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Transcript of Newborn
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New born child. Peculiarities of the
newborn period. Main components of
neurological and psychological
development in children of early age. Transitory
states in a new-born period
prof. Pavlyshyn H.A.
TERMS:
Neonatology: The branch of pediatrics that deals with the diseases and care of newborns.
Neonatal period: From birth to the 28th day of life (4 weeks after birth). Perinatal period: From the 28th completed week of gestation to the 7th day after birth.
TERMS:
Full term infant: An infant born at a gestational age between 37 and 42 completed weeks
Preterm infant: An infant that is born prior to 37 weeks of gestation (22 -37 weeks or weight greater than 500g).
Post-term infant: An infant that is born after the 42nd week of gestation
AGA ( appropriate for gestational age) Infants with birth weight for their gestational age that falls between the 10th and 90th centiles. SGA ( small for gestational age) Infants with birth weight for their gestational age that falls below the 10th centiles. LGA ( large for gestational age) Infants with birth weight for their gestational age that falls above the 90th centiles.
Apgar Score of the Newborn
SIGNSCORE 0
1 2
Heart rate Absent <100 beats/min >100 beats/minRespiratory effort Absent Weak, irregular Strong cryMuscle tone Flaccid Some flexion WellReflex irritability (response to catheter in nostril)
No Grimace Cough or sneeze
Skin colour Blue, pale
extremities blue
pink
Significance of Apgar score
Healthy newborn: 7-10 at both 1 and 5 minutes
Moderately depressed newborn: 3-6 (Need resuscitation )
Severely depressed newborn: 1-3 (Intensive resuscitation )
The Apgar score is used to evaluate
• brain function at birth• circulatory status at birth• the effectiveness of respiratory and
circulatory adaptations thereafter• which babies need active assistance
(resuscitation).
Purpose
The APGAR scoring chart is used to evaluate the conditions of the baby at
birth, determine the need for resuscitation, evaluate the effectiveness of
resuscitative efforts, to identify neonates at risk for morbidity
and mortality.
Take Anthropometric Measurements
Weight – 2, 500g – 4, 000g Physiologic weight loss - it is normal for
the newborn infant to loose 5-10% of weight in the first 4 to 5 days of life (causes: low nutritional intake, defecation, urination);
Length – 45-55 cm HC – 33-55 cm, 2-3 cm larger than chest CC
– 30-33cm, AC-29-33 cm
FontanellesThe anterior fontanel is located at the intersection of the sutures of the two parietal bones and the frontal bones.Anterior: diamond shape about 2-3-4 cm, will close in about 12 to 18 mos;
The posterior fontanel is located between of the sutures of the 2 parietal bones and occipital bone. It is small, triangular shaped, normally closes at 1,5 to 3 mos of age.
Respiratory system
Fetal lung development Filled with fluid Surfactant synthesis: begins at 24-28w, peak at 35w
Establishment of breathing after birth - opening of the alveoli by mechanical,chemical,thermal, sensory stimuli
Characteristics of Newborn respirations Normal RR 30-60, shallow and irregular, 5-15 second periods of apnea Apnea: no breathing for periods of greater than 15 sec Abnormal findings: retractions, grunting, nasal flaring, more 15 sec
apnea; abnormal rate
Circulatory system Heart rate: ranges from 140 to 160 per minute. Heart murmur:
Transient murmurs may result from the incomplete closure of the fetal circulation (the ductus arteriosis or foramen ovale)
90% of all murmurs are transient and not associated with anomalies.
Blood pressure: from 46 to 80 mmHg (systolic)
Hemotological system High: RBC 4.8-7.1; Hgb 14-24; Hct 44-64 18,000 @ birth; 23-25,000 @ 1 day with relative
neutrophilia
Coagulation: Vit K dependent clotting factors are decreased.Platelet counts ok (150,000-350,000)
•These characteristics are essential to provide adequate oxygenation in utero and during the first few postnatal days before the lungs expand fully. •Oxygenation improves during the first two weeks of life to the extent that a high red cell count and hemoglobin are no longer necessary, and haemolysis occurs.
