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Questions and Answers
What is the average temperature of newborns at birth?
99° F (37.2° C)
What causes the temperature of newborns to fall immediately after birth?
Heat loss and immature temperature regulating mechanisms
The average birth weight for a mature female newborn is _____ kg.
3.4
The average birth length of a mature female neonate is _____ cm.
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Newborns have efficient insulation to conserve body heat.
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What is the heart rate of a fetus in utero?
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What is considered unusual birth weight for newborns?
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Which method helps to conserve heat in newborns?
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What are Epstein’s pearls and how should they be perceived?
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What does a scaphoid appearance of a newborn’s abdomen suggest?
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When should bowel sounds be expected after birth?
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What indicates the presence of one vein and two arteries in a newborn's umbilical cord?
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What does nuchal rigidity in a newborn possibly indicate?
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How can extreme tenderness in a newborn be identified?
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How does the umbilical cord appear at the first hour after birth?
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What should the edge of the liver be like in relation to the right costal margin in newborns?
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What role does the decrease in pressure in the pulmonary artery play after birth?
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When a newborn cries, what effect does this have on blood pressure?
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What is typically the primary method of oxygenating blood in a newborn after the cord is clamped?
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What is a possible indication that a newborn has not properly transitioned to breathing after birth?
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What happens to the gastrointestinal tract of a newborn shortly after birth?
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What is required for a baby to breathe easier after its first breath?
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What physical change occurs in the cardiovascular system of a newborn that is necessary after birth?
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What should be done to prevent the testes from slipping upward during palpation?
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What should be monitored in a newborn who has trouble with establishing respirations at birth?
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What indicates good muscle tone in a newborn's arms?
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Which condition could be indicated by unusually short arms in a newborn?
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What is a simian crease and its significance in newborns?
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What does the cremasteric reflex test assess?
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Which of the following is a possible cause of cryptorchidism?
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What is true regarding the newborn's fingers and palms?
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Which observation is considered abnormal during a physical exam of a newborn's arms?
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What is the typical daily urinary output for a newborn during the first 1 or 2 days of life?
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What characteristic is observed in the first voiding of a newborn?
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Why are immunizations against childhood diseases generally not given to infants younger than 2 months?
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What does the extrusion reflex in a newborn involve?
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What type of antibodies do newborns possess at birth?
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Which reflex helps maintain a clear airway in a newborn?
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Which statement accurately describes the swallowing reflex in newborns?
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What does caput succedaneum refer to in a newborn?
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Which protective function does the extrusion reflex serve in newborns?
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How does the shape of a newborn's head change after birth?
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What indicates that a newborn's external ear is set lower than normal?
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What physical defects are commonly associated with low-set ears in infants?
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What is a common response indicating a hearing infant when a bell is rung near them?
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What indicates a potential fracture during birth concerning the clavicle?
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What is the normal range for a newborn's respiration rate?
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What does it mean if a newborn's chest appears asymmetric?
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Study Notes
Newborn Vital Statistics
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Weight varies based on racial, nutritional, intrauterine, and genetic factors; plotted on a standard neonatal graph to identify high-risk infants.
- Average birth weight (50th percentile) for a mature female newborn is 3.4 kg (7.5 lb); mature male newborn is 3.5 kg (7.7 lb).
- Newborns of other races weigh approximately 0.5 lb less.
- Birth weight exceeding 4.7 kg (10 lb) is unusual, but weights as high as 7.7 kg (17 lb) have been documented; if a newborn weighs more than 4.7 kg, the baby is said to be macrosomic and maternal illness, such as diabetes mellitus, must be suspected.
- Second-born children usually weigh more than first-born. Birth weight continues to increase with each succeeding child in a family.
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Length
- Average birth length (50th percentile) for a mature female neonate is 53 cm (20.9 in); mature male is 54 cm (21.3 in).
- Lower limit of normal length is 46 cm (18 in).
- Rare, but babies have been reported with lengths as great as 57.5 cm (24 in).
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Head Circumference
- The average head circumference of a newborn is between 33 and 35.5 centimeters.
- If a newborn’s head circumference is less than 33 cm or more than 35.5 cm, the baby is at risk for complications such as hydrocephalus (water on the brain) or microcephaly (a small head).
Newborn Vital Signs
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Temperature
- Newborns have a temperature of about 99° F (37.2° C) at birth but quickly drops below normal due to heat loss and immature temperature regulation.
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Factors contributing to heat loss:
- Insulation: Newborns have little subcutaneous fat, making them ineffective at conserving heat.
- Shivering: Rarely seen in newborns.
- Brown fat: Special tissue found in mature newborns that helps conserve or produce body heat by increasing metabolism.
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Methods to conserve heat:
- Drying and wrapping newborns.
- Placing newborns in warmed cribs or under radiant heat sources.
- Skin-to-skin care: Placing a newborn against the mother’s skin and covering with a blanket transfers heat.
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Pulse
- Fetal heart rate in utero averages 120 to 160 beats per minute (bpm).
- Immediately after birth, the newborn's heart rate may be as rapid as 180 bpm as the newborn struggles to initiate respirations.
