Transcript New born child. Peculiarities of the newborn period. Main components of

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.
1
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
Apgar Score of the Newborn
SIGNSCORE
Heart rate
0
Absent
1
2
<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.
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
 WBC: 18,000 @ birth; 23-25,000 @ 1 day with
relative neutrophilia
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.
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.
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 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.
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
neonate’s 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
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.
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 examiner’s
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: 36.5–37.5°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 at
rest is between 36.7 and 37.3°C and oxygen consumption
and caloric utilization are lowest
Temperature Regulation
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
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 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
preterm
term
pink，well-nurished，
Less fine-hair
Skin
Dark-red,edema，
transparent，more
fine-hair
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