After the first few days (5 days or so ) the white cell count is likely to be below 10 000/ mm3 with characteristically relative lymphocytosis of infancy and early childhood.
WBC:
Gastrointestinal System sucking becomes coordinated @32 wks little saliva until 3 months of ageStomach hold 60 to 90 ml. Regurgitates easily because of an immature cardiac
sphinter between the stomach and esophagus. Immature liver function may lead to lowered
glucosed and protein serum level.
Hepatic FunctionLiver produces substances essential for clotting of
blood. Stores needed iron for the first few months. Preterm & small
infants have lower iron stores than full term (full term infants stores last 4-6 mo)
Physiologic Jaundice - after 24-48 hs of age, d/t increased breakdown of RBC’s and immature liver functioning.
This is a yellow discoloration that may be seen in the infant's skin or in the sclera of the eye.
Jaundice is caused by excessive amounts of free bilirubin in the blood and tissue.
Urinary system
Renal function: GFR - glomerular filtration rate is lower, about one fourth to one half of that in an adult.
Kidneys not fully functional until child is 2 years of age. Urine often contains protein in small amounts. Urine may contain an abundance of urates which may
give the diaper a pink stain during the first week of life. The ability to dilute urine is good, but the time taken to
reach the maximal ability is relatively long, so newborns are apt to become water overloaded.
Kidneys and Urination initial urine: cloudy, scant amounts, uric acid
crystals-> reddish stain on diaperUrine pH ranges from 5 to 7, specific gravity ranges
from 1.006 to 1.020. The first urination occurs within 24 hrs. It ranges
from 4 to 6 times/day in the first days and 20 times or so /day in later days of the neonatal period.
Kidneys not fully functional until child is 2 years of age.
Immune SystemLimited specific and Non-specific
immunity at birthpassive immunity(from mom- IgG) for
the first 3 months of life ~ this will be reduced if baby is born premature
breastfeeding = ^ passive immunity (IgA)
Neuromascular System
Mature newborns demonstrate neuromuscular function by moving their extremities, attempting to control head movement, exhibiting a strong cry and demonstrating newborn reflexes.
A newborn occasionally makes twitching or flailing movements of the extremities in the absence of stimulus because of the immature of the nervous system.
Newborn Reflexes
Sucking reflex
• When a newborn lips are touched, the baby makes a sucking motion.• This reflex helps a newborn find food: when the newborn lips touch the mothers breast or bottle, the baby sucks and takes food.• The sucking reflex begins to diminish at about 6 months of age
Newborn Reflexes
Rooting reflex - If the check is brushed or stroke near the corner of the mouth, a newborn infant will turn the head in that direction.
• This reflex serves to help a newborn find food: when a mother holds the child and allows her breast to brush the newborn’s cheek, the reflex makes the baby turn toward the breast. • This reflex disappear at about the sixth week of life.
Rooting
touch a finger to the neonate’s cheek or the corner of mouth.
neonate turns the head toward the stimulus, opens the mouth and searches for the stimulus
Newborn Reflex
Blink Reflex - bright light shinning in eyes or clap hands near eyes - closes eyelids quickly
A sudden movement to ward the eye can elicit the blink reflex. Swallowing reflex - food that reaches the posterior
portion of the tongue, automatically swallowed. Gag, cough, and sneeze reflexes are present to maintain airway
in the event that normal swallowing does not keep the pharynx free from obstructing mucous.
Baby is held horizontally, then swiftly lowered a few inches, or the head may be lowered a few inches, or a loud sudden noise will make baby's arms fling out and then come together as hands open then clutch.
MORO reflex
Absence or weakness of this reflex may suggest a severely disturbed CNS
Startle reflex
sudden loud noise causes abduction of the arms wit flexion of elbow, hand remain clenched
disappears by age of 4 months
Palmar Grasp Reflex
• newborn grasp an object placed in their palm by closing fingers on it.
• Mature newborn grasp so strongly that they can be raised from a supine position and suspended momentarily from an examiner’s fingers. • Reflex disappears to 3 months of age.
PLANTERS GRASP
Pressing thumbs against the balls of baby's feed will make his toes flex.
