	Distinct (not connected in midline)	Connection in midline	Cornelia de Lange syndrome
NOSE
Shape Placement Patency	Midline Some mucus but no drainage Preferential nose breather Sneezing to clear nose	Copious drainage, with or without regular periods of cyanosis at rest and return of pink color with crying	Choanal atresia, congenital syphilis, chromosomal disorder
	Slight deformity (flat or deviated to one side) from passage through birth canal	Malformed	Congenital syphilis
		Flaring of nares	Respiratory distress
EARS
Pinna	Correct placement: line drawn through inner and outer canthi of eyes reaching to top notch of ears (at junction with scalp)	Agenesis Low placement	Chromosomal disorder, mental retardation, kidney disorder
	Well-formed, firm cartilage	Lack of cartilage Preauricular tags Size: possibly overly prominent or protruding ears	Prematurity
Hearing	Responds to voice and other sounds	No response to sound	Deaf, rubella syndrome
	State (e.g., alert, asleep) influences response
Placement of ears on the head in relation to a line drawn from the inner to the outer canthus of the eye. A, Normal position. B, Abnormally angled ear. C, True low-set ear. (Courtesy Mead Johnson Nutritionals, Evansville, IN.)
FACIES
Observe overall appearance of face	“Normal” appearance, well-placed, proportionate, symmetric features	Infant appearance “odd” or “funny”	Hereditary, chromosomal aberration
	Positional deformities	Usually accompanied by other features, such as low-set ears, other structural disorders
MOUTH
Lips Buccal mucosa	Symmetry of lip movement Dry or moist Pink Transient circumoral cyanosis	Gross anomalies in placement, size, shape Asymmetry in movement of lips Cyanosis, circumoral pallor	Cleft lip and/or palate, gums Cranial nerve VII paralysis Respiratory distress, hypothermia
Gums	Pink gums Inclusion cysts (Epstein pearls—Bohn nodules, whitish, hard nodules on gums or roof of mouth)	Teeth: predeciduous or deciduous	Hereditary
Tongue	Tongue not protruding, freely movable, symmetric in shape, movement Sucking pads inside cheeks	Macroglossia Short lingual frenulum Thrush: white plaques on cheeks or tongue that bleed if touched	Prematurity, chromosomal disorder Candida albicans
Palate (soft, hard):
Arch	Soft and hard palates intact	Cleft, hard or soft palate
Uvula	Uvula in midline
	Epstein pearls
Chin	Distinct chin	Micrognathia	Pierre Robin sequence or other syndrome
Saliva	Mouth moist	Excessive saliva	Esophageal atresia, tracheoesophageal fistula
Reflexes: Rooting Sucking Extrusion	Reflexes present Reflex response dependent on state of wakefulness and hunger	Absent	Prematurity
NECK
Sternocleidomastoid muscles	Short, thick, surrounded by skin folds; no webbing	Webbing	Turner syndrome
	Head held in midline (sternocleidomastoid muscles equal), no masses Transient positional deformity Freedom of movement from side to side and flexion and extension, no movement of chin past shoulder	Restricted movement, holding of head at angle Absence of head control	Torticollis (wryneck), opisthotonos Prematurity, Down syndrome
Thyroid gland	Thyroid not palpable	Masses	Enlarged thyroid
		Distended veins	Cardiopulmonary disorder
CHEST
Thorax	Almost circular, barrel shaped	Bulging of chest, unequal movement	Pneumothorax, pneumomediastinum
	Tip of sternum possibly prominent	Malformation	Funnel chest—pectus excavatum
Respiratory movements	Symmetric chest movements, chest and abdominal movements synchronized during respirations	Retractions with or without respiratory distress, seesaw respirations	Prematurity, RDS
	Occasional retractions, especially when crying
Clavicles	Clavicles intact	Fracture of clavicle; crepitus	Trauma
Ribs	Rib cage symmetric, intact; moves with respirations	Poor development of rib cage and musculature	Prematurity
Nipples	Prominent, well formed; symmetrically placed	Supernumerary, along nipple line Malpositioned or widely spaced
Breast tissue	Breast nodule: approximately 3-10 mm in term infant	Lack of breast tissue	Prematurity
	Secretion of witch’s milk	Maternal hormones
ABDOMEN
Umbilical cord	Two arteries, one vein	One artery	Renal anomalies
	Whitish gray	Meconium stained	Intrauterine distress
	Definite demarcation between cord and skin, no intestinal structures within cord	Bleeding or oozing around cord	Hemorrhagic disease
		Redness or drainage around cord	Infection, possible persistence of urachus
	Dry around base, drying	Herniation of abdominal contents into area of cord (e.g., omphalocele); defect covered with thin, friable membrane, possibly extensive
	Odorless
	Cord clamp in place for 24 hr
	Reducible umbilical hernia
	Rounded, prominent, dome shaped because abdominal musculature not fully developed	Gastroschisis: fissure of abdominal cavity
	Some diastasis of abdominal musculature
	Liver possibly palpable 1-2 cm below right costal margin
	No other masses palpable
	No distention	Distention at birth	Ruptured viscus, genitourinary masses or malformations: hydronephrosis, teratomas, abdominal tumors
		Mild	Overfeeding, high gastrointestinal tract obstruction
		Marked	Lower gastrointestinal tract obstruction, imperforate anus
		Intermittent or transient	Overfeeding
		Partial intestinal obstruction	Stenosis of bowel
Visible peristalsis	Obstruction
		Malrotation of bowel or adhesions
		Sepsis	Infection
Bowel sounds	Sounds present within minutes after birth in healthy term infants	Scaphoid, with bowel sounds in chest and respiratory distress	Diaphragmatic hernia
Stools	Meconium stool passing within 24-48 hr after birth	No stool	Imperforate anus
Color	Linea nigra possibly apparent		Hormone influence during pregnancy
Movement with respiration	Respirations primarily diaphragmatic, abdominal and chest movement synchronous	Decreased abdominal breathing	Intrathoracic disease, phrenic nerve palsy, diaphragmatic hernia
		“Seesaw”	Respiratory distress
GENITALIA
Female
General appearance	Female genitalia	Ambiguous genitalia—enlarged clitoris with urinary meatus on tip, fused labia	Chromosomal disorder, maternal drug ingestion
Clitoris Labia majora < div class='tao-gold-member'> Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: 8. Selected Newborn Complications 1. Pregnancy 6. Selected Postpartum Complications 2. Selected Pregnancy Complications Stay updated, free articles. Join our Telegram channel Tags: Clinical Companion for Maternity _ Newborn Nursing Jul 18, 2016 \| Posted by admin in NURSING \| Comments Off on 7. The Newborn Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access