Examination of newborns is the key to ensuring a healthy baby and screening for possible health problems. The discussion considers normal and abnormal findings and identifies the intervention for abnormal findings.
Sneezing is a reflex present in newborns as a way of clearing the air passages and facilitates breathing. Newborns breathe through their nose so that signs of distress show whenever there is obstruction in the airway. (Pillitteri, 2006) Sneezing is also a reaction to the particles in the air (Hatfield & Broadribb, 2008). There should be no sign of other reasons for sneezing other to clear nasal passages or as reaction to air particles for sneezing to be normal. However, if sneezing with yellowish or greenish nasal drainage, nasal stuffiness, coughing, nasal flaring, and breathing distress such as the newborn turning blue and stops breathing beyond a few seconds as well as frequent sneezing spells and other signs of distress, then the sneezing is not normal (Hatfield & Broadribb, 2008; Simpson & Creehan, 2008). The signs of abnormal sneezing could be an indication of respiratory problems that could worsen very quickly. Immediate reporting of these observed symptoms is the imperative response. (Rosdahl & Kowalski, 2008)
Misshaped Heads (Molding)
Molding describes the longer and narrower shape of the head of newborns right after birth. This is due to pressure on the fetal skull pressing against the not yet dilated cervix. The shape of the skull then facilitates passage through the pelvis in normal delivery. (Pillitteri, 2006) The misshapen head of a newborn could also occur in using forceps or vacuum to facilitate delivery (Simpson & Creehan, 2008). The long and narrow shape of the newborn’s head is visible right after a normal delivery. This is distinguishable from the more rounded head of newborns in breech position or normal position delivered through caesarian section. The more elongated and narrower shape of the head could remain between 2 to 3 days (Simpson & Creehan, 2008) or 3-5 days (Lowe, 2007). If the shape of the skull does not return to the normal circumference after 5 days, at most, then this could indicate an abnormal condition. In addition, observations and tests should look for considerations such as caput succedaneum or edema of the scalp, which should be only a few centimeters and should resolve within 28 hours. The test should also consider cephalhematoma or blood vessel injury, which should not be of excessive size and should resolve in several days to weeks. A scalp exam should also consider subgaleal bleed. The excessive size of the birth-related injury, which affects the shape of the head, could indicate bleeding disorder or infection. Test should also consider craniosynostosis by feeling the fontanelle and the head shape. (Lowe, 2007) In case of abnormal findings, the intervention includes relieving any bleeding, infection or inflammation, improving the shape of the head by positioning or stretching, or surgery when necessary (Rosdahl & Kowalski, 2008).
Soft spots are the fontanelles of newborns. In checking newborns, palpating the head would reveal the soft spots and suture lines. There should be an anterior fontanelle found where the two parietal bones and two fused frontal bones meet. The shape is diamond-like and measures around 2-3 centimeters. There should also be a posterior fontanelle located at the area where the parietal and occipital bones meet. The shape is triangular and measures around 1 centimeter. The anterior fontanelle closes between 12-18 months while the posterior fontanelle closes when the baby reaches 2 years of age. (Pillitteri, 2006; Hatfield & Broadribb, 2008) The fontanelles should feel like soft spots but it should not appear indented to indicate dehydration or bulge to indicate intracranial pressure. The intervention would be to alleviate dehydration and ease intracranial pressure. The fontanelles should also not close very early or very late because these indicate slow or excessive brain development and ventricle growth. Whether a very early or very late fontanelle closure is abnormal depends on the co-occurrence of other conditions such as chromosomal defects, congenital infections, fetal alcohol syndrome, hypoxic-ischemic encephalopathy and normal genetic variation for premature closing and congenital hypothyroidism, intracranial pressure, familial macrochepaly, and other conditions for late closing. (Kiesler & Ricer, 2003; Simpson & Creehan, 2008) In case of abnormal conditions, interventions could include continuous monitoring of prematurely closed fontanelles to determine brain development and treatment of emerging conditions as well as treating the cause of the very late closing of the fontanelles such as monitoring brain development and other symptoms as well as treatment of infection, inflammation and other causes.
It is normal for newborns to develop skin rashes with difficult to ascertain causes. The skin of newborns is delicate and easily irritated. If the cause is unknown, the treatment should be symptomatic. Exposing newborn skin to air usually relieves rashes and itching. Some of the skin rashes by newborns develop and resolve on their own within days or weeks such as Epstein’s pearls, erythema toxicum, forceps marks, miliaria, milia, neonatal acne, sebaceous gland hyperplasia, seborrheic dermatitis, and transient neonatal pustular melanosis. (Rosdahl & Kowalski, 2008) However, if the condition is severe such as reddish and scaly skin or prolonged symptoms leading to irritation, weight loss, diarrhea, hair loss, and other conditions, then intervention is necessary such as lotion or ointments and medication (Hatfield & Broadribb, 2008).
To examine newborns effectively, healthcare workers need to have a comprehensive understanding not only of the normal conditions of newborns but also the signs and symptoms of an abnormal condition.
Hatfield, N. T., & Broadribb, V. (2008). Broadribb’s introductory pediatric nursing (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Kiesler, J., & Ricer, R. (2003). The abnormal fontanel. American Family Physician, 67(1), 2547-2552.
Lowe, M. C. (2007). The normal newborn exam, or is it?. Emergency Medicine Clinics of North America, 25(4), 921-946.
Pillitteri, A. (2006). Maternal and child health nursing: Care of the childbearing & childrearing family (5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Rosdahl, C. B., & Kowalski, M. T. (2008). Textbook of basic nursing (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Simpson, K. R., & Creehan, P. A. (2008). Perinatal nursing (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.