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Growth and Development: The

Newborn Baby

1- Newborn stage

Newborn stage is the first 4 weeks or first month of life. It is a transitional period from intrauterine life to extra uterine environment.

Normal Newborn Infant

Physical growth

- Weight = 2.700 – 4 kg - Wt loss 5% -10% by 3-4 days after birth - Wt gain by 10th days of life - Gain ¾ kg by the end of the 1st month

Weight:

They loose 5 % to 10 % of weight by 3-4 days after birth as result of :

Withdrawal of hormones from mother.Loss of excessive extra cellular fluid.Passage of meconium (feces) and urine.Limited food intake.

Height

• Boys average Ht = 50 cm • Girls average Ht = 49 cm • Normal range for both (47.5- 53.75 cm)

Head circumference33-35 cm Head is ¼ total body length Skull has 2 fontanels (anterior & posterior)

Anterior fontanel

• Diamond in shape• The junction of the sagittal, corneal and

frontal sutures forms it• Between 2 frontal & 2 parietal bones• 3-4 cm in length and 2-3 cm width • It closes at 12-18 months of age

Soft Spots

Posterior fontanel

• Triangular • Located between occipital & 2 parietal bones • Closes by the end of the 1st month of age

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• Large head, overridden sutures.• Head molded to fit cervix.• Caput succedaneum:

– Edema of the soft scalp tissue at the presenting part of the head.

– Accumulation of serum in the tissues above the bone– Cross suture lines– Disapear in few days

• Cephalhematoma:– Localized collection of blood between the skull bone and its

periosteum– May involve one or both parietal bones– Weeks to resolve– Dose not cross sutures

Head

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Caput Succedaneum Cephalohematoma

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Molding of infant’s head

Chest circumference

It is 30.5 to 33cm (usually 2–3cm less than head circumference).

Proportion

• Large: head and abdomen• Short/small: arms and legs• Head grows rapidly b/c brain development• Soft spots allow head to grow and close

Care of Newborn in Delivery Room:

Adequate breathing pattern established Mouth suctioned 1st Nurse wraps infant in warm blanket & places under

radiant warmer Drying motion usually stimulates 1st cry. Drying

helps prevent heat loss Note time of 1st cry & success at breathing

attempts. May need resuscitative attempts. infant kept unwrapped on clean/dry radiant warmer

to promote thermoregulation

Physiological growth

• Vital signs - Temperature (36.3 to37.2C ). - Pulse ( 120 to 160 b/min ). - Respiration ( 35 to 50C/min) .

Simulation for vital signs

Apgar Score

Apgar score - assessment scale since 1958 to assess newborn well-being at 1 & 5 min.

Newborn observed & rated on 5 components .

Heart rate Respiratory effort Muscle tone Reflex irritability Color

APGAR scoring chart

Apgar score

Score of 0, 1, or 2 - each component Five scores added & final number @ 1 & 5 min 9/9 common - 2 on HR, Resp, reflexes, muscle

tone & 1 on color d/t acrocyanosis. Heavy sedation of mother may lower respiratory effort

or reflex irritability score. Score of 4 or less indication that infant most likely

needs resuscitative efforts Score of 4-6 may indicate suctioning and oxygen

therapy.

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Physiologic adjustment to extrauterine life:

• First period of reactivity: – lasts for ½ hour, baby is alert & exhibit exploring

searching activities, making sucking sounds, rapid H.R & R.R.

• Resting period: – lasts 90 minutes, baby generally sleeps, slower H.R & R.R.

• Second period of reactivity: – between 2-6 hours of life. Baby is a wake, gagging

and choking on mucus. Gain alert & responsive and interest to surrounding.

