NEWBORN/NEONATE
Mrs. Tina Ann John
Associate Professor
Dept. of Child Health Nursing
Hoskote Mission Institute of Nursing
INTRODUCTION
• THE NEONATE IS OFTEN REFERRED TO AS A NEONATE BECAUSE “NEO” MEANS
NEW AND “NATAL” MEANS BIRTH.
• AT THE BIRTH THE NEONATE IS NO LONGER COMPLETELY DEPENDENT ON THE
MOTHER FOR SURVIVAL.
DEFINITIONS
• NEONATE: from birth to 4 weeks (28 days) of age, the baby is called
neonate or newborn.
• PERINATAL PERIOD: The period extending from 22nd weeks of gestation to 7
days after birth.
• EARLY NEONATAL PERIOD: from birth to 7 days of life or 168 hours, is early
neonatal period.
• LATE NEONATAL PERIOD: from the 7th day to 28th days of life is late neonatal
period.
• LIVE BIRTH: it is defined as the complete expulsion or extraction from mother
the product of conception, which after separation shows signs of life for
atleast 1 hour.
• TERM BABY: Any Neonate born between 37-42 weeks of gestation.
• PRE-TERM BABY: Any Neonate born before 37 weeks of gestation.
• POST-TERM BABY: Any Neonate born at or after 42 weeks of gestation.
CLASSIFICATION OF NEONATES
ACCORDING TO SIZE
• LOW-BIRTH WEIGHT (LBW): An infant whose birth weight is less than 2500 gms,
regardless of gestational age.
• MODERATELY LOW- BIRTH WEIGHT (MLBW): An infant whose birth weight is
1501-2500 gms.
• VERY LOW-BIRTH WEIGHT (VLBW): An infant whose birth weight is less than
1500 gms.
• EXTREMELY LOW-BIRTH WEIGHT (ELBW) : An infant whose birth weight is less
than 1000 gms.
• APPROPRIATE FOR GESTATIONAL AGE (AGA) : An infant whose birth weight
falls between the 10th-90th percentiles on the intrauterine growth curves.
• SMALL FOR DATES (SFD) OR SMALL FOR GESTATIONAL AGE (SGA) : An infant
whose rate of intrauterine growth was slowed and whose birth weight falls
below the 10th percentile on the intrauterine growth curves.
• INTRAUTERINE GROWTH RETARDATION (IUGR) : Found in infants whose intrauterine growth is retarded.
• LARGE FOR GESTATIONAL AGE (LGA) : An infant whose birth weight falls
above the 90th percentile on the intrauterine growth curves.
CLASSIFICATION OF NEONATES
ACCORDING TO GESTATIONAL AGE
• PREMATURE /PRE-TERM : An infant who is born before 37 weeks of gestation
regardless of the birth weight.
• FULL TERM : An infant born at the beginning of the 38 week and completion
of 42 weeks of gestation, regardless of birth weight.
• POST TERM : An infant born after 42 weeks of gestational age, regardless of
birth weight.
CLASSIFICATION OF NEONATES
ACCORDING TO MORTALITY
• FETAL DEATH : An infant born before completion of 37 weeks of gestation
and before delivery, with absence of any signs of life after birth.
• NEONATE DEATH : Death that occurs in the first 27 days of life is known as
neonatal death.
• EARLY NEONATAL DEATH: Death that occurs in the 1st week after birth.
• LATE NEONATAL DEATH : Death that occurs between 7-27 days after birth
• PERINATAL MORTALITY: It describes the total number of of fetal and early
neonatal deaths per 1000 live births.
• POST NATAL DEATH : Deaths of neonates that occur between 28 days to 1
year.
IMMEDIATE PHYSIOLOGICAL CHANGES IN NEONATES
IMMEDIATE PHYSIOLOGICAL
CHANGES SEEN IN NEONATES
• During the process of birth, the newborn goes through various physiological
changes and also exposed to environmental changes which produce stress
in newborns.
• The neonates needs to adjust to the extra-uterine life to maintain normal
physiological activity.
• The various systems that undergo changes include:
•
•
•
•
•
•
•
•
•
Respiratory changes
Circulatory changes
Neurologic changes
Digestive system
Renal system
Integumentary system
Endocrine system
Musculo-skeletal system
Blood
RESPIRATORY SYSTEM
CHANGES THAT OCCUR IN
RESPIRATORY SYSTEM
•LUNGS:
• The most important vital organ that needs to
be adequately functional in the neonate.