Cardiovascular System
- The cardiovascular system in a newborn undergoes changes to accommodate lung function, as the lungs now have to oxygenate the blood.
- The clamping of the umbilical cord forces the neonate to breathe through its lungs.
- The lungs inflate for the first time and the pressure in the pulmonary artery decreases. This promotes closure of the ductus arteriosus (a fetal shunt).
- A Doppler method can be used to take blood pressure in newborns.
- Blood pressure tends to increase when a newborn cries.
Respiratory System
- The first breath of a newborn requires a significant amount of pressure (about 30 to 40 cm H2O) to inflate the alveoli.
- Once the alveoli are inflated with the first breath, breathing becomes easier, requiring only about 6 to 8 cm H2O pressure.
- Within 10 minutes of birth, newborns establish a good residual volume.
- Newborns struggling to breathe after birth should be examined carefully for potential issues like a cardiac murmur.
- A patent ductus arteriosus may be a sign of remaining fetal cardiac structures in the newborn.
Gastrointestinal System
- The gastrointestinal tract is usually sterile at birth, but bacteria can be cultured from the intestinal tract within 5 hours after birth.
- A typical newborn voiding produces about 15 ml of urine, which may be overlooked in a bulky diaper.
- The specific gravity of newborn urine ranges from 1.008 to 1.010.
- A newborn's daily urinary output during the first 2 days is about 30 to 60 ml.
- By the first week, this volume increases to approximately 300 ml.
- The first voiding might appear pink or dusky due to uric acid crystals formed in the bladder during gestation. This is harmless.
Immune System
- Newborns are susceptible to infections because they struggle to form antibodies until about 2 months of age.
- This lack of antibody formation is the reason why most immunizations against childhood diseases are not administered to infants younger than 2 months of age.
- Newborns possess some immune protection from passively acquired antibodies (immunoglobulin G) from their mothers that crossed the placenta.
Swallowing Reflex
- The swallowing reflex in a newborn is identical to an adult’s.
- Food reaching the posterior portion of the tongue triggers automatic swallowing.
- Gag, cough, and sneeze reflexes are also present in newborns to maintain a clear airway.
Extrusion Reflex
- Newborns instinctively extrude any substance placed on the anterior portion of their tongue, preventing the ingestion of inedible matters.
- This reflex typically disappears around 4 months of age.
Appearance of the Newborn
- The head of a newborn may appear oddly shaped due to the molding process during birth.
- The pinna (external ear) of a term newborn should be firm enough to spring back after being bent.
- The top of the external ear should align with a line drawn from the inner to the outer canthus of the eye.
- Ears positioned lower than this could indicate certain chromosomal abnormalities.
Caput Succedaneum
- This involves scalp edema at the presenting part of the head during delivery.
- It can affect wide areas of the scalp or resemble a large egg.
- The edema crosses suture lines, indicating its superficial nature.
Hearing
- It is recommended to test a newborn's hearing by ringing a bell about 6 inches from each ear.
- A hearing infant will stop crying momentarily at the sound.
- A quiet infant may blink, appear attentive, or startle.
Nose
- Epstein's pearls, small round pearl like cysts, can be found on the palate of newborns. They are harmless and will disappear within a week.
Neck
- A newborn's neck is usually short and plump.
- Congenital torticollis (neck rigidity) may be present if there was injury to the sternocleidomastoid muscle during delivery.
- Meningitis may be indicated by nuchal rigidity (stiff neck) in newborns whose membranes were ruptured more than 24 hours before delivery.
Extremities
- A newborn's arms and legs appear short.
- Hands are usually plump and clenched into fists.
- Newborn fingernails are soft and smooth, and usually long enough to extend over the fingertips.
- Test upper extremity muscle tone by unflexing the arms. If the tone is good the arm will snap back to the flexed position.
- The fingertips should reach the proximal thigh.
- Unusually short arms may indicate achondroplastic dwarfism.
- The chest should have the same width as the anteroposterior diameter.
- The clavicles should be straight and free of crepitus. A crepitus may indicate a fracture during birth.
- The abdomen should be slightly protuberant, a sunken appearance could suggest issues like diaphragmatic hernia.
- Bowel sounds should be present within 1 hour after birth.
- The liver is usually palpable 1 to 2 cm below the right costal margin and the spleen 1 to 2 cm below the left costal margin. It can be difficult to determine tenderness in a newborn.
Umbilical Cord
- The umbilical cord stump initially appears white and gelatinous.
- Three vessels should be present: one vein and two arteries.
- Inspect the cord clamp to ensure it is secure.
- The cord dries and shrinks, becoming brown in color by the second or third day.
Genitalia
- Both testes should be present in the scrotum.
- A cremasteric reflex can be elicited by stroking the internal side of the thigh. The testis on that side should move upwards. This tests the integrity of spinal nerves T8–T10.
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Description
This quiz covers essential information about newborn vital statistics, focusing on factors influencing birth weight and length. It includes average measurements, variations by race, and implications of abnormal weights. Test your understanding of neonatal health indicators!
