New+Born.pdf

1.Know the different changes in the newborn at birth 2.Know the physiologic changes of happening in new born 3.Know difference between term and preterm infant 4.Common problems in new born  5 criteria to check for a baby APG...

1.Know the different changes in the newborn at birth 2.Know the physiologic changes of happening in new born 3.Know difference between term and preterm infant 4.Common problems in new born  5 criteria to check for a baby APGAR SCORING - Created by Dr. Virginia Apgar - Quick assessment of a newborn that is performed at 1 and 5 minutes after birth - Assess newborn’s health and determine if immediate care is needed - Good indication of how well infant is transitioning - A low 5th minute score is associated with increased risk of neonatal mortality and morbidity  APGAR SCORING Indicator 0 points 1 point 2 points Appearance Blue, pale Pink body, blue Pink (pink X extremities undertones appropriate for skin color) P Pulse Absent Below 100 Over 100 beats/minute beats/minute G Grimace Floppy Minimal response Prompt response Activity Absent Flexed arms and Active A legs R Respiration Absent Slow and irregular Vigorous cry  APGAR SCORING Indicates how well a newborn is transitioning to life after delivery Scores: 7-10 normal IV line , T 4 – 6 needs some assistance with breathing or other Oxygen interventions 0 – 3 newborn is in critical condition and requires immediate medical intervention Recreilate IMMEDIATELY Taken 1st-> 5th-> 15 minute - ↳sometimes  APGAR SCORING interpretation 0-3 4-6 7-10 Immediate medical Abnormal; specific Reassuring interpretation intervention interventions required score implying required depending on areas that newborn is scored low transitioning well Initiate neonatal Circulatory/respiratory intervention resuscitation issues are most common; protocol interventions such as suctioning, fluids, ventilation Measurements Normal range (10th to 90th percentile at 40 weeks gestation) Length: ∼ 50 cm (48– 53 cm) Weight: ∼ 7½ lb (2500 – 4600 g) Boys: 6 lb, 6 oz to 8 lb, 9 oz (2.9– 3.9 kg) Girls: 6 lb, 2 oz to 8 lb, 6 oz (2.8– 3.8 kg) Head circumference: ∼ 35 cm (33–37 cm) - Important marker of health - Very small babies or very large babies are at greater risk for problems - Weight is taken every day while in the nursery to monitor growth and need for fluid and nutrition - Normally babies lose 5% to 7% of their birth weight and gain back with in the first 2 weeks after birth - Premature babies may not begin to gait weight immediately Regains weight * Zak diabatic mother < # baby =. - WEIGHT MOST IMPORTANT TO TAKE !!! WEIGHT * Big babies Big when =  Glabella Glabella > - Occip. Pertub. > - - reflects brain size * injury b4 7 y/o = Cerebral Palsy - routinely measured up to 36 months ~ - At birth, the brain is 25% of adult size, and head circumference averages 35 cm. - increases an average 1 cm/month during the first year - growth is more rapid in the first 8 months, and by 12 months, the brain has completed half its postnatal growth and is 75% of adult size - increases 3.5 cm over the next 2 years - the brain is 80% of adult size by age 3 years and 90% by age 7 years. almost filly developed  Vital signs REMEMBER THIS !! Respiratory rate: 40–60 breaths per minute Heart rate: 120–160 beats per minute o o Temperature : 36. C to 37 C in normal room temperature Blood pressure: 60-80/30-45 Oxygen saturation: 95% to 100% on room air  Vital signs Kahit wag na it ↳Closes & 18th month Diamond in shape The junction of the sagittal, corneal and frontal sutures forms it Between 2 frontal & 2 parietal bones 3-4 cm in length and 2-3 cm width It closes at 12-18 months of age Decreased ipit structures inside =  Triangular Located between occipital & 2 parietal bones Closes by the end of the 1st month of age (or second month) Closure of anterior fontanelle at birth may be due to microcephaly or molding Tension or bulging in the fontanelle ay be due to increase intracranial pressure or sunken due to dehydration Craniostenosis – premature closure of cranial sutures  Bilirubin: TOXIC -Yellow Skin & Saleva Leye) · Physiologic jaundice – occurs between · 2nd to 8th day · Pathologic jaundice – before the third day I days Bilirbin TOXI2 to baby LAUSES : Infection = - ② QBO incompatibility (diff hype blood mom baby pH: ≥ 7.2 (slightly more acidic than adults) 1st Stool Urine and meconium First passage of urine within 24 hours of birth First passage of meconium; (a black-green, tarry substance that forms the newborn's feces) within 48 hours after birth  * Colostrum-1st milk (has antibodies) Contains immunoglobulin (passive immunity Feeding: encourage and provide counseling regarding breastfeeding Losing weight after birth Loss of up to 7% of birth weight in first five days of life is normal; and no specific treatment is required. Newborns normally regain their birth weight by the time they are 10–14 days old. Consequences of intrauterine estrogen exposure Breast bud development is normal in newborns, Witch Milk independent of sex.. Newborn girls may have bloody mucoid vaginal discharge from mother lost 2-3 mos. Colostrum * * Immunity is Preterm is defined as babies born alive before 37 weeks of pregnancy are completed Sub-categories of preterm birth (based on gestational age) extremely preterm (less than 28 weeks) very preterm (28 to less than 32 weeks) moderate to late preterm (32 to 37 weeks) * Normal : 20-40wks. Risk Factors Pregnancy with twins, triplets or other multiples. A span of less than six months between pregnancies. * Note: ideal to wait 18 to 24 months between pregnancies. Assisted reproduction e.g. in vitro fertilization. More than one miscarriage or abortion. A previous premature birth. Preeclampsia Placenta previa Prelabor rupture of membrane Characteristics Preterm Term Posture Relaxed attitude, limbs more extended, body