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PHYSIOLOGY AND CHARACTERSTICS OF NORMAL NEWBORN
Presented by:Ms. Hemlata
M.Sc.Nursing 1st yearRoll no- 1915722
INTRODUCTION
DEFINITION Period from birth to 28
days of life
The first week of life is called as early neonatal period.
7th to 28 th day is known as late neonatal period.
Normal NewbornTerm (38-42 weeks)Average birth weight (exceeds 2500 grms)Cries immediatelyEstablished independent rhythmic respirationAdapt to the changed environment
PHYSICAL CHARACTERSTICS
OF HEALTHY NEWBORN
WEIGHT
•Average weight is 2.5 kilogram to 3.5 kilogram.
LENGTH
• Average crown heel length of the term infant is 50 cm with the range of 48 – 53 cm
HEAD CIRCUMFERENCE• It varies from 33 to 37 cm , with the
average of 35 cm.
CHEST CIRCUMFERENCE• It is about 3 cm less than head
circumference. The chest is• rounded rather than flattened antero-
posteriorly.
SKINSkin is pinkish but bluish hand and feet(Acrocynosis)It may covered with Vernix Caseosa, Milia and lanugo hair, especially at back.
EAREar cartilage is firm and fully curved, showing good elastic recoil.External auditory canal is relatively short and straight .Eardrum is thick and Eustachian tube is short and broad.
EYES largely covered with eye lids.
SINUSES Maxillary and ethmoid sinuses are small . The frontal and sphenoidal sinuses are poorly developed.
BREAST
Breast nodules is palpable measuring over 5mm in diameter
ABDOMEN Prominent with short neck and large head. The trunk is relatively larger and the
extremities are short.Kidney, Liver and Spleen may be palpable.
SCROTUM ( in Male) It shows adequate rugae with deep pigmentation and palpable testes (at least one).
GENETILIA (in Female) • The Labia majora covers the labia minora
and clitoris.
FOOT
Prominent deep creases.
PHYSIOLOGY OF
NORMAL NEWBORN
IMMEDIATE ADJUSTMENT
RESPIRATORY SYSTEMThe stimuli that help in initiating the first
breath are primarily1. Chemical factor in the blood ( low
oxygen, high carbon dioxide , and low Ph)2. thermal stimulus
RESPIRATORY SYSTEM
• Tactile stimulation may assist in initiating respiration
RESPIRATORY SYSTEM
CIRCULATORY SYSTEM
CIRCULATORY SYSTEMThe functional closure of the fetal shunt: the foramen ovale, the ductus arteriouses, and eventually the ductus venousIncreased blood flow dilates the pulmonary vessels, pulmonary vascular resistance decreases, and systemic resistance increases, thus maintaining blood pressure.
BLOOD COAGULATIONthe prothrombin level
decreases and clotting time in all
infants is prolonged.
vitamin K is manufactured by
the baby and clotting time
stabilizes within a week to ten days
DURING FIRST FEW DAYS OF
LIFE
THERMOREGULATION
Three factors predispose the newborn to excessive heat loss .
1. large surface area2. thin layer of subcutaneous fat3. Non shivering thermogenesis. (NST)
PREVENTION
HEMATOPOIETIC SYSTEM
•full term infant blood volume 80 to 85 ml/kg of body weight .
•Immediately after birth the total blood volume averages 300 ml but, depending on how long cord clamping is delayed , as much as 100 ml can added to the blood volume.
FLUID AND ELECTROLYTE BALANCE
• Total birth weight of the infant includes:- 73% fluid(85% in adult )
GASTROINTESTINAL SYSTEM
• Deficiency of pancreatic lipase limits absorption of fats, especially with ingestion of foods with high saturated fatty acid content such as cow’s milk.
• Human milk, despite its high fat content , is easily digested because it contains enzymes such as lipase , which assist in digestion.
LIVER
• Immature organ.• The activity of the enzyme
glucuronyl transferase is reduced ,which affect the conjugation of bilirubin with glucuronic acid and contributes to the physiologic jaundice of the newborn.
• liver is also deficient in forming plasma proteins concentration probably plays a role in edema usually seen at birth
• liver stores less glycogen leads to
hypoglycemia , which may be prevented by early and effective feeding , especially breastfeeding
SALIVARY GLAND• It function - birth, but do not
begin to secrete saliva until about 2 to 3 months , when drooling is frequent.
• Stomach capacity is limited to about 90 ml thus the infant requires frequent small feeding.
