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2/28/2012

Assessment of the Neonate
Arthur Jones, EdD, RRT
http://rc-edconsultant.com/

Learning objective: Interpret findings from physical and physiological assessments of the newborn.

Apgar score
Rated at one and five minutes Intended only to assess general condition Does not:
define asphyxia predict future development influence Ivy League admission

Neonatal ScoringSystems

Health premature infants will likely have low Apgar scores
FYI - Click for article on use and abuse of Apgar score
http://pediatrics.aappublications.org/cgi/content/abstract/pediatrics;98/1/14 1

Apgar scoring system ƒObservations Color - skin colorimetry reflects
illness severity Heart rate Reflex activity Activity Respirations

Apgar scoring system
0 Color central cyanosisperipheral cyanosis 1 pink 2

Copyright 2008 AP Jones

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Apgar scoring system
0 Color Heart rate central cyanosis none detectable peripheral cyanosis 100 2

Apgar scoring system
0 Color Heart rate central cyanosis none detectable peripheral cyanosis 100 2

Respiratory apnea effort

Apgar scoring system
0 Color Heart rate central cyanosis none detectable peripheralcyanosis 100 2

Apgar scoring system
0 Color Heart rate central cyanosis none detectable peripheral cyanosis 100 2

Respiratory apnea effort Reflex none

Respiratory apnea effort Reflex none

crying

crying well-flexed

Muscle tone flaccid (activity)

Gestational age estimation
Prenatal
menstrual cycle - 1st day of last menstrual period + 280 days fundal height measurement mom'sabdomen ultrasound

Gestational age estimation
Postnatal
ultrasound measurement - femur length Ballard score - AKA BallardDubowitz score

Copyright 2008 AP Jones

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Ballard score ƒEstimation of gestational age ƒPhysical signs Skin Breast Lanugo Eye/ear Plantar surface Genitalia
FYI - Click to view/bookmark Ballard Score videoshttp://www.ballardscore.com/Pages/videos.aspx

Ballard score - physical signs
Gestational age/ score Skin 24-26 wk score = 0 gelatinous, red, translucent 35-40 wk score = 4 parchment, deep cracks, no visible vessels

Ballard score - physical signs
Gestational age/ score Skin 24-26 wk score = 0 gelatinous, red, translucent none to sparse 35-40 wk score = 4 parchment, deep cracks, no visible vessels none to sparse

Ballardscore - physical signs
Gestational age/ score Skin 24-26 wk score = 0 gelatinous, red, translucent sparse no crease 35-40 wk score = 4 parchment, deep cracks, no visible vessels mostly bald creases over entire sole

Lanugo

Lanugo Plantar surface

Click to see skin scoring
http://www.ballardscore.com/Pages/mono_phys_skin.aspx

Click to see lanugo scoringhttp://www.ballardscore.com/Pages/mono_phys_lanugo.aspx

Click to see plantar surface scoring
http://www.ballardscore.com/Pages/mono_phys_plantar.aspx

Ballard score - physical signs
Gestational age/ score Skin 24-26 wk score = 0 gelatinous, red, translucent sparse no crease barely perceptible 35-40 wk score = 4 parchment, deep cracks, no visible vessels mostly bald creases over entire sole full areolae; 5-10 mm bud

Ballardscore - physical signs
Gestational age/ score Skin 24-26 wk score = 0 gelatinous, red, translucent sparse no crease barely perceptible lids open, pinna flat & stays folded 35-40 wk score = 4 parchment, deep cracks, no visible vessels mostly bald creases over entire sole full areolae; 5-10 mm bud eyes open, ear thick cartilage, stiff

Lanugo Plantar surface Breast

Lanugo Plantar surfaceBreast Eye and ear

Click to see breast scoring
http://www.ballardscore.com/Pages/mono_phys_breast.aspx

Click to see eye & ear scoring
http://www.ballardscore.com/Pages/mono_phys_eyear.aspx

Copyright 2008 AP Jones

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Ballard score - physical signs
Gestational age/ score Genitalia- male Genitalia-female 24-26 wk score = 0 scrotum empty, faint rugae prominent clitoris...
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