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Classification of infants based on gestational ages and birth weights

• Preterm or premature: infant born before the end of 37 weeks, regardless of weight

• Term or full term: born between 38 & 42 weeks, regardless of weight

• Postterm: an infant born after 42 weeks regardless of weight

• Low birth weight: any infant at birth who weighs less than 2500 gm

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• Small for gestational age (SGA): any newborn whose weight is below the 10th percentile, This means that they are smaller than 90 percent of all other babies of the same gestational age (according to intrauterine growth curve) regardless of gestation

• Appropriate for gestation age (AGA): any newborn whose intrauterine growth has been normal (according to intrauterine growth curve) for that length of gestation

• Large for gestational age (LGA): any infant born whose weight is above the 90th percentile regardless of gestation

• Intrauterine growth restriction (IUGR): failure of fetus to grow as expected during gestation

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• Flexion posture.• Looks , red or cyanotic.• Body covered with varying

amount of lanugo and vernix caseosa.

Appearance of newborn

Umbilical Cord Umbilical Cord: After delivery, 2 clamps placed

Cord clamped again 1- 2 inches from umbilicus Vessels counted [2 arteries; 1 vein - AVA].

Bleeding may occur if clamp not tight

umbilical stump; falls off by 7th - 10th day

Teach: do not bathe infant until site completely healed

Sponge bath

Identification of Newborn

Done immediately > delivery by same nurse assisting mother

Prevent giving wrong infant to wrong mom. Identification is 1 band on mom, one on significant other & 2 on baby.

Nurse’s Responsibilities in Delivery Room

Eye Care: erythromycin ointment > delivery Eliminates gonorrhea/chlamydia. Vitamin K Injection: produced in intestinal tract and

used by body for coagulation. Newborn @ risk for bleeding disorders during 1st wk

of life. injection given IM within 1st hour [Dose = 0.5 mg. to 1.0 mg.] Site: vastus lateralis

In DR, infant given to mom to begin bonding process & breast feeding started.

Newborn Senses

• Senses - Touch - Vision - Hearing - Taste - Smell

Touch

• It is the most highly developed sense.

• It is mostly at lips, tongue, ears, and forehead.

• The newborn is usually comfortable with touch.

Vision

• Pupils react to light

• Bright lights appear to be unpleasant to newborn infant.

• Follow objects in line of vision

Hearing

• The newborn infant usually makes some response to sound from birth.

• Ordinary sounds are heard well before 10 days of life.

• The newborn infant responds to sounds with either cry or eye movement, cessation of activity and / or startle reaction.

Taste

Well developed as bitter and sour fluids are resisted while sweet fluids are accepted.

Smell

Only evidence in newborn infant’s search for the nipple, as he smell breast milk.

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• Eyes: tearless cry (lacrimal ducts mature at 3 months) permanent eye color between 3-12 mon.

• Ears: pinna tends to bend easily. • Nose: large for face.

• Mouth: prominent, large, & short tongue. Natal teeth are unusual. Thrush indicates candida infection.

• Neck: short & chubby with many folds. Head lags

Normal Newborn Infant

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Skin

• Vernix casoesa• Acrocyanosis• Lanugo• Bruising, petechiae

from birthing• Mongolian spots—

generally back and buttocks

• Milia

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Milia

• Small, whitish-yellow papules found close to the skin surface

• Particularly common around eyes and midface

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– Resting hr 100-160– Hr above 160 or below 100 should be reevaluated – Blood volume: 80-85 ml/kg, average about 300 ml

but can have an additional 100 ml if cord is not cut in reasonable length of time

– Fetus needs additional blood cells for O2 exchange– Hgb 14-24 g/dl– Infant Hgb F – higher O2 affinity– Hgb A production largely replaces Hgb F by 4 months– Iron stores good for 5 months– Blood coagulation: born with long coagulation time (lower

level of vit. K).

Circulatory & hemopoietic

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GI SYSTEM

• Baby learns to coordinate breathing, sucking and swallowing

• Bacteria not present in gut vitamin k • Digestion-simple CHO and protein. (Starches

and fats are not easily digested at this time)• Feeding varies—cues hand to mouth movement

and sucking fingers intensify when hungry• Prevent regurgitation by not overfeeding,

frequent burping and positioning the head slightly elevated

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GI 2

• Stool—meconium—greenish black

• Stools change and the stooling pattern change indicates good bowel functioning

• Color time and character of first stool should be documented.