• The colon also has a small volume. The newborn may have a bowel movement after each feeding .
• Newborns who breastfeed usually have more frequent feeding and more frequent stools than infants who receive formula.
INTESTINE• Intestine is longer , which result in large number of
secretary gland and for absorption.• Infants have rapid peristaltic waves and
simultaneous non-peristaltic waves along the entire esophagus, which propel nutrient forward.
• Progressive changes in the stooling pattern indicate a properly functioning gastrointestinal tract.
• The relative immaturity of the peristaltic waves, combined with decreased lower esophageal sphincter (LES) pressure, inappropriate relaxation of the LES , and delayed gastric emptying , make regurgitation a common occurrence .
RENAL SYSTEM• A deficiency in the
kidney’s ability to concentrate urine and to cope with condition of fluid and electrolyte stress such as dehydration or a concentrated solute load.
• Volume of urine /24 hrs- 200 to 300 ml (by the end of the first week)
• However, bladder voluntarily empties when stretched by a volume of 15 ml , resulting in as many as 20 voiding per day
• The first voiding should occur within 24 hours . The urine is colorless and odorless and has a specific gravity of about 1.020.
INTEGUMENTARY SYSTEM• Skin parts are present but
immature
• RETE PEGS (between epidermis and dermis),are not developed . a light friction across the the epidermis , such as from rapid removal of adhesive tape , can cause separation of these layers and blister formation
• Sebaceous glands are active in early and late infancy.
• Present on the scalp, face and genetilia and produce the greasy vernix caseosa that covers the infant at birth .
• Plugging of the sebaceous gland cause milia
• Eccrine glands produce sweat in response to higher temperature than those required in adult , and the retention of sweat may result in miliaria.
• Apocrine gland remains small and non functional until puberty.
• The growth phases of hair follicles usually occur simultaneously at birth. Boy’s hair grows faster than girl’s hair, and in both sexes scalp hair growth slower at crown.
MUSCULOSKELETAL SYSTEM • At birth - larger amounts of cartilage than of
ossified bone.• Process of ossification is rapid during the first
year..
• The muscular system is almost completely formed at birth . Growth in size of muscular tissue is caused by hypertrophy , rather than hyperplasia, of cells
MACROPHAGE SYSTEMSKIN AND MUCOUS MEMBRANES
ANTIBODIES TO AN ANTIGEN
DEFENCES AGAINST INFECTION
• Infants does not produce their own immunoglobulin (Ig) until the beginning of second month of life, but they receive from breastmilk.
ENDOCRINE SYSTEM • Endocrine system is adequately
developed , but immature . • For example, the posterior lobe of the
pituitary gland produces limited quantities of antidiuretic hormone or vasopressin which inhibits diuresis leads to dehydration.
• The effect of maternal sex hormone is particularly evident in the newborn.
• Labia -hypertrophied • Breast of both genders -engorged and
secrete milk (witch’s milk) from the first few days of life to as long as 2 months of age .
• Female newborn -pseudo menstruation (more often seen as a milky secretion than actual blood) from a sudden drop in progesterone and estrogen level.
NEUROLOGIC SYSTEMNervous system is incompletely integrated but sufficiently developed to sustain extra uterine life.
Most neurologic functions are primitive reflexes. The autonomic nervous system is crucial during transition because it stimulates initial respirations , helps maintain acid – base balance , and partially regulates temperature control.
• Myelin is necessary for rapid and efficient transmission of some , but not all , nerve impulses along the neural pathway .
• The tracts that develop myelin earliest are the sensory , cerebellar and extra pyramidal tracts .
• This accounts for the acute senses of taste , smell and hearing in the newborn , as well as the perception of pain. All cranial nerves are present and myelinated except for the optic and olfactory nerves.
• Myelination follow cephalocaudal proximodistal ( head- to- toe –centre –to- periphery ) laws of development and is closely related to observed mastery of fine and gross motor skills.
SENSORY FUNCTIONS• Well developed and have a significant
effect on growth and development , including the attachment process.
HEARINGAfter the amniotic fluid has drained from the ears, the infant probably has a auditory acquity similar to that of an adult . The neonate reacts - 90 decibels with startle reflex .There is also an early sensitivity to the sound of human voices , although not specifically speech sounds.
