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Which newborn physical characteristics would the nurse likely assess in a Postterm infant?

1 Jahrs vor
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A newborn infant's skin goes through many changes both in appearance and texture.

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The skin of a healthy newborn at birth has:

  • Deep red or purple skin and bluish hands and feet. The skin darkens before the infant takes their first breath (when they make that first vigorous cry).
  • A thick, waxy substance called vernix covering the skin. This substance protects the fetus's skin from the amniotic fluid in the womb. Vernix should wash off during the baby's first bath.
  • Fine, soft hair (lanugo) that may cover the scalp, forehead, cheeks, shoulders, and back. This is more common when an infant is born before the due date. The hair should disappear within the first few weeks of the baby's life.

Newborn skin will vary, depending on the length of the pregnancy. Premature infants have thin, transparent skin. The skin of a full-term infant is thicker.

By the baby's second or third day, the skin lightens somewhat and may become dry and flaky. The skin still often turns red when the infant cries. The lips, hands, and feet may turn bluish or spotted (mottled) when the baby is cold.

Other changes may include:

  • Milia, (tiny, pearly-white, firm raised bumps on the face) which disappear on their own.
  • Mild acne that most often clears in a few weeks. This is caused by some of the mother's hormones that stay in the baby's blood.
  • Erythema toxicum. This is a common, harmless rash that looks like little pustules on a red base. It tends to appear on the face, trunk, legs, and arms about 1 to 3 days after delivery. It disappears by 1 week.

Colored birthmarks or skin markings may include:

  • Congenital nevi are moles (darkly pigmented skin markings) that may be present at birth. They range in size from as small as a pea to large enough to cover an entire arm or leg, or a large portion of the back or trunk. Larger nevi carry a greater risk of becoming skin cancer. The health care provider should follow all nevi.
  • Mongolian spots are blue-gray or brown spots. They can emerge on the skin of the buttocks or back, mainly in dark-skinned babies. They should fade within a year.
  • Café-au-lait spots are light tan, the color of coffee with milk. They often appear at birth, or may develop within the first few years. Children who have many of these spots, or large spots, may be more likely to have a condition called neurofibromatosis.

Red birthmarks may include:

  • Port-wine stains -- growths that contain blood vessels (vascular growths). They are red to purplish in color. They are frequently seen on the face, but may occur on any area of the body.
  • Hemangiomas -- a collection of capillaries (small blood vessels) that may appear at birth or a few months later.
  • Stork bites -- small red patches on the baby's forehead, eyelids, back of the neck, or upper lip. They are caused by stretching of the blood vessels. They often go away within 18 months.

Newborn skin characteristics; Infant skin characteristics; Neonatal care - skin

Balest AL, Riley MM, O'Donnell B, Zarit JS . Neonatology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 2.

Bender NR, Chiu YE. Dermatological evaluation of the patient. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 664.

Narendran V. The skin of the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 94.

Walker VP. Newborn evaluation. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 25.

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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What is a gestational age assessment?

Gestational age assessment means figuring out the number of weeks of your pregnancy. A full-term pregnancy is usually 40 weeks. It's important to assess if gestational age is uncertain or if your baby is smaller or larger than expected.

The Ballard score is commonly used to determine gestational age. Here’s how it works:

  • Scores are given for 6 physical and 6 nerve and muscle development (neuromuscular) signs of maturity. The scores for each may range from -1 to 5.

  • The scores are added together to determine the baby’s gestational age. The total score may range from -10 to 50.

  • Premature babies have low scores. Babies born late have high scores.

How is physical maturity assessed?

The physical assessment includes an exam of the following physical characteristics:

  • Skin texture. Skin may be sticky, smooth, or peeling.

  • Lanugo. This is the soft downy hair on a baby's body. It's absent in premature babies. It's present in full-term babies, but not in babies born late.

  • Plantar creases. These are the creases on the soles of the feet. They range from absent to covering the entire foot.

  • Breast. The thickness and size of the breast tissue and the areola (the darkened area around each nipple) are assessed.

  • Eyes and ears.  Eyelids are checked to see if they are open or fused shut (more likely in a premature baby). The amount of cartilage and stiffness of the ear tissue are also noted.

  • Male genitals. The presence of testes and the look of the scrotum, from smooth to wrinkled, is verified.

  • Female genitals. The appearance and size of the clitoris and the labia are noted.

How is neuromuscular maturity assessed?

The neuromuscular assessment includes an exam of the following:

  • Posture. How the baby holds their arms and legs.

  • Square window. How far the baby's hands can be flexed toward the wrist.

  • Arm recoil. How well the baby's arms spring back to a flexed position.

  • Popliteal angle. How well the baby's knees bend and straighten.

  • Scarf sign. How far the elbows can be moved across the baby's chest.

  • Heel to ear. How close the baby's feet can be moved to the ears.

Gestational age assessment is an important way to learn about your baby's well-being at birth. By identifying any problems, your baby's healthcare provider can plan the best possible care.

Medical Reviewers:

  • Donna Freeborn PhD CNM FNP
  • Heather M Trevino BSN RNC
  • Liora C Adler MD

Why do Postterm babies have dry skin?

Postterm newborns have dry, peeling, loose skin and may appear abnormally thin because they have not received sufficient nutrition at the end of the pregnancy.

What are 4 common signs of respiratory distress in a newborn?

Signs and Symptoms Grunting “ugh” sound with each breath. Changes in color of lips, fingers and toes. Widening (flaring) of the nostrils with each breath. Chest retractions - skin over the breastbone and ribs pulls in during breathing.

Which finding is indicative of hypothermia in newborn?

Neonates demonstrate clinical findings that alert the practitioner toward hypothermia including: palpable cold temperature, acrocyanosis, irritability, hypotonia, decreased feeding, and hypoglycemia as the cold stress heightens1, 8.

How do you assess respiratory distress in a newborn?

Assessment for respiratory distress may differ depending on clinical setting but should include at least some of the following parameters: (1) measurement of respiratory rate (normal 40–60); (2) observation for increased work of breathing: inspiratory sternal, intercostal and subcostal recession/in-drawing, tracheal ...

newborn physical characteristics nurse assess postterm infant Positive Moro reflex

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