size More subcutaneous fat, rests in a more flexed is small, head appear larger in proportion than attitude body Scrotum Undeveloped, not pendulous, minimal rugae Well developed, pendulous, rugated Testes Testes may be in the inguinal canal or in Testes down scrotal sac abdominal cavity Clitoris & labia Prominent, labia majora poorly developed and Fully developed labia majora, clitoris not majora gaping Malaki prominent Scarf sign Elbow may be brough across chest with little or no Resisting attempt to bring elbow past midline resistance Ears Cartilages poorly developed, easily fold Ear cartilages well formed Bend ear3 it doesn't go back Hair Lanugo over back and face Firm hair, separate glands Respiratory Presence of distress, breathing complications Fully developed lungs Brain By 35th weeks baby’s brain still needs to grow 50% higher brain functioning. Body fat Unable to regulate temperature through body fat Has enough fat and energy to regulate body until 34th week function Feeding Weak suck/swallowing; not fully developed till 34th Able to suck, swallow leading to rapid weight weeks gain Cardiac Patent ductus arteriosus If infant is more than 30 weeks, 98% it will close by the time of discharge Central nervous system Poor suck, apneic episode, intraventricular hemorrhage, development of cognitive delays Eyes Retinopathy of prematurity – interfere with the normal vascularization process due to abnormal vessel development and sometimes defects in vision such as blindness Myopia and /or strabismus Gastrointestinal tract Feeding intolerance increasing risk of aspiration Infection Sepsis, meningitis 4x more likely in preterm infant occurring 25% in very low birthweight infants Lungs Pulmonary complications such as respiratory distress syndrome, chronic lung disease Surfactant production is inadequate to prevent alveolar collapse and atelectasis causing respiratory distress syndrome (RDS) * Atelectasis - "Hirap Huminga" long collapse Metabolic problems Hypoglycemia, hyperbilirubinemia Hyperbilirubinemia more common in infant and kernicterus (brain damage caused by hyuperbilirubinemia) occurs even with serum bilirubin is low as 10mg/dL  BRAIN DEVELOPMENT Early stage from embryo to fetus Day 16 – notochord arises from mesoderm which induces the ectoderm to form the neural plate 3rd week – neural plate represents the earliest form of CNS Neural plate rises forming two parallel fold called neural folds resulting in fusion and formation of neural tube Neural tube closes starting from middle Day 25 complete closure of cranial neuropore; day 28 complete closure of caudal neuropore - Fourth week – cranial ends of the neural tube exhibit 3 expansions becoming the primary vesicles: - Proscencephalon - Mesencephalon - Rhombencephalon  BRAIN DEVELOPMENT 5th week – secondary vesicles arise where the primary vesicles further divides into 5 secondary brain vesicles  BRAIN DEVELOPMENT - Prosencephalon or forebrain consists of the diencephalon and the telencephalon. - The diencephalon forms: - thalamus - hypothalamus - third ventricle - choroid plexus - pineal body and neurohypophysis - Interventricular foramina of Monro (allows communication of CSF between lateral ventricle) - The telencephalon forms - cerebral hemispheres - lamina terminalis - Lateral ventricles BRAIN DEVELOPMENT - Mesencephalon is a primary brain vesicle that does not divide further - it forms the midbrain - contains the aqueduct of Sylvius BRAIN DEVELOPMENT - Rhombencephalon or hindbrain consists of the metencephalon and myelencephalon - metencephalon - forms the pons and cerebellum and contains the upper portion of the fourth ventricle - myelencephalon - forms the medulla oblongata and contains the lower portion of the fourth ventricle - alar plates of the metencephalon and myelencephalon, which exist on the dorsal aspect of the neural tube, each consist of three groups of sensory nuclei a. general visceral afferents b. special afferents c. general somatic afferents - basal plates of the metencephalon and myelencephalon (on ventral aspect) for 3 three groups of motor nuclei a. general visceral efferents b. special efferents c. general somatic efferents Congenital Disorders Anencephaly - is the absence of a significant portion of the brain and skull - Due to failure of the neural tube to close between day-23 and day-26 results in the disorder - absence of the scalp, skull and the majority of the brain - usually only the telencephalon is absent Congenital Disorders Exencephaly is a cephalic disorder where the brain is found outside of the skull - absent cranial cavity and scalp with protruding brain tissue - absence of the flat bones of the calvarium and bulging eyeballs - Incompatible with life  Congenital Disorders Cephalocele - protrusion of the meninges and/ or neural tissue through an opening of the skull bones - result from aberrant neural tube development - Craniofacial abnormalities often present in patients with cephaloceles - Meningocele -only the meninges is present outside the skull - pencehalomeningocele including both the meninges and cerebral tissue - encephalocystocele for a ventricular protrusion - gliocele involving a glial-lined cyst with cerebrospinal fluid - All types of cephaloceles lead to development of hydrocephalus, quadriparesis, seizures and severe mental retardation  Congenital Disorders Holoprosencephaly - fetal prosencephalon fails to develop into two cerebral hemispheres develop restricts the division of the cerebral hemispheres - Results in craniofacial abnormalities such as cyclopia which is a midline defect classically typified in a solitary median eye - Clinical signs include varying degrees of craniofacial abnormalities as well as seizures and mental retardation Any Questions? 1.Gametogenesis 2.Fertilization and Implantation 3.Parturition and Labor 4.The New Born