The internal and middle ear is large at birth , but the external canal is small .For example, infants younger than 3 days of age can discriminate the mother’s voice from that of other women
VISIONThe eye is structurally incompleteThe ciliary muscles are also immature, limiting the eyes’ ability to accommodate and focus on an object for any length of time . The infant can track and follow objects.The pupils react to light , the blink reflex is responsive to minimal stimulus , and the corneal reflex is activated by a light touch.
Tear glands usually do not begin to function until 2 to 4 weeks of age.The newborn has a ability to focus within 20 cm (8 inches) and in the midline of the visual field . Infact , the infant’s ability to fixate on coordinated movement is greater during the first hour of life than during the succeesing several days
visual acquity - 20/ 100 to 20/400 ,.The infant also demonstrates visual preferences : medium colors (yellow , green , pink ) over bright ( red , orange , blue) or dim colors; black and white contrast pattern , especially geometric shapes and check boards ; large object with medium complexity rather than small, complex object; and reflecting object over dull ones.
SMELL Newborns react to strong odors such as alcohol or vinegar by turning their heads away. Breast –fed infants are able to smell breast milk and will cry for their mothers when they smell leaking milk. Infants are also able to differentiate the breast milk of their mother from the breast milk of other women by smell.
TASTEThe newborn has the ability to distinguish between tastes. Various types of solutions elicit differing gustofacial reflexes. Various types of solutions elicit no facial expression ; a sweet solution elicit an eager suck and a look of satisfaction; a sour solution causes the usual puckering of the lips; and a bitter liquid produces an angry, upset expression.
TOUCH
At birth the infant is able to perceive tactile sensation in any part of the body , although face (especially the mouth) , hands, and soles of the feet seem to be most sensitive There is increasing documentation that touch and motion are essential to normal growth and development . Gentle patting of the back or rubbing of the abdomen usually elicit a claming response from the infant. In turn , painful stimuli , such as a pinprick, will elicit an upset response.
SUMMARY
NORMAL NEWBORN
CONCLUSION Newborn health is the key to child health and
maintaince of normal physiological and physical characteristics are very important.
RESEARCH ARTICLE• TITLE-Association between newborn birth
weight and the risk of postpartum maternal venous thromboembolism: a population-based case-control study
• SOURCE- http://www.ncbi.nlm.nih.gov/association between newborn birth weight and risk of postpartum maternal venous thromboembolism.
• AUTHOR- Blondon M, Quon BS, Harrington LB, Bounameaux H, Smith NL.
• BACKGROUND• Postpartum venous thromboembolism (VTE)
is a potentially fatal and preventable event leading to substantial short- and long-term morbidity. We sought to evaluate whether the delivery of term newborns of low or high birth weight was associated with greater risks of VTE.
• METHODS -The present case – control study was conducted in Washington State from 1987 – 2011.
• Control group was randomly selected postpartum mother without venous thromboembolism. They compared the risk of VTE for mothers of newborns of low and high birth weights (<2500 g and >4000 g, respectively) versus mothers of newborns of normal birth weight (2500-4000 g)..
RESULTS• Patients with VTE (n=547) were older, had a
higher body mass index, and experienced more pregnancy-related complications than controls (n=9482). In comparison with mothers of newborns with normal birth weight, mothers of newborns with low birth weight had a 3-fold increased risk of VTE, which persisted after multivariable adjustment (odds ratio, 2.98; 95% confidence interval, 1.80-4.93).
• Mothers of newborns with high birth weight had only a slightly increased risk of VTE, which was attenuated after multivariable adjustment (odds ratio, 1.26; 95% confidence interval, 0.99-1.61).
• CONCLUSION-The delivery of a newborn with low birth weight is associated with a 3-fold increased risk of maternal postpartum VTE. This should be considered when assessing VTE risk at delivery.
BIBLIOGRAPHYBOOKS1. Ghai O P, Gupta Piyush, Paul V K. Essential
Paediatrics, 6thed. New Delhi: CBS Publishers and distribution; 2006.
2. DuttaParul. Paediatric Nursing, 2nded. New Delhi: Jaypee Brothers Medical Publishers (P) ltd. 2009 Pg 66-67 .
3. Wong Donna L.,Winkelstein Marilyn L. Et al.Textbook of Nursig Care of Infants and Children, 7th ed. New Delhi, Elsevier Publication. 2006 .
INTERNET1. https://www.nlm.nih.gov/medlineplus/e
ncy/article/002395.htm Olsson J. The newborn. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics Update Date 12/4/2013
2. http://www.ncbi.nlm.nih.gov/pubmed/ newborn relation with maternal thromboembolism