Absence of this reflex may indicate damage to the spinal chord.
Stepping reflex
• Hold the neonate in an upright position and touch one foot lightly to a flat surface (such as the bed)
neonate makes walking motions with both feet
BABKIN
When both of baby's palms are pressed, her eyes will close, mouth will open and her head will turn to one side.
Absence of this reflex or if it reappears after vanishing around 3-4 mos., it may signify a malfunctioning CNS
BABINSKI
Absence of reflex may suggest immaturity of the CNS, defective spinal chord, or other problems.
Baby's foot is stroked from heel toward the toes. The big toe should lift up, while the others fan
out.
When newborn lie on their backs, their head usually turn to one side or the other.
The arm and the legs on the side toward which the head turns extend, and the opposite arm and leg contract.
This is also called the boxer or fencing reflex.
The reflex disappears between the second and third months of life.
Tonic neck reflex Fencing posture
Extrusion Reflex - newborn extrudes any substance that is placed on the anterior portion of the tongue.
This protective reflex prevents the swallowing reflex of inedible substance.
It disappears at about 4 months of age
Extrusion Reflex
Thermoregulation
Newborn physiology •Normal temperature: 36.5–37.5°C•Hypothermia: < 36.5°C --Significant contribution to deaths in low birth weight infants and preterm newborns•Stabilization period: 1st 6–12 hours after birth
The body temperature is likely to be influenced by the environmental temperature.
Neutral environmental temperature: the environmental temperature at which the core temperature of the infant atrest is between 36.7 and 37.3°C and oxygen consumption and caloric utilization are lowest
Newborn’s temperature may drop several degrees after delivery because the external environment is cooler than the intrauterine environment
Rapid heat loss in a cool environment occurs by conduction, convection, radiation and evaporation;
Cold stress in the newborn → an increase in the metabolic rate --> increased O2 demands and caloric consumption, metabolic acidosis
Temperature Regulation
Physiologic jaundiceNeonatal jaundice is often seen in infants around the second day after birth, lasting until day 8 in term births, orto around day 14 in premature births.
Milia- all newborn sebaceous
glands are immature.- White papule can be
found on the cheek or across the bridge of the nose of every newborn.
- Disappear by 2 to 4 weeks of age, as sebaceous glands mature and drain.
Erythema Toxicum Erythematous macules and
firm 1-3 mm yellow or white papules or pustules
Pustules contain eosinophils and are sterile
Appear in the first 3-4 days of life
Range: Birth to 14 days Benign and self limited
Lanugo
- Is the fine hair, downy hair that covers a newborn’s shoulder, back and upper arm.
- It maybe found also on the forehead and ears.
- A baby born after 37 to 39 weeks of gestation has more lanugo than a newborn of 40 weeks.
- By 2 weeks of age it disappear
Vernix Caseosa
- At birth the infant is generally covered with vernix caseosa, a cream cheesy-white substance adherent to the skin that serves as a skin lubricant.
- It is helpful for protecting the baby against infections, and should not be taken off.
Mongolian spots Are collections
of pigment cells
90% of African infants, 81% of Asian, and 9.6% of Caucasian infants
Slate-gray to blue-black lesions Usually over lumbosacral area and buttocks Accumulation of melanocytes within the
dermis They disappear by school age without
treatment
Features in appearance of normal term neonate and preterm neonate
pink , well-nurished,Less fine-hair
term
Dark-red,edema , transparent , more fine-hair
preterm
SkinSkin
soft ear stick to the skull, poor figuration
preterm
Good ear figuration, well-developed cartilage
term
earear
Enlargement of the breasts
• Enlargement of the breasts and production of milk may occur at the age of 3 to 5 days in some newborn boys or girls. This stops at the postnatal age of 2 to 3 weeks. This is also caused by transmission and withdraw of maternal hormones. This no requires management.
Essential Newborn Care Interventions
• Clean childbirth and cord care– Prevent newborn infection
• Thermal protection– Prevent and manage newborn
hypo/hyperthermia• Early and exclusive breastfeeding
– Started within 1 hour after childbirth• Initiation of breathing and resuscitation
– Early asphyxia identification and management