NEW BORN

Mrs.Deepa Sudheesh

Senior lecturer

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.

Classification of the neonates

By birth
weight

By gestational
age

By both GA and BW

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.

GA 40 w,
BW3000g
GA 34 w,
BW2000g

 Assessment:
The initial assessment:
APGAR scoring
system
Purpose:
is to assess the newbornS immediate
adjustment to extrauterine life
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Apgar Score of the Newborn

SIGNSCORE

Heart rate

Absent

<100 beats/min >100 beats/min

Respiratory effort

Absent

Weak, irregular

Strong cry

Muscle tone

Flaccid

Some flexion

Well

No

Grimace

Cough or
sneeze

Blue,
pale

extremities
blue

pink

Reflex irritability
(response to
catheter in nostril)
Skin colour

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.

Transitional assessment
(Periods of reactivity):

First period of reactivity:

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 Stage 1:
During the first 30 min. through
which the baby is characterized
as Physiologically unstable ( ),
very alert, cries vigorously, may
suck a fist greedily, & appears
very interested in the
environment.
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Stage 2:
It lasts for about 2-4 hours, through
this period; all V.S & mucus production
are decreased. The newborn is in state
of sleep and relative calm.
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Second period of
reactivity
It lasts for about 2-5 hours,
through which the newborn is alert
and responsive, heart & respiratory
rate, gastric & respiratory
secretions are increased & passage
of meconium commonly occurs.

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 Following this stage is a period

of stabilization through which
the baby becomes
physiologically stable & a
vacillating pattern of sleep and
activity.

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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

Assessment of Growth

Head Circumference
HC 33-55 cm,
2-3 cm larger than chest

Take Anthropometric Measurements

Head Circumference

Chest Circumference

Abdomen Circumference

Fontanelles
The anterior fontanel is located
at the intersection of the sutures
of the two parietal bones and the
frontal bones.
Anterior: diamond shape about 23-4 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

Cardiovascular System

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

WBC:
neutrophilia

After the first few days (5 days or so ) the white cell count is
Coagulation: Vit K dependent3 clotting factors are decreased.
likely
to be below 10 000/ mm with characteristically relative
Platelet counts ok (150,000-350,000)
lymphocytosis of infancy and early childhood.

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.

Gastrointestinal System
sucking becomes coordinated @32 wks
little saliva until 3 months of age
Stomach 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.

Alimentary system

Hepatic Function
Liver 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 RBCs 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.

JAUNDICE

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 diaper
Urine 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 System
Limited specific and Non-specific
immunity at birth
passive 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

Sucking

place a finger in the

neonates mouth
neonate sucks on the finger

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
newborns 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 neonates
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.

MORO reflex

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.
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 examiners
fingers.
Reflex disappears to 3 months of
age.

Grasp

place a finger in the neonates palm

neonate grasps the finger

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
Baby's foot is stroked from heel toward the toes.
The big toe should lift up, while the others fan
out.

Absence of reflex may

suggest immaturity of the
CNS, defective spinal
chord, or other problems.

Tonic neck reflex

Fencing posture

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.

Extrusion Reflex

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

Thermoregulation
Newborn physiology
Normal temperature: 36.537.5C
Hypothermia: < 36.5C --Significant contribution to
deaths in low birth weight infants and preterm newborns
Stabilization period: 1st 612 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 at
rest is between 36.7 and 37.3C and oxygen consumption
and caloric utilization are lowest

Temperature Regulation
Newborns 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

The Four modalities by which the

infant lost his/ her body
temperature:

1- Evaporation:
Heat loss that
resulted from expenditure of
internal thermal energy to convert
liquid on an exposed surface to
gases, e.g.: amniotic fluid, sweat.
Prevention:
Carefully dry the
infant after delivery or after

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2- Conduction:
Heat loss
occurred from direct contact
between body surface and
cooler solid object.
Prevention:
Warm all objects
before the infant comes
into contact with them.
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3- Convection:
Heat loss is
resulted from exposure of an
infant to direct source of air
draft.
Prevention:
Keep infant out of
drafts
Close one end of heat
shield in incubator to
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4- Radiation:
It occurred
from body surface to
relatively distant objects
that are cooler than skin
temperature.
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SKIN
Observation and palpation

SKIN

Common variations
Acrocyanosis - result
of sluggish peripheral
circulation.

Physiologic jaundice
Neonatal jaundice
is often seen in
infants around the
second day after
birth, lasting until
day 8 in term
births, or
to 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 newborns
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
preterm

term

Darkpink well-nurished

red,edema tr
Less fine-hair
ansparent m
ore fine-hair

Skin

ear
term

Good ear figuration, welldeveloped cartilage

preterm

soft ear stick to the skull,

poor figuration

Sole markings
term

Obvious, over all the sole

preterm

Shallow and less

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

The End