Download to read offline
Newborn is the period of life from birth to one month or 28 days. pptx
- 1. The Newborn •The periodfrom birth to 28 days of life is called neonatal period and the infant in the period is termed as neonate or newborn baby. •The first week of life is known as early neonatal period (birth to 6th days of life) and the late neonatal period extends from 7th to 28th days of age.
- 2. Characterstic of NormalNewborn • The healthy normal newborn infant born at term, between 38 to 42 weeks, cries immediately after birth, establishes independent rythmic respiration , quickly adopts with the extra-utrine environment, having an average birth weight and no congenital anomalies
- 3. Physical characterstics ofhealthy neonate: • weight : 2.9 kg. with the variation of 2.5 to 3.5kg. But it is variable from country. • Height: • Crown to heel measurement:50 cm with the range of 48 to 55cm. • Head circumference: 33 to 37 cm with average to 35 cm. The head shows moulding and caput succedaneum. • The ear cartilage is firm and fully covered, showing good elastic recoil. • The eye: largly covered by eye lid.
- 4. • Chest circumference:3 cm less than head circumference. • The chest is rounded than flattened anteropostriorly. • Other characterstics: • Upper segment to lower segment ratio is 1.8: 1 and the trunk is relatively larger and extremities are short. Abdomen is relatively larger and extrimities are short. • Abdomen is prominent with short neck and large head. • Posture: Partial flexion attitude as in uterus.
- 5. • The skin •color pinkish and covered by vernix casecosa and lanugo hair,especially at back. • Breast noduels is palpable, measuring over 5 mm in diameter . the scrotum shows adequate rugae with deep pigmentation and palpable testes . The labia majora covers the labia minora. the sole of foot shows prominent deep creases. • The external auditory canal is relatively short and straight. The eardrum is thick. The eustachian tube is short and broad. Kidney, liver and spleen may be palpable. •
- 6. Physiological characterstics: • Thehealthy neonates cries almost immediately after birth and eastablishes satisfactory and spontaneous respiration. the respiratory rate varies between 30-60 breaths per minute. The neonate can breath both through nose and mouth. • Respiration is usually priodic,shallow but irregular . It may be slow in some babies. It is usually thoraco-abdominal without any retractions and grunting. • The heart rate varies between 120 to 160 beats /minute, with an a rage of 140 beats per minute. It may increased during crying and may e slow about 80 to 100 beats /minute during sleep.
- 7. • Blood pressurerange from 50 to 80 mmHg systolic and diastolic 25-40 mmHg. • Normal tempreture-36.5-37.5.C which falls after birth but become normal with 4 to 8 hours. • The cry of the newborn baby is vigorous. Rooting, suckling and swallowing reflexes are well –developed. The newborn baby is able to take breastfeeding withing one hour of birth and then fall asleep. • The baby spends about 80%(20hours) of the time of sleeping. • Feeding required undemand.
- 8. • The energyrequirement initially is 55 cal/kg which increase to about 120 cal /kg/ day at the end of the first week of age. Protein and carbohydrates are efficiently digested by the neonates but the fat is not. • Limitations of anatomical structure, slow peristalsis and imperfect control over cardiac spincters can cause regugitation and vomiting.
- 9. • The neonatelooses about 7-8 percent of body weight(10%) during first week of life. The baby regain the birth weight about20-30 gm/day from 10th day for 3 months of age. • The baby passes urine shortly after birth or within 24 hours. Some baby pass within 48 hours.Limitations of renal functions may lead to dehydration, acidosis and hyperkalamia. • The first stool or meconium is usually and viscid . It is sterile and consists of cast off intestinal epithelial cells, lanugohair, mucus, digestive juice, bile salts and bile pigments. Then the transitional stools(greenish-brown) with milk curds passed for 3-4 days. The stools of a breastfeed baby may be passed after one week of age. It is golden yellow, soft, slight sour smell with acidic reaction
- 10. • It isgolden yellow, soft, slight sour smell with acidic reaction. • Blood volume about 80ml /kg body wt. with RBC 6-8million/cmm and Hb-18gm%, WBC- 10,000-17,000cmm,. platelets-350000/cmm. Red cells - 500/cmm. ESR is markedly eleveted and poor clottings power are seen due to deficient vit K. Blood sugar and calcium levels are relatively low. IgG level is high but IgM, IgA, IgE levels are negligible.
- 11. • Neurological mechanismsare immature and not fully developed anatomically and physiologically. Reflexes are important indicators of neurological development. • Tempreture regulation is not fully developed. heat production is low so the infant responds readily to environmental heat and cold. • Limited hepatic function leads to decreased ability to congugate bilirubin, regulate blood glucose level and produce coagulation factors. Endocrine glands are better organized than other systems
- 12. Adjustment to extrauterinelife • Since birth, the baby starts to first independent existence of postnatal life from paraitic dependent intrauterine life. Immidiately after delivery, the baby must assume life support functions performed by placenta in utero. Transitional period that encompasses the neonate for adaptation from intrauterine to extra uterine life existed within 24 hours phase.
