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Characteristics of healthy newborns with common variations.pptx
- 1. Unit:2 Newborn Care Characteristicsof healthy newborns with common variations
- 2. Normal healthy newborn The normal newborn baby born at term, between 38-42 weeks, birth weight 2500gm-3900gm, cries immediately after birth, establishes independent rhythmic respiration and quickly adapts to the changed environment. Newborn is the period of life from birth to one month or 28 days. It is critical time for extra-uterine adjustment. It is divided in to 2 period. Birth to 7 days of life is called early neonatal period and 7-28days or 1 month of life after birth is known as late neonatal period.
- 3. Cont…….. The newbornis in the stressful transition from a warm, dark, fluid filled environment to an outside world with light, sound and novel tactile stimuli. To begin life as an independent being, the newborn must immediately establish pulmonary ventilation in conjunction with marked circulatory changes.
- 4. Characteristics of Healthy NewbornBaby A. General Appearance: Baby is pinkish red in colour. Vernix caseosa, a white sticky substance is present on the baby’s skin at birth. The newborn assumes the attitude of its intrauterine existence- extremities flexed and fist clenched. The extremities may appear short in comparison to the body, but hands should be able to touch the upper thighs when extended. Eyebrow and eyelashes present similar varieties, and the cartilage of the ears is well formed.
- 5. Cont…. Has alarge, round abdomen with umbilical areas that may protrude for several weeks until the cord stump fails off. A caput succedaneum may be present after a prolonged labor. Eyelids may be puffy and eye color indistinguishable. Nails are fully formed and adherent to the tip of the fingers, sometimes extending beyond the finger tips. Hair are soft and silky, some babies have virtually no hair and appear somewhat bald and some babies have plentiful straight or curly hair.
- 6. B. Skin: Slightperipheral skin cyanosis (accrocyanosis) is quite common but soon become pinkish with the establishment of cardiopulmonary function. Vernix caseosa covers the skin. Lanugo is present over the face, back and the extremities. Mongolian spots are present over the sacrum and they disappear by 4 years of age. A mature baby has plentiful skin creases on the palms of his hands and soles of his feet.
- 7. Cont….. Distended glands, miliamay be present over the nose and cheeks. Sebaceous gland are present but relatively inactive. Sweat gland are present over inactive in the 1st day of life. The vasoconstrictor mechanism is inefficient because the vascular plexuses are underdeveloped. The infant’s poor melanin production renders him vulnerable to sunburn. Birthmarks: small reddened areas
- 8. C.APGAR score: Thenormal newborn baby should get 7-10 APGAR score.
- 9. D. General Measurement: Weight: Normal weight at birth: 2500gm- 3900gm 100-200 gm weight is loss by the 3rd day of birth because of the loss of fluid by physiological loss, deficiency of fluid intake and loss of fluid in the form of meconium and urine. The weight gain start again by the 3rd day of birth i.e. 30-50 gram per day. At 10 days f birth, the birth weight and actual weight is equal. The baby gain weight 160 gram weekly during 1st month.
- 10. Cont…… Length: Theaverage length of baby is approximately 48-52 cm. The baby is measure from vertex to heel. The crown to rump length is 31-35cm ( 12.2-13.8 inches).
- 11. Head circumference: Head circumference is measure encircling at the occipital protuberance at the supra-orbital ridge with the measuring tape. The normal head circumference is 33-35cm. Head circumference may be somewhat less immediately after birth due to molding. Usually by 2nd and 3rd day, it remains its normal size and shape. It is somewhat equal to crown to rump length.
- 12. Chest circumference: The size of the chest is smaller than head. The circumference of chest is 30-31cm.
- 13. E. Vital signs Temperature: Newborn’s body temperature drops immediately after birth in response to extra uterine environment. Newborn’s internal organs are poorly insulated and skin is very thin, and does not contain much subcutaneous fat. The infant’s heat mechanism has not fully developed and infant’s temperature rapidly reflects that of his environment. Rectal temperature is higher than skin temperature. Tympanic temperature can also be taken.
- 14. Normal range: Rectal 36.6°Cto 38°C (97.9°F to 100.4°F) Ear 35.8°C to 38°C (96.4°F to 100.4°F) Oral 35.5°C to 37.5°C (95.9°F to 99.5°F) Axillary 36.4°C to 37.2°C (97.5°F to 98.9°F)
- 15. Pulse rate: Normal range: 120-140 beats per minute The rate may rise to 160 beats per minute during crying and drop to 100 beats per minute during sleep. It is normally irregular due to immaturity of the cardiac regulatory center of medulla. Respiration rate: Normal range: 30-60 breaths per minute Normally it is quite, rapid and shallow. It can be observed by watching abdominal movements.
