NEWBORN NURSING ASSESSMENT

RCP/09 – Revised February/2018

NEWBORN NURSING ASSESSMENT

Birth Date

Birth Time

Sex

Band #

Birth Wt (g) Head Circ. (cm) Length (cm)

Blood Group Feeding Breast Exclusive

Mother Baby Coombs With suppl. Formula

GESTATIONAL AGE ASSESSMENT

< 37 WEEKS (Preterm) ≥ 37 WEEKS (Term) GESTATIONAL AGE

BREAST TISSUE ≤ 3 mm > 3 mm

PLANTAR CREASES Smooth, Single Crease Covering Ant. 1/3 or More By Dates _____________wks.

EAR Relatively Flat, Pliable Stiff Cartilage, Deep Crease at

Outer Aspect By Assessment _________wks.

GENITALIA Male Testes in Canal Testes well within Scrotum

Female Labia Minora visible Labia Majora cover Minora

HEAD TO TOE ASSESSMENT Erythromycin eye

ointment given Yes NO

NORMAL ABNORMAL (comment on abnormalities) Vitamin K Dose / Route __________________

1. GENERAL Given by ________________________________

APPEARANCE Newborn Screening: Discussed

Done

Arranged 2. SKIN Bruising Peeling

Petechiae Jaundice

Meconium Stain Other CCHD Screening:

Edema Age at initial screen: hours Soft tissue wasting Moderate Severe R. Hand Foot % Diff Action

P / R / F

P / R / F

P / F

3. HEAD Overriding suture Molding Caput

Hematoma Other

4. EENT Cleft Lip/Palate Other P=Pass / R=Repeat / F=Fail

Suspected Choanal Atresia Further Assessment Required See Notes

Screening Declined

Not Clinically Appropriate 5. RESP Grunting ↓ Breath Sounds

Nasal Flaring Tachypnea Date: __________________ Time: ____________

Retracting Other Signature: ________________________________

6. CVS Murmur Central Cyanosis DISCHARGE Weight ___________ g

Arrhythmia Absent Femoral Pulses Physician assessment completed

Order for discharge written Tachycardia Other

7. ABDOMEN Scaphoid Other Feeding: Breast Exclusive With suppl Distended Formula _____________________

Medically indicated

Well Established

Problems Ongoing

8. UMBILICAL Meconium Stain Thin

CORD 2 Vessels Other

9. MUSCULO- Spine Foot abnormal Follow-up Plan: ___________________________

SKELETAL Hip abnormal Other ________________________________________ Clavicle ________________________________________

10. GENITO- Hydrocele Imperforate anus COMMENTS

RECTAL Hypospadias Other

Undescended testes

11. CNS Tone Tone Other

Abnormal Cry Jittery

Date ___________________________ Time _______________________________ Date _____________ Time _______________

Signature _______________________________________________________________ Signature ________________________________