Characteristics of Normal Newborn PDF

Characteristics of normal newborn Prepared by Prof. Noha Hassan Associate professor of maternity & pediatric Midwifery Email : [email protected]  Define new born  Define new born care  Determined objectives of immediate care o...

Characteristics of normal newborn Prepared by Prof. Noha Hassan Associate professor of maternity & pediatric Midwifery Email : [email protected]  Define new born  Define new born care  Determined objectives of immediate care of the newborn  Identify physiology of new born  Identify assessment of new born  Describe nursing care  Describe nutrition  Determine local tradition related to new born care and feeding  II Is Definition of newborn: b S It is the first 4 weeks of life & it is transitional period from intrauterine life to extra uterine environment.  Definition of newborn care: Tests 3194 It is the care given to the newborn to assist him to adjust to the extra-uterine environment and to promote optimum wellbeing.  1-Respiratory system: The respiratory rate of 30-60 breaths /min, and breathing is diaphragmatic Shallow and irregular. The pattern of respiration alters during sleeping. Interspersed with brief 10-15 sec, period of apnea, this is known as periodic breathing.  2- Cardiovascular system: The heart rate is rapid, 120-160 b/min. BP ranges 80/50 mmHg in the first 10 days of life Peripheral circulation is sluggish, this results in mild cyanosis of hands &feet.  3- Temperature regulation:  The normal temperature is 36-37 C˚.  A healthy clothed, term baby will maintain this body temperature satisfactorily.  Hyperthermia can occur when the baby is exposed to radiant heat source.  Temperature regulation is inefficient and the baby remains vulnerable to hypothermia particularly when exposed to cold, wet or when deprived of nutrition  4 - Gastrointestinal system  The mucus membrane of the mouth is pink and moist.  The stomach has small capacity (15-30 ml).  Gastric emptying time is normally 2-3/hr  Meconium, present in the large intestine from 16 week of gestation,  Passed within first 24 hrs/ of life and is totally exerted within 48-72/hrs  From 3rd to 5th day stool undergo transitional stage and are brownish- yellow in color  The baby pass 8-10 stools a day, or pass as infrequently as every 2-3 day  5 - Immunological adaptation:  The baby has some immunoglubins at birth.  Breast milk, and essentially colostrum provides the baby passive immunity.  This provides passive immunity during the first few months of life.  Levels of IgM at term are 20 % those of the adult.  8- Senses: Vision  The structures necessary for vision are present and functional at birth.  Babies are sensitive to bright lights. Hearing  Newborn babies’ eyes turn towards sound.  Newborn babies can discriminate between voices, giving preference to their mother's & this promotes mother–baby interaction Smell and taste:  Babies prefer the smell of milk.  Within a few days babies can differentiate the smell of their mother's milk from another woman. Touch:  Baby are acutely sensitive to touch, enjoying skin to skin contact.  The grasp reflexes enhance relationship with the mother  1- Anthropometric measurements  Head circumference: 33-37cm.  Chest circumference: 30-33cm  Weight 2.5-3.5 kg..  Length 45-55 cm. 2- Posture flexion of head and extremities rest on chest and abdomen. 1. What is the typical appearance of a newborn’s skin? o A) Always smooth and clear o B) Flaky and peeling, especially on hands and feet o C) Covered in thick hair o D) Always red and swollen tea Thin hair 3- Skin: smooth , flexible , good skin turgor and worm with presence of: vernix caseosa so lanugo hair Mongolian spots me 2 Milia 055 2. What is lanugo? o A) A type of rash o B) Fine hair covering a newborn’s body o C) A birthmark o D) A type of skin infection vernix caseosa: it is a soft yellowish cream, which covers the neonates at birth to protect the skin from infection. lanugo hair : it is a long soft growth of fine hair observed on the shoulder, back , extremities , forehead and temples of the neonate. Mongolian spots: black coloration on the lower back, buttocks, anterior trunk and rarely on fingers and feet. Milia: theses are small pinpoint white or yellow spots due to increased fat secretion. Common on nose, forehead, cheeks, and chins. 