Topic 4
THE NEWBORN
CHILD
LESSON 2
Terms:
Perinatal
Intra
natal
Neonatal
newborn
Prenatal
Classification of newborn by
weight and gestational age
• Help in predict potential problems
– LBW: <2500gm
– VLBW: <1500gm
– ELBW: <1000gm
• Term :completed 37 weeks gestation till
40 week
• Premature; less than 37 weeks gestation
• After term: 40-42 week
Apgar Score
• Originally proposed as a predictor for
newborns at risk for complications for bad
outcomes (cerebral palsy)
• Outcomes
– If the Apgar score at twenty minutes after
delivery is less than five, there is still only a
20% chance of a handicapping condition. Level
of evidence (LOE) 5
Apgar Score
Score
0
1
2
Heart Rate
Absent
<100
>100
Respiratory Effort
Absent,
irregular
Slow, crying
Good
Muscle Tone
Limp
Some flexion of Active motion
extremities
Reflex irritability
(nose suctioning)
No response
Grimace
Cough or
sneeze
Color
Blue, pale
Acrocyanosis
Completely pink
Scoring at 1 and 5 minutes of age
Additional scoring could be continued at 5 minute intervals if
needed.
Apgar V. Anesth Analg 1953; 32:260.
METHODS OF HEAT
LOSS
• Evaporation eg wet with amniotic
fluid
• Convection- e.g. removed from
incubator
• Radiation- e.g. placing cold objects
near incubator
• Conduction-e.g. cold stethoscope
DESCRIBE FUNCTIONAL ABILITIES OF
THE NEWBORN GASTROINTESTINAL
TRACT AND LIVER
• By birth the newborn
has experienced
swallowing, gastric
emptying, and
propulsion
• Meconium is formed in
utero
• Newborn passes
meconium witin 48
hours
Assessment of the
Newborn
• Newborn Care In
The Delivery Room
– Maternal
history/labor data
– Apgar Scoring
– Brief physical exam
– Nursing
Interventions
ACROCYANOSIS
GESTATIONAL AGE
ASSESSMENT
• Two parts
– External physical characteristics
– Neurological characteristics
Maternal conditions, such as pre eclampsia, diabetes, and
maternal analgesics and anesthesia may impact certain
components of gestational assessment
COMPARISON OF
CEPHALHEMATOMA AND CAPUT
SUCCEDANEUM
• CEPHALHEMATOMA –is a collection of blood resulting from
ruptures blood vessels between the surface of a cranial
bone and the periosteal membrane. They may be bilateral
or unilateral and do not cross the suture lines
• CAPUT SUCCEDANEUM
is a localized, easily identifiable, soft area of the scalp,
generally resulting from a long and difficult labor or vacuum
extraction.
Cephalohematoma
Caput
Examination precaution
•
•
•
•
Hand washing
Thermal environment
Light and noise
5-10 minutes examination time
Important History points
in caring of newborn
• Maternal diabetes
– Metabolic and congenital defect
• Polyhydramnios
– Swallowing defect, GI obstruction
• Oligohydramnios
– Renal disease, pulmonary hypoplasia
• Maternal age
– Old age and chromosomal
• IUGR
• family history
Important History points in
caring of newborn
• Rupture of membrane
– sepsis
• Delivery type
– c/s and TTN
• Prenatal care
• Maternal blood group
– ABO, Rh disease
• Infection risk
– Maternal Hepatitis carrier
– Maternal GBS colonization
Physical Eamination
• Vital signs
– RR 40-60
– HR 120-160
– Temperature axilary 35.5-37.5
• Over bundling
• Heater
Physical Examination
• skin
–
–
–
–
Pink is normal
Acro cyanosis is normal
Cyanosis
Jaunduce
• 1st 24 hours
• Cephalopedal distribution
– Pale and grayish color in anemia and acidosis
respectively
– Common skin rash
• Erythema toxicum, mongolian spot,
General inspection
• Flexion of upper and lower
extremities
• Cortical thumb
• Asymetric movement
– Brachial plexus and fractured
humerous
• Ventral, vertical suspension and
head control for tone
assessment
General inspection
• Symmetry of the mouth and face
– Facial nerve
• Vigorous cry is assuring
• Weak cry
– sepsis, asphyxia,metabolic, narcotic use
• Hoarseness
