![]() Seen first on the head and face, jaundice progresses downward to the trunk and extremities and then to the sclera of the eye. Jaundice progresses in a cephalocaudal fashion. The skin color change associated with an elevated direct bilirubin has a greenish hue ( Gomella, Cunningham, & Eyal, 2009a). An elevated direct bilirubin level that may occur as early as 24 hours of life is never normal and suggests some pathology involving the liver. ![]() ![]() A mildly elevated indirect bilirubin level is considered normal in the first few days of life. Jaundice results from the reduced ability of the newborn’s liver to conjugate bilirubin. Up to 60% of healthy term newborns develop some degree of jaundice ( Kaplan, Wong, Sibley, & Stevenson, 2011). Jaundice, a bright yellow or orange discoloration of the skin, results from deposits of unconjugated bilirubin. Identifying newborns that are preterm, term, or postterm and those who are IUGR, small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age (LGA) increases the likelihood of early identification and timely interventions for potential complications related to birth weight and gestational age during the immediate newborn period. Although some hospitals make gestational age assessment of all newborns a routine practice, other institutions have established criteria for performing gestational age assessment such as birth weight less than 2,500 g or more than 4,082 g, suspected intrauterine growth restriction (IUGR), gestation less than 37 weeks, and cesarean birth and in some organizations, it is not part of the nursing assessment but instead determined during the primary care provider’s assessment. A gestational age assessment, evaluating physical and neuromuscular characteristics, is usually performed as part of the initial physical examination. The American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG) (2007) recommend that the gestational age of newbornsīe established by incorporating both obstetric and the initial physical and neurologic findings of the newborn. Tables describe pathologic findings and their causes. ![]() Normal findings and common variations for each body system are identified in the text. It is also assumed that the reader has basic knowledge of physical assessment skills and terminology. ![]() Although some references are made to preterm newborns, that subject is not the intended focus of this chapter. Home care nurses may also find the information pertinent during early postpartum home visits. The focus of this chapter is the physical assessment and findings that the perinatal nurse may observe during the time the newborn is in the hospital or birthing center. It also provides an opportunity for parents to ask questions about the newborn’s physical appearance and condition. Conducting the examination while parents observe allows the nurse to use this time to identify and discuss normal newborn characteristics and note variations. Ideally, this examination occurs in the presence of the parents. Perinatal and neonatal nurses frequently perform the first head-to-toe physical assessment of the newborn. ![]()
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