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Newborn Admission Assessment

Perform hand hygiene and apply clean gloves. Verify the patient's identity using two patient identifiers in accordance with institutional policy.

Place the infant on radiant warmer or Isolette and remove clothes. Apply the skin probe and set temperature if using radiant warmer.

Examine the general appearance of the infant.

    * Skin color and integrity, checking closely for soft tissue injury or birthmarks
    * Posture and tone
    * Alertness and response to stimuli
    * Any gross anomalies
    * Obvious work of breathing

   1. Perform vital signs assessment.
   2. Measure head, chest, and length. Weigh the infant and plot findings on appropriate growth chart.
   3. Perform GA assessment as per institutional policy.

Examine the head.

   1. Shape: level of molding and condition of sutures (caput succedaneum and cephalohematoma)
   2. Fontanelles: presence and condition (soft, firm, bulging, etc.)

Examine the eyes.

   1. General appearance
   2. Symmetry
   3. Location
   4. Condition of lacrimal ducts, presence of discharge
   5. Pupillary movement, size, and reaction to light (PERRL = pupils equal, round, reactive to light)

Examine the ears.

   1. Placement: top of the ear should be in line with the outer canthus of eyes
   2. Condition: firm, folded, etc.

Examine the nose.

   1. General appearance and location
   2. Presence of drainage
   3. Patency of both nares

Examine the palate

  1. By inserting gloved finger in mouth, checking suck reflex at the same time. Check for teeth and assess whether tongue is tied.
  2. Palpate clavicles for patency and check arm movement/range of motion.

Examine the chest.

   1. General appearance
   2. Symmetry
   3. Condition of ribs, sternum, and xiphoid process
   4. Lung sounds and work of breathing
   5. Breast size and location

Examine the abdomen.

   1. General appearance
   2. Symmetry (e.g., bowel loops or masses)
   3. Assess bowel sounds in all four quadrants and determine presence and quality of bowel sounds
   4. Condition of umbilical cord and presence of three vessels, including two arteries and one vein
   5. Palpable liver 1 to 2 cm below right costal margin

Examine the genitalia.

   1. Females
   2. Patency of vaginal opening
   3. Presence of skin tags and/or edema
   4. Presence of discharge (pseudomenstruation or pinkish discharge is normal)
   5. Males
   6. Location of meatus
   7. Condition and function of foreskin
   8. Presence of descended testes
   9. Condition of scrotum (hydrocele, hernias, etc.)
  10. Verify whether the infant has voided and assess amount and color.
  11. Examine the anus for patency and sphincter response. First meconium should occur within 24 to 48                     hours of age.

Examine the extremities.

   1. Amount and condition of fingers and toes (e.g., webbing or dactyly)
   2. Color of limbs (acrocyanosis)
   3. Symmetry of limbs
   4. Appropriate range of motion of limbs
   5. Appropriate startle reflex; grasp, plantar and Babinski reflexes; and also assess whether they are                       symmetrical.
   6. Presence of hip dysplasia (assessed using the Ortolani or Barlow procedure)
   7. Examine the patency of the spine by running fingers along its length, checking for sinuses or lumps.

Dress the infant and ensure the infant temperature remains within normal limits.

    * Remove gloves and discard with supplies in proper trash receptacles. Perform hand hygiene.
    * Return the infant to family or nursery.
    * Communicate any abnormal findings to appropriate health care personnel.
    * Document the procedure in the patient's record.
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