- 16. Blood Pressure: The newborn’s BP may be taken with a Doppler blood pressure device. Average BP is 65/41 mm of Hg at 1-3 days of life.
- 17. F. Head Thehead is 1/4th of the total length and covered with fine, silky hair. In a vertex delivery, head is usually flattened at the forehead, with the apex rising and forming a point at the end of the partial bones and the posterior skull or occiput dropping abruptly due to molding. There are 4 suture in skull i.e. frontal, coronal, saggital and lambdoid suture. In head, there are 2 fontanels i.e. Anterior(Diamond shaped) and Posterior (tringle shaped) fontanel. Anterior fontanel is strongly pulsatile, about 2-3 cm in length and normally closes at 12-18 months. Posterior fontanel is less pulsatile, about 0.5-1cm in length and normally closes at 6-8 weeks.
- 18. G. Eyes Newbornstend to have their eyes tightly closed. Edema of the eyelids may be observed normally for the 1st 2 days after delivery. Sclera is white and clear. Cornea is transparent clear and the iris is round. Nystagmus and strabismus may be present. Corneal reflex is present and is seen even in minimum stimuli. Pupil are responsive to light.
- 19. Cont….. At birth,the iris color is usually grayish blue. The gradual deposition of pigment produces the final eye color of the baby at the age of 3-6 months and sometimes it may take a year. Sub conjunctival hemorrhage may be present due to pressure in the neonate’s head during vaginal delivery which results in impairment of venous return of the blood and rupture of the small capillaries in the sclera. It will disappear in 2-3 weeks. The lacrimal gland is small and nonfunctioning at birth and tears are not usually produced with crying until 1-3 months of age.
- 20. H. Ears Symmetrical,pinna flexible, cartilage present, folded and creased. A line drawn through the inner and outer canth of the eye should come to the top notch of the eye should come to the top notch of the ear where it joints the scalp. The newborn usually responds to sound at birth. Babies can hear loud and soft noises at birth. Loud noises may cause baby to startle, and soft noise keep clam.
- 21. I. NOSE Patentnose, nasal discharge present, sneezing present.
- 22. J. Neck Short,usually surrounded by skin fold.
- 23. K. Breasts, Genitaliaand Anus Both boys and girls have a nodule of breast tissue around the nipple. In girls, witch's milk is seen in the first few days of life. In boys, in term newborn the testicles are descended into the scrotum which has plentiful rugae, but in preterm may not be descended. The urethral meatus opens at the tip of the penis and the prepuce is adhered to the glans. In girls, in term newborn the labia majora normally cover the labia minora. The hymen and clitoris may appear disproportionately large.
- 24. Cont….. The genitalsin female newborn may be edematous. Discharge of blood and mucus from the vagina, called pseudo menstruation, may occur in response to maternal hormones. Urine and stool: Urine is passed during or shortly after birth, 94% newborns pass urine by 24hrs. The 1st stool which is black, thick, viscid is known as meconium and is passed within 48hrs.
- 25. L. Spine andextremities The spine should be free of swelling lesions, dimple or hairly patches. Arms and hands are generally flexed against the body and hands are in tight fists. Both arms should move evenly. Both hands should free from wedding or extra digits. Nails often extend, beyond the fingertips. Legs should be equal in length, hips move freely, no swelling over bone, no crying when arm, shoulder, or leg is touched.
- 26. M. Face andmouth Facial features and movements are regular and symmetrical. The lips, gums and palate are intact. Intact high arched palate, uvula in midline, frenulum of tongue and upper lip, scant saliva. Moist, pink, smooth lip and smooth gum. Sucking, rooting, gag reflex present. Papillary light reflex is present. The cheeks are full due to sucking pads of fat.
- 27. N. Neurological System A.Survival Reflex: I. Rooting reflex: Touching baby’s cheeks or the corner of mouth then the neonate turns the head toward the stimulus, searches for the stimulus and open his mouth ready to suckle. It is important in feeding and is most often demonstrated when the infant is hungry. The reflex is presenting in utero at 24 weeks and disappears by 3- 4 months of birth. May persist during sleep 9 to 12months.
- 28. II. Sucking reflex Touching lips or placing finger or mother’s nipple or sterile artificial nipple in the neonate’s mouth, then, the neonate sucks the finger or nipple forcefully and rhythmically, creating vacuum by cheeks, lips and tongue. Present after 28 weeks of gestation and well developed after 34 weeks. Sucking is coordinated with swallowing. It is disappears by 1 year.
