Importance Of Assessment Of Neonate

Assessment of the neonate is vitally important for immediate and long-term health. All body systems need to be assessed but there are several critical areas. Respiratory function is naturally the first system to place focus. Before the umbilical cord is cut, the neonate is sharing his mother’s oxygen supply. There are many major changes that occur within the first few minutes of life outside the womb. A typical neonate will cry once the umbilicus is cut and his skin will turn pink. If a neonate does not cry, has flaring nostrils, is grunting, or is cyanotic, he may need suctioned or given supplementary oxygen. Neonates cannot retain body heat through shivering; therefore, assessment of temperature is important to prevent cold stress. They are kept under warming lights or a blanket is placed on their head and they are wrapped in blankets. Neonates that are born to mothers with diabetes or born large for gestational age are at risk for hypoglycemia. Blood glucose levels under 40 mg/dL indicate hypoglycemia in a neonate and should be treated immediately. It is important for these babies to be fed as soon as possible, so they can stabilize their own metabolism. Other areas of assessment include: fontanelles, for signs of bulging or sinking; body measurements of head, chest, length, and weight; eyes; ears; mouth, noting any cleft lip or palate; cardiac, palpating pulses and noting any murmurs; abdomen, for indications of hernia; umbilical cord, for presence of 2 arteries and 1 vein; external reproductive organs; rectum patency; musculoskeletal; and neurological. Many of these will be looked at in detail during the gestational age assessment.Importance Of Assessment Of Neonate

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Gestational age assessment of a newborn is determining the developmental maturity of the neonate within hours of birth. Size is not a good indicator of neonatal maturity, as premature infants can be large for gestational age due to conditions in the mother, such as gestational diabetes. This is also for neonates that are born full term but small for gestation age, caused by conditions such as polyhydramnios or multiple birth. Gestational age assessment is typically performed using the Ballard Maturational Assessment developed by Dr. Jeanne Ballard, MD. The assessor performs a series of maneuvers which corresponds to a worksheet to provide a score based on predetermined physical and neuromuscular criteria. The initial Ballard assessment gave an estimation of gestational age between 26 and 44 weeks. In 1991, the assessment was revised to include extremely premature infants, expanding the estimation from 20 to 44 weeks, and became known as the New Ballard Score. Studies show that this assessment is accurate within 1 to 2 weeks in neonates over 26 weeks gestational age. Other gestational age assessments include the Dubowitz Score, Parkin Score, Amiel-Tison Neurological Assessment at Term, Farr, Finnström, and anterior lens capsule vascularity. Neonates in the United States routinely undergo diagnostic testing for approximately 30 disorders (Durham and Chapman, 2014). In Ohio, newborn screenings are mandatory, but parents can sign a form opting out due to religious objection. All parents are given educational material about the screening, how it is done, and what tests are being performed. Congenital anomalies commonly seen in newborns are spina bifida, hip dysplasia, tracheoesophageal fistula, cleft lip and palate, digit anomalies, abdominal hernias, such as gastroschisis, clubfoot, and brain malformations. The cause of these conditions is unknown, but some have been linked to chromosomal abnormalities, infections in the pregnant mother, and folic acid deficiency. These disorders range in severity from being easily treatable to incompatibility with life.

Hyperbilirubinemia and Group B streptococcus are two common medical conditions that require treatment. Hyperbilirubinemia, also known as Jaundice, is a condition in which the byproduct of red blood cell breakdown, called bilirubin, builds up in the blood. The condition in which bilirubin not easily excreted by the newborn due to liver immaturity is called physiologic jaundice. Excess bilirubin is excreted in the urine and stool; therefore, it is important to ensure the newborn is eating adequately. Breastfed babies should be fed eight to twelve times daily and formula fed babies should be given one to two ounces every two to three hours. Breastfed babies who are not improving may need to be supplemented with formula. Phototherapy may also be used for moderate to severe Jaundice. Group B streptococcus is bacteria commonly found in the vagina or rectum of pregnant women and they are tested during their third trimester. If the test is positive, the woman will receive antibiotics during labor to prevent infection in the newborn. A newborn who contracts Group B streptococcus can develop meningitis, an infection of the tissue covering the brain, and bacteremia, a bloodstream infection. These infections are treated with intravenous antibiotics and corticosteroids.Importance Of Assessment Of Neonate

Substance abuse by the pregnant mother can have lasting effects on the newborn. Illicit drugs, such as cocaine, crack, and speed increase the risk of miscarriage. Babies born to mothers who used drugs can be born have increased risk of preterm birth, bleeding in the brain, stroke, permanent brain damage, and death. Abuse does not just occur with illicit drugs; legal substances can also have an impact on the developing fetus. Alcohol use during pregnancy can lead to a condition called Fetal Alcohol Syndrome, which is associated with low birth weight, heart defects, and mental retardation. Smoking or other nicotine use may cause fetal death, low birth weight, stillborn, and newborn death. The effect of caffeine on the fetus has been debated but is believed to be detrimental to development and medical professionals recommend limiting caffeine during pregnancy.Importance Of Assessment Of Neonate

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One of the top priorities for the nurse to complete during a hospital stay for new parents is education. First time parents are often inexperienced and scared at the prospect of taking home their infant. Even parents who have children already do not always remember the care involved with a newborn. Education about nutrition should be tailored to fit each family unit. A breastfeeding mother should be instructed on how to feed her baby and what a good latch includes. She should be counseled on her nutrition and taking care of her needs to, in turn, provide the needed nutrients for her child. Community resource information should be given for lactation help and support. Parents of formula fed babies should be educated on the importance of not watering down formula or replacing formula with milk before one year. Fathers can be included in feeding of the baby, whether it’s changing a breastfed baby to bring her to mom or helping to bottle feed. A newborn has a small stomach that only holds one to three ounces and parents should be cautioned against saving expressed breastmilk or formula left over from feeds due to the growth of bacteria. An adequately fed baby should have six or more diapers a day and several bowel movements. Color and consistency of stool should be discussed to familiarize the parents with expectations and when to call with concerns. Importance should be placed on putting the newborn on their back to sleep, to reduce the risk of SIDS, or sudden infant death syndrome. The National Institute of Child Health and Human Development (NICHD) states, “The single most effective action that parents and caregivers can take to lower a baby’s risk of SIDS is to place the baby to sleep on his or her back for naps and at night.” Other important education topics for parents should include umbilical care and, if needed, circumcision care.Importance Of Assessment Of Neonate