8. What is a common characteristic of a newborn’s eyes? o A) Always blue o B) Cross-eyed appearance o C) Always brown o D) Fully coordinated movements 1. What is the typical appearance of a newborn’s genitals? o A) Always fully developed o B) Swollen due to maternal hormones o C) Always underdeveloped o D) Always the same size as an adult’s  5- Eyes: edematous eye lids, reacted pupils, absence of tears, blinking reflex in response to light or touch.  6- Ears: at the top of pinna on horizontal line with outer canthus of eye, pinna is flexible with presence of cartilage.  7- Nose; patent with thin, white discharge.  8- Mouth and throat: intact, high arched palate, minimal salivation, presence of gag, sucking and rooting reflex.  9- Neck: short, thick, surrounded by skin folds. 2 Artery Vain  10- Abdomen: protuberant contour, soft, three vessels in umbilical cord.  11. Genitals Male: smooth glans , meatus centered at tip of penis. Female: swollen genitals as result of maternal estrogen.  12-Extremities: symmetric with free movement.  13- Back: Observe spine for symmetry of vertebrae. Check anus for patency and meconium  Conditions may appear in the head which are Caput succedaneum: is edema of the scalp resulting from pressure on presenting part during labor.  Conditions may appear in the head which are: Cephalhematoma:  is hemorrhage under the periostieum of one of the cranial bones resulting from trauma of labor. Comparison between caput succedaneum & cephalhematoma Characteristics caput succedaneum cephalhematoma Appears At birth no Several hours increase in size. after birth, icrease in size for 2-3 cm. Disappear Several days Approximately6 after birth. weeks after birth. Border Vague, poorly Marked, well defined defined Cross suture line Some times. Never. Cause Edametous Subperiosteal swelling hemorrhage. involving the soft tissue. Complications Rarely anemia. Jaundice, intracranial hemorrhage, shock.  14- Neurological assessment (reflexes) Observe: Rooting and sucking reflex Grasp reflex of hand and feet. Moro reflex.  14- Neurological assessment: Startle reflex: hold the infant with head supported and allow the head to drop back, the response will be lateral extension of and opening of hands. Stepping reflex: when the infant is held upright, he makes stepping movement.  Midwifery care Immediate care and assessment of the newborn: ABCW principle of delivery to ensure adequate resuscitation of the infant: Airway Breathing Circulation Warmth  The airway: To clear the airway, hold the infant upside down for few seconds and perform gentle suction to establish breathing, and improve infant's color.  The ABGAR score Involves consideration of signs, and degree to which they are present or absent it is recorded at 1and 5 minutes after birth. The ABGAR score sign 0 1 2 Heart rate absent Slow below Fast and 100 above 140 Respiration absent Weak crying Good crying Muscle tone Limb or flaccid Some flexion Active flexion Reflex No response Grimace Good irritability response color Blue and pale Body pink & Completely extremities pink blue Total score =10 Normal response =7-10 Mild asphyxia =4-6 Severe asphyxia=0-3  Warmth: it is very important to keep the infant warm at birth because he will lose heat rapidly through evaporation. The labor room should be warm and the infant should be dried gently and wrapped in a warm dry towel.  Umbilical cord:  Double ligation may be used, the first at 5cm from umbilicus to prevent strangulation of congenital umbilical hernia. The second at 2cm further for security.  Disposable plastic clamp may also be used and placed 3-5 cm from the umbilicus  The excess cord is cut off.  Nowadays, alcohol gauze and bandage are not applied to the stamp  Weight and measurements: Weigh the infant after birth. The normal weight is 2.5-3.5 kg Measure its length, the average length is 50cm. Measure its circumference. The head and chest circumferences.  Identification:  It is very important to identify the infant by its sex, and its mother name.  An identity bracelet is placed around the infant's wrist or ankle.  A wrist or ankle band or foot print may be used Breast-feeding