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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.

Classification of the neonatesBy both GA and BWBy birth weightBy gestational age

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

GA 40 w, BW3000gGA 34 w, BW2000g

Apgar Score of the Newborn

SIGNSCORE0 12Heart rateAbsent100 beats/minRespiratory effort AbsentWeak, irregularStrong cryMuscle toneFlaccidSome flexionWellReflex irritability (response to catheter in nostril) NoGrimace Cough or sneezeSkin colourBlue, paleextremities bluepink

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

Assessment of Growth

Head CircumferenceHC 33-55 cm, 2-3 cm larger than chest

Take Anthropometric Measurements Head Circumference Chest Circumference Abdomen Circumference

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 apneaApnea: 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 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 Systemsucking becomes coordinated @32 wkslittle 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.

Alimentary system

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 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 Urinationinitial 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 prematurebreastfeeding = ^ 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

Suckingplace 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.

Rootingtouch 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

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 palmneonate 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

BABINSKIAbsence 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: 36.537.5CHypothermia: < 36.5C --Significant contribution to deaths in low birth weight infants and preterm newbornsStabilization 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 atrest is between 36.7 and 37.3C and oxygen consumption and caloric utilization are lowest

SKIN

Observation and palpation

SKINCommon variationsAcrocyanosis - result of sluggish peripheral circulation.

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.

Miliaall 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 ToxicumErythematous macules and firm 1-3 mm yellow or white papules or pustulesPustules contain eosinophils and are sterileAppear in the first 3-4 days of life Range: Birth to 14 daysBenign 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 infantsSlate-gray to blue-black lesionsUsually over lumbosacral area and buttocksAccumulation of melanocytes within the dermisThey disappear by school age without treatment

Features in appearance of normal term neonate and preterm neonate pinkwell-nurishedLess fine-hairtermDark-red,edematransparentmore fine-hairpretermSkin

ear

pretermShallow and less Sole markings

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 InterventionsClean childbirth and cord carePrevent newborn infectionThermal protectionPrevent and manage newborn hypo/hyperthermiaEarly and exclusive breastfeedingStarted within 1 hour after childbirthInitiation of breathing and resuscitationEarly asphyxia identification and management

The End

BBC 4: Predictable Newborn PatternsRev. April 2009*Total Lesson Time: 60 minutes

Refer to Session Plan for:Objectives- also listed on slide 2RationaleKey MessagesToolbox - AV - Materials & Handouts - EquipmentActivities

*Infants