- 13. Respiratory system: • Themost critical and immediate physiological change required of the newborn is onset of breathing. The stimuli that help initiate respiration are primarily chemical and thermal. These stimuli can be external and internal. • External stimuli: • Mechanical : Chest compression during birth process • Sensory stimuli: sound, light, smell, touch and pain etc stimulate related chemoreceptor • Thermal stimuli: change in environment from warm to outside cool room. • Other stimuli: tactile stimulation, cord occlusion ,bright light, noise and squeezing of of the lungs fluid during birth process. •
- 14. • Internal stimuli: •Chemical stimuli include decreased pao2 increased paco2 and decreased pH which stimulate aortic and carotid chemo receptors. Chemical , thermal and sensory stimuli influence respiratory center in medulla resulting in contraction of the diaphragm. • Contraction of diaphragm cause negative intrathoracic pressure in the lung helps to draw air in the lung, increasing intra thoracic volume. Sensory impulses in the skin that is transmitted to the respiratory centre causes intiation of breathing. •
- 15. Circulatory change: • Fetalcirculation must convert to neonatal circulation during the trasitional period of extra uterine life. This changes in circulation is due to changes in the lungs, heart and major blood vessels. • At birth when the baby cries the lungs expand and the vascular field is increased. That result decreased pulmonary vascular resistance and increased pulmonary blood flow. So blood from the right ventricle instead to passing through the ductus arteriosus flows through the pulmonary artery to the lungs and ductus arteriosis is closed soon after birth but anatomic closure from deposition of fibrin and cell product taken longer so early functional mumur during neonatal perod is normal.
- 16. • As thelungs recieve bood, the pressure in right atrium,right ventricles,and pulmonary artery decreased. At the same time there is a progressive rise in systemic vascular resistance, increased pulmonary vascular resistance and an increased volume of blood as result of cord clamping. So the pressure in the left side of the heart is increased and it causes to return blood flow to the left atrium. It results in increased pressure in left atrium with higher pressure than in right atrium. This changes in pressure causes closure of foramen ovale functionally. • Along with these changes the others two structures of fetal life i,e. the hypogyastric arteries and ductus venous also cease to function. • Thermo regulation: There will be changed in body tempreture when the baby enters in a cool extra uerine enviroment from a warm intra uterine enviroment at birth. So the heat regulation is another important area for newborn’survival
- 17. Causes of heatloss in newborn are: • Large body surface area comparison to body weight • Low subcutaneous fat • low brown fat
- 18. • The heatregulation mechanism is maintained by beat regulation center situated in the hpothalamus that is well developed in healthy neonates. In neonate heat is produced by the oxidation of brown fat that is deposited during the last trimester of pregnancy. Brown fat is prent in the nape of the meck betwwn the scapula, mediababy.stinum and around the kidney in term baby.
- 19. • Similarly heatis lossed by convection, conduction, radiation, and evaporation during the time of birth. So quick wiping of the body and covering from head toe by warm soft clothes, well ventilated room for entrance of oxygen, warm room tempreture between 25 to 28.C and skin to skin contact are important to preserve body heat of the newborn
- 20. Gastrointestinal system: • Afterbirth the neonate must assume the digestive functions which previously performed by the placenta. The sucking and swallowing reflexes are developed towards the middle of the third trimester i,e. by 34 weeks of pregnancy. So baby feeding should be initiated soon after birth.
- 21. • A healthynewborn can ingest, aboserb and digest nutrients. Gastric capasity is 60 to 90ml for the first few days after birth. It increases with subsequent feeding. Because of this limited capacity, nutrients needs must be met through frequent small volume of feeding. • The cardiac spicter and pyloric spicter is not well developed so the neonate has a tendency to regurgitate milk. To prevent regurgitation and aspiration, the baby should be placed in the lateral position following feeding. The gastric empty time is 2-4 hours varies according to feeding and peristalsis.
- 22. • The initialstool is called meoconium that is sticky greenish black in colour passed within the first 48 hours after birth. The nature of the stool changes during first week and stool becomes typical milk stool i,e. yellow and pesty with a peculiar smell. Urinary system: • All structural components are present with renal system but there is a functional deficiency in the kidney to conentreate urine and cope with concentrated solute load. The neonate usually voids within 24 hours of birth. • The specific gravity of urine ranges from 1.005 to 1.015. The bladder capasity is about to 15ml so frequent urination occurs as many as 20 times a day. The neonate pass 200 -300ml of urine within 24 hours.
- 23. Endocrine system • Anatomicallyendocrine system is mature but functionally is not mature. Thyroid hormone, cortisol and adenocorticotropic hormone(ACTH) is peak after few hours of birth in response to stress. Interaction between the neurological and edocrine system help in coordination to extra uterine life. Neurological system: • Neurological mechanisms are immature and not fully developed anatomically and physiologically. Reflexes are important indicators of neurological development.
- 24. • Integumentary system: •The healthy neonate is moist and warm while to touch. The neonate’s skin serve as the first line of defense against infection. • Muscular skeletal system: • In neonate , the skeletal system contain larger amount of cartilage than ossified bone. The skull bones are relatively soft and not yet joined. Muscular system is almost completely formed at birth due to hypertrophy of muscular tissue but sinuses are incompletely formed.
- 25. • Sensary Function: •Incomplete anatomical development • limited ability to accomodate and fixate an object • pupils react to light, the blink reflex is responsive with minimal stimulus and corneal reflex is activited. • Visual acuity is 20/100
- 26. • Ears: • Auditoryacuity is similiar to that of an adult. The newborn can detect the loud sound. • Smell: • Newborn reacts to strong odors such as smell of breast milk. so the baby try to turn head and cry for mother when the breast milk is leaking. • Taste: • The newborn can distinguish between taste. • Touch: • The newborn can perceives the tactile sensation in any parts of body, but the face, hand an soles of feet seem to be most sensitive to touch.