– Hypocalcemia, airway injury
• High pitch cry
– CNS causes, kernicterus
Congenital anomalies
• Facial gestalt; overall look of facial features
that give impression of diagnosis ie: Down
syndrome
• Minor anomaly: common and no effect on
organ function such as simian crease or ear
tag
• Major anomaly: less common and involve main
organ dysfunction like neural tube defect,
multicystic dysplastic, kidney
Head
• Forceps and vaccum marks
• Caput succedaneum
– Boggy edema in presenting part of head
– Cross suture lines
– Disapear in few days
• Cephalhematoma
– Subperiosteal
– Weeks to resolve
– Dose not cross sutures
head
•
•
•
•
•
•
Head cicumference
Molding
Brachycephaly: flat occiput
Widening of suture
Fontanelles
Head auscultation: bruits
Ears, Nose, Mouth
• Low set ears?,Preauricular pits,
External meatus tie
• Natal teath
• Choanal atresia
• Epstein pearls
• Cleft, submucosal
Neck and clavicle
• Webbing; turner syndrome
• Excess skin at base of neck posterior
in Down syndrome
• Goiter
• Fracture in clavicle
– Asymmetric moro reflex
Respiratory
• Tachypnea
• Nasal flaring
• Respiratory effort
– Mild retraction
• Grunting
• asymetric chest rise
• supra-sternal, intercostal, subcostal
retraction
Chest, back
•
•
•
•
Pectus excavatum
Pectus carinatum
Suprmammary nipple
Breast hpertrophy
– Milk production
– No redness
• Back
– abnormal curvature
– Sinus trsct, tuft of hair, MMC…
Respiratory
• Inspection is the key
– No grunting, flaring. Retraction
• Auscultate
– Air entry, symmetry
– Early crepitation sound is transmitted
upper sound
– Late inspiratory crepitation
Cardiovascular
•
•
•
•
•
HR 100-160 beats/min
Color, perfusion
Central cyanosis
Single S1
Splited S2
– No split ;single ventricle, pulmonary
hypertension
Abdomen
• Inspection
– Scaphoid
– Distention
– Abdominal wall defect (gastroschisis)
• Palpation;
–
–
–
–
baby sucking and use warm hands
Kidneys are normaly palpable
Liver 2-3 cm
Spleen palpable
Umblical vessels
• 2 artery, one vein
– Hernias ; umbilical and inguinal
Genitalia and anus
• Penile size
• Hypospadias, epispadias
• Testes
– 2% crypoorchid
– Hydrocele
• Premature
–
–
–
–
Prminent clitoris and minora
Vaginal skin tag
Vaginal discharge /blood
Labial fusion
Extremities
• Erb’s palsy: extended arm and internal
rotation with limited movement
• Humerous fracture
• Digital abnormality
– Syndactaly, brachdactaly, polydactaly
• Single palmar crease
• Hip dislocation
– Female, breach
CNS
•
•
•
•
•
•
•
Awakenes and alertness
moving extremities
Flexed body posture
Minimal Head lag
Ventral suspension
Vertical suspension
Moro reflex
Neuromuscular Maturity
•
•
•
•
•
•
Posture
Square window
Arm recoil
Poplitteal angle
Scarf sign
Heel to ear
Physical Maturity,
with maturity
• Skin: thicker , less translucent, dry, peeling
• Lanugo:
•
•
•
•
•
– fine non pigmented hair all over 27-28 wks
– disappears gradually
Plantar surface: presence or absence of creases
Breast: areola development
Ear cartilage
Eyelid opening
External genitalia
– Rugation, desend
– Prominent labia majora
Condition
Hyperventilation
Physiological
erythema
Toxical erythema
Physiological
jaundice
Hyperthermia
Physiological
weight loss
Physiological
oliguria
Albuminuria
Urea crystalluria
Sex crisis
Disbacteriosis
Time of appearance
Time of disappearance
At birth
On the 3rd-5th day of life
2nd-3rd day of life
By the end of the 1st week
On the 2nd -5th day of life
On the 3rd - 4th day
By the end of the 1st week
The 7th-10th day
On the 3rd - 5"1 day
On the 2nd -3rd day
By the end of the 2nd week
By the end of the Is' week
At birth
The 3rd day
At birth
On the 3rd-4m day
On the 3rd - 4th day
The first week
The 3rd day
By the end of the 2nd week
By the end of the 1st week
By the end of the 2nd week