• Diarrhea stool—loss of fluid quickly

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• Passive immunity from mom• Immunoglobulins gradually

develop• High risk of infection in first

few month—abnormal discharges or rashes should be evaluated

Immune system

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Renal system

• Should void in first 24 hour• Frequency depends on intake• Not able to concentrate urine• May see blood in diaper of female• Hypospadias

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Hepatic system

• Iron storage• Conjugation of bilirubin—function not well

developed at birth—• Physiologic jaundice—after 24 hours—preterm

increase and more severe• Pathologic jaundice—before 24 hours• Kernicterus—usually higher than 25• Breastfeeding—may occur up to 2 weeks pp

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• Patent anus (check for imperforate anus). Meconium within 24 hour.

• Male genitalia: edematous scrotum, check for undescended testicles, epi or hypospadias.

• Female genitalia: swollen vulva (maternal hormones), pseudomenstruation.

Anogenital

Gross Motor Development

Motor development: The newborn's movement are random,

diffuse and uncoordinated. Reflexes carry out bodily functions and responses to external stimuli.

Fine motor development

• Holds hand in fist

• When crying, he draws arms and legs to body

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• The newborn is born with certain specific responses that are triggered by specific stimuli.

• Some of these reflexes, such as rooting and sucking, appear to have survival implications.

• Other reflexes appear to be precursors for later voluntary motor behavior.

• The newborn’s reflexes may also give information about the health of the child’s nervous system.

Neuromuscular system

Reflexes• Swallowing

• Gagging

• Sucking

• Grasp

• Tonic-neck

One month-Reflexes

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Sucking

• Onset: ~28weeks GA• Well-established: 32-34 weeks GA• Disappears: starting around 12

months• Elicited by the examiner stroking the

lips of the infant.

Head Control

Newborn Age 6 months

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• This reflex begins when the corner of the baby's mouth is stroked or touched. The baby will turn his/her head and open his/her mouth to follow and "root" in the direction of the stroking. This helps the baby find the breast or bottle to begin feeding.

Rooting

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• The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his/her head, extends out the arms & legs, with fingers extended in “c” shape, cries, then pulls the arms and legs back in. lasts about five to six months.

Moro Reflex

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Grasp reflex

• Stroking the palm of a baby's hand causes the baby to close his/her fingers in a grasp. The grasp reflex lasts only a couple of months and is stronger in premature babies.

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• When a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. lasts about six to seven months.

Tonic Neck Reflex

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Babinski reflex

• When the sole of the foot is firmly stroked, the big toe bends back toward the top of the foot and the other toes fan out. This is a normal reflex up to about 2 years of age.

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Step reflex

• This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his/her feet touching a solid surface.

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The Newborn’s States

• Sleeping• Newborns sleep an average of 16-18 hours

daily.• Newborns usually follow a sleep-wake cycle of

around 4 hours of sleep followed by 1 hour of wakefulness.

• By 3 or 4 months newborns usually sleep through the night.

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The Newborn’s States

• Crying• Basic Cry

– Starts softly and builds in volume and intensity. Often seen when the child is hungry.

• Mad Cry– More intense and louder.

• Pain Cry– Starts with a loud wail, followed by long

pause then gasping.• Be calm and patient• Do not shake baby• Know signs of emergencies

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Types of Development

• Physical – growth in the body’s size and ability• Intellectual – maturing of the mind• Emotional/Social – expression of feelings and

relationships with others

Cognitive development

The cognitive development of newborn infant is difficult to understand or observe it.

Newborn/InfantIntellectual Development

• One-Two Months–Gains information through senses–Makes eye contact–Prefers faces to objects

Emotional development

The newborn infant expresses his emotion just through cry for hunger, pain or discomfort sensation

Social development

Newborn/Infant Emotional/Social Development

• One Month–Coos and babbles