Which condition would the nurse assess for in a newborn with blue hands and feet?

The family’s new apple of the eye is already out, and everybody can’t wait to cuddle and hold the little angel. Everyone is anxious about the health of the little one, so it is best to know the normal profile and activities of the newborn.

• Profile of the Newborn
  • Vital Statistics
  • Vital signs
• Adjustment to Extrauterine Life
• Appearance of the Newborn
• Practice Quiz: The Newborn

Profile of the Newborn

Newborns may look alike, but each has their own physical attributes and personalities. Some newborns are fat and short while some are long and thin. There are newborns who never give a fuss whenever they are changed or cuddled, but some can cry in high decibels whenever you lift them from their cradles.

• The weight of newborns varies according to their race, genetics, and nutritional factors.
• To determine if the newborn’s weight is appropriate for its gestational age, a neonatal graph should be used in plotting the newborn’s weight.
• Plotting the height and head circumference of the newborn also helps determine any disproportions.
• The average birth weight for a mature female newborn in the United States is 3.4kg or 7.5 lbs, and for a mature male, the newborn is 3.5 kg or 7.7 lbs.
• For all races, the normal weight is 2.5 kg or 5.5 lbs.
• The newborn loses 5% to 10% of its birth weight during the first few days of life, then has 1 day of stable weight, and gains weight rapidly afterward.
• The newborn must gain 2 lbs per month for the first six months of life.
• The average birth length of mature female newborns is 53 cm or 20.9 inches. The mature male newborn has an average birth length of 54 cm or 21.3 inches.
• A mature newborn has a head circumference of 34 to 35 cm.
• Head circumference is measured with a tape measure drawn across the center of the forehead and around the most prominent part of the posterior head.
• The chest circumference in a mature newborn is 2 cm less than the head circumference.
• Chest circumference is measured at the level of the nipple using a tape measure.

Vital Statistics

Vital signs

Adjustment to Extrauterine Life

• The newborn’s color on the first 15 to 30 minutes of life is still acrocyanotic, and after 2 to 6 hours, there are quick color changes that may occur with movement or crying.
• The temperature within the first 15 to 30 minutes after birth falls from the intrauterine temperature of 100.6⁰F or 38.1⁰C then stabilizes at 37.6⁰C after 2 to 6 hours.
• The rapid heart rate of as much as 180 BPM on the first 15 to 30 minutes of life will have wide swings in rate with activity as it slows to 120-140 BPM.
• The newborn’s respirations are irregular in the first few minutes of life, then slows to 30-60 breaths per minute after 30 minutes and will become irregular again only during activity.
• The newborn would be alert in the first 15 to 30 minutes of life, and later on, will alternate between the sleeping and awakening phases.
• Just a few minutes after birth, the newborn would respond to stimulation vigorously but would be difficult to arouse while it is still on a resting period until it becomes responsive again 2 to 6 hours after birth.
• The bowel sounds can be heard after the first 15 minutes of life and becomes present afterward.

Appearance of the Newborn

• Increased concentration of red blood cells in newborns, and decreased amount of subcutaneous fat gives them a ruddy complexion.
• In the first month, this ruddy complexion slightly fades.
• A pale and cyanotic newborn signifies that she may have poor central nervous system control.
• A gray color in newborns may indicate infection.
• Acrocyanosis is normal in a newborn, wherein the hands, feet, and lips are bluish in color.
• Central cyanosis, however, is a cause for concern as this may indicate a decrease in oxygenation.
• Jaundice appears on the second or third day of life as a result of the breakdown of fetal red blood cells.
• Early feeding to speed the passage of feces through the intestine and prevent reabsorption of bilirubin from the bowel may diminish physiologic jaundice.
• Pallor in newborns is a sign of anemia, and the newborn must be watched closely for signs of blood in the stool or vomitus.
• Harlequin sign or when a newborn who is lying on his or her side appears red on the dependent side and pale on the upper side does not have a clinical significance.
• Vernix caseosa or the white cream cheese-like substance is washed away in the first bath, but never rub harshly as it will only come off gradually.
• Lanugo or the fine, downy hair that covers the shoulders, arms and back of the newborn would be rubbed away by the friction of the bedding and clothes of the newborn.
• A white, pinpoint papule called milia can be found in some newborns, mainly on the cheek or the bridge of the nose, and they disappear by 2 to 4 weeks of age.