- 29. III. Swallowing reflex Place fluid on the back of the tongue, swallowed fluid should be coordinated with sucking. It present throughout life. Baby swallows when the mouth is filled with milk.
- 30. B. Safety reflex 1.Moroor embracing reflex: • On making loud noise or changing baby’s position causes baby to extend both arms outward with fingers spread, then bring them together in a tense. • It is present after 32 weeks of gestation and disappears by 6 months. In CNS dysfunction Moro reflex is absent. If Moro reflex is asymmetry, brachial plexus injury, paralysis or fracture of clavicle may present.
- 31. Cont…….. The preferredmethod of eliciting this reflex is to hold the infant with head supported then allow the head drop backward a short distance(few inches). The normal response of neonate extends and abducts all extremities bilaterally and symmetrically, with the fingers fanning open and thumbs and fore fingers forming C position. The arms then return to their normal flexed states with am embracing motion, The legs may also extend and then flex.
- 32. 2.Grasp reflex This isvery strong at birth. There are two reflexes: Palmar grasp reflex: It (appears at birth) occurs when the infant’s palm is touched near the base of fingers. The hand closes into a tight first. The grasp reflex may be weak or absent if the nerves of the arms are damaged. Palmar grasp reflex present at 32 week of gestation, lessens 3-4 months, and disappears by 5-6 months.
- 33. Planter graspreflex: • It is similar to the palmar grasp reflex. When the area below the toes is touched, the baby’s toes curl over the finger or pencil. • Planter grasp reflex disappears by 8-9 months.
- 34. 3. Pupilary reflex: Darkenthe room and shine a penlight direct into the neonate’s eye normally constrict equally bilaterally at that time. 4. Blinking reflex: If light flash baby response the eyelids close. 5. Startle reflex: In sudden loud noise baby response similar to Moro reflex in the arm, fits clenched. It disappears by 4 months. 6. Gag reflex: Gag reflex is elicited to remove out the milk to prevent chocking.
- 35. 7. Cough reflex: Toget rid of mucus. 8.Stepping reflex(automatic walking): Hold the neonate in an upright position and touch one foot lightly to a flat surface. The neonate makes walking motions with both feet or they lift one foot and then the other giving the appearance that they are trying to walk. Present at birth and disappears by 4-7 months.
- 36. 9.Tonic neck reflex: Refers to the posture assumed by newborns when in a supine position. The infant extends the arm and leg on the side to which the head is turned and flexes the extremities on the other side. This is sometime referred to as the fencing reflex because the baby’s position is similar to that of a person engaged in fencing match. It may be weak at birth at birth appears 2-3 weeks and increase to 1 months then disappears by 5-6 months.
- 37. 10. Babinski (Planter)reflex: When stroke outer sole of foot upward from heel and ball of the foot, then the baby response as hyperextension of toes, dorsiflex of great toe, and fans the toe upwards. It present at birth and disappear by 9-10 months. 11. Glabellar reflex: When tape briskly on glabella of neonate, then cause tight closure of eyes.
- 38. Behaviour: Newborn babywill spend most of time for sleeping or eating. Baby may be very alert or very quiet and drowsy right after birth. During the next month, baby will spend less time sleeping and more time awake. When sleeping babies have 2 sleep states; Deep and light. When awake, baby’s behavior may range from alert to fussy. When the baby is quietly alert, this is the best time to feed, play and talk with baby. Crying is only means of communication. Cry can be used to indicate hunger, pain or simply the need for attention. Crying is a response to unpleasant stimulation. It may signal of hunger , pain, desire of attention. A high pitch cry may indicate neurological problems.
- 39. References Subedi Prasai,D., $ Gautam Bhattarai, S. (2017).Midwifery Nursing(3rd edition) Kathmandu: Medhavi Publication Gautam Bhattarai, S. (2017). A Textbook Of Midwifery and Gynaecological Nursing-III(1st edition) Kathmandu; Medhavi Publication Tuitui, R., $ Suwal, S.N. (2020). Manual of Midwifery and Gynecological Nursing III Postpartum care and Domiciliary Midwifery with Family Planning (15th edition) Kathmandu; Vidyarthi Pustak Bhandar Tuitui, R., $ Suwal, S.N. (2012). Manual of Midwifery and Gynecological Nursing III Postpartum care and Domiciliary Midwifery with Family Planning (8th edition) Kathmandu; Vidyarthi Pustak Bhandar