Before each body system is assessed.
it is important to describe the general posture and behavior of the newborn.
The overall appearance yields valuable clues to the physical status of the infant.
Posture In the full-term neonate, the posture is one of flexion, a result of in utero position.
The infant born in a vertex position keeps the head flexed.
With the chin resting on the upper chest.
The arms are held in a clenched or fisted position.
The legs are flexed at the knees, and the hips are flexed in such a position that the thighs rest on the abdomen.
The feet are dorsi-flexed and positioned on the anterior aspect of the legs.
The vertebral column is also flexed.
It is important that any deviation from this very characteristic fetal position be recognized.
For example, infants of preterm birth as well as hypoxic infants do not assume a posture of total flexion, but rather one of limp extension.
Non-vertex presentations also result in variations in posture.
In breech presentations, the posture will depend ont he presenting part; for example, a frank breech presentation results in extended legs, abducted and fully rotated thighs, a flattened head on top and a neck that appears elongated.
Behavior The infant's behavior is carefully noted, especially the degree of alertness, drowsiness and irritability.
which are common signs of neurological problems.
Some questions that the doctor may mentally ask when assessing behavior include: is the infant awakened easily by a loud noise; is he comforted by rocking, sucking, or cuddling; are there periods when he experiences deep and light sleep; when awake, does he seem satisfied after feeding; what stimuli elicit responses from him; and when he is disturbed, how much does he protest? Skin The skin of the newborn is velvety smooth and puffy, especially about the eyes, the legs, the dorsal aspect of the hands and the feet and the scrotum or labia.
At birth, the skin is covered with a grey-white, cheese-like substance called Vernix caseosa.
If it is not removed during bath, it will dry and disappear by about 24 to 48 hours.
It is thought to have insulating and bacteriostatic properties.
A fine, downy hair called lanugo is present on the skin, especially on the forehead, cheeks, shoulders, and back.
Milia, distended sebaceous glands, appear as tiny white papules on the cheeks, chin, and nose.
They usually disappear spontaneously in a few weeks.
Sudamina are distended sweat glands that cause minute vesicles on the skin surface, especially on the face.
Skin color depends on racial and familial background.
The white infant is usually pink to red; the black newborn may appear a pinkish brown.
Infants of Oriental descent may resemble a shade of tea rose; tot he skin.
By the second or third day, the skin turns to its more natural tone and is more dry and flaky.
General observations are made about the color of the skin in relation ot activity, position and temperature changes.
In general the infant becomes redder when crying and may demonstrate transient periods of cyanosis.
Decreased temperature increases the degree of cyanosis because of vasoconstriction.