• The fontanelles or the spaces or openings where the skull bones join are soft spots on the newborn’s head.
  • The anterior fontanelle is located between the two parietal bones and the two frontal bones which gives it a diamond shape, and normally closes at 12 to 18 months of age.
  • The posterior fontanelle is located at the junction of the parietal bones and the occipital bone and is triangular in shape, and closes at the end of the second month.
• Newborns cry tearlessly until three months of age when the lacrimal ducts mature.
• Birthmarks
  • Hemangiomas are vascular tumors of the skin.
  • Nevus flammeus are muscular purple or dark red lesion. Generally appear on the face and thighs.
  • Strawberry hemangiomas—elevated areas formed by immature capillaries and endothelial cells.
  • Cavernous hemangiomas—these are dilated vascular spaces.
  • Mongolian spots—slate gray patches across the sacrum or buttocks and consist of a collection of pigment cells.
  • Forceps marks—these are circular or linear contusion matching the rim of the blade forceps on the infant’s cheeks.
• Permanent eye color appears on the 3rd to 12th month of age.
• The newborn’s external ear is not yet fully formed, and the top part of the external ear should be on a line drawn from the inner canthus to the outer canthus of the eye and back across the side of the head.
• The newborn’s nose tends to look large for the face but the rest of the face will grow more than the nose does.
• The newborn’s mouth must open evenly when he or she cries.

Practice Quiz: The Newborn

Quiz time!

1. How could you determine if the newborn’s weight is appropriate for its age?

A. By weighing the newborn on a weighing scale.
B. By plotting its weight on a neonatal graph.
C. By weighing the newborn after 24 hours.
D. By calculating the BMI of the newborn.

2. A few days after birth, the mother complained that the newborn lost weight. What should be the best action?

A. Report the findings to the primary care provider.
B. Assess the newborn for any anomalies or diseases.
C. Assure the mother that this is normal.
D. Instruct the mother to increase her feedings.

3. What is the condition wherein the newborn’s lips, hands, and feet are bluish in color?

A. Acrocyanosis
B. Central cyanosis
C. Milia
D. Harlequin sign

4. What should a mother do to the white, cream cheese-like substance that coats her baby?

A. Have it examined by her primary care provider.
B. Scrape or rub it off using a towel.
C. Allow it to be gradually washed off.
D. Remove it using baby oil.

5. When does the anterior fontanelle close?

A. At the end of the third month
B. At 12 to 18 months of age
C. At the end of the second month
D. At 15 to 24 months of age

Answers and Rationale

1. Answer: B. By plotting its weight on a neonatal graph.

A neonatal graph would show if the newborn’s weight is appropriate for its age.

2. Answer: C. Assure the mother that this is normal.

A newborn loses 5% to 10% of its weight during the first few days of life.

3. Answer: A. Acrocyanosis 

Acrocyanosis is a normal phenomenon where the newborn’s lips, hands, and feet are bluish in the first few minutes of life.

4. Answer: C. Allow it to be gradually washed off.

The vernix caseosa is a lubricating substance that would gradually disappear with washing and bathing.

5. Answer: B. At 12 to 18 months of age

When the newborn reaches 12 to 18 months of age, the anterior fontanelle should be closed.

The appearance of each newborn is unique in its own way, no matter how alike they seem to look. This is what makes them endearing to the people around them; their innocent personality and their tiny features would really make you love and care for them tenderly, whether you’re a family member or a healthcare provider.

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