• Largely dependent on maturation of the
fetus.
ADAPTATION AT BIRTH-
FACTORS THAT FOSTER THAT
INITIAL BREATH
• Mechanical–
“Vaginal squeeze” is followed by chest recoil after birth.
• Chemical –
Transient asphyxia at birth results in:
* decreased pO2
* decreased pH as low as 7.25
* increased pCO2
These changes stimulate chemoreceptors around the aorta and
carotid which tells the respiratory center in the medulla to start
breathing.
CONTD….
• Temperature—
The drop in temperature from a cozy 98.6 to 65-70 F. stimulates the
neonate’s CNS to breathe.
• Sensory stimuli– all 5 senses are brought to life in the delivery
room
*Noise in the delivery room
*Bright lights in the delivery room
*Tactile stimulation– drying off the baby, stroking and
caressing by parents, etc.
*Smells in the delivery room
*Taste when bulb syringe or gloved hand is introduced
into mouth, & when mother nurses the neonate for the first time.
CONTD….
• Quality of respirations-- 30-60/min.
• gasping, irregular, shallow breathing is normal at
first
• periodic breathing is typical.
• true apnea= >20 sec. without breathing is
abnormal.
• “wet” lungs– common in the first 5 minutes of life;
if persistent, may require DeLee suctioning,
CIRCULATORY SYSTEM
CIRCULATORY CHANGES:
Once lungs
expand
Cord clamping leads to
rise in systemic vascular
resistance due to blood
volume in placenta.
Inspired o2 dilates
pulmonary vessels
Decreases
pulmonary
vascular resistance
Decreases pressure
in right side of heart
& pulmonary
arteries
Increase
pulmonary blood
flow
CONTD……
Pressure in the left
side of heart
increases
Blood flows from
high pressure to
low pressure
Blood circulation
through fetal
shunts is reversed.
Foramen ovale
These changes
lead to functional
closure of fetal
shunts
Ductus arteriosus
Ductus venosus
NEUROLOGIC SYSTEM
NEUROLOGIC SYSTEM
• At birth, the nervous system is sufficiently developed to sustain extra uterine
life.
• Most of the neurologic functions are primitive reflexes.
• Role of the autonomic nervous system is crucial during transition, as it
stimulates respiration, helps maintain acid-base balance and partial
regulation of temperature.
• Myelination of nerves occur following cephalo-caudal and proximo- distal
pattern which leads to mastery of fine and gross motor skills.
GASTRO-INTESTINAL SYSTEM
DIGESTIVE SYSTEM:
• The ability of newborns to digest, absorb, and metabolize
foodstuff is adequate but limited in certain functions.
• Enzymes are adequate to handle proteins and simple
carbohydrates.
• Deficient production of pancreatic amylase impairs use of
complex carbohydrates.
• Deficiency of pancreatic lipase limits absorption of fats, especially
with ingestion of foods with high saturated fatty acid content such
as cow’s milk.
• Human milk, despite its high fat content, is easily digested because
the milk itself contains enzymes such as lipase, which assist in
digestion.
CONTD…
• The liver is the most immature of the gastrointestinal organs.
• The activity of the enzyme glucuronyl transferase is reduced
• Affects the conjugation of bilirubin with glucuronic acid and
contributes to physiologic jaundice of newborns.
• The liver is also deficient in forming plasma proteins.
• The liver stores less glycogen at birth than later in life.
• Consequently, newborns are prone to hypoglycemia.
• Some salivary glands are functioning at birth, but the
majority do not begin to secrete saliva until about age 2
to 3 months, when drooling is frequent.
CONTD….
• Stomach capacity varies in the first few days of life, from about
5 ml on day 1 to about 60 ml on day 3.
• thus, infants require frequent small feedings
• An infant’s intestine is longer in relation to body size than that
of the adult.
• Therefore, there are a larger number of secretory glands and a
larger surface area for absorption compared with an adult’s
intestine.
CHANGES IN STOOL PATTERN IN
NEONATES
• Meconium
• Infant’s first stool; composed of amniotic fluid and its constituents, intestinal
secretions, shed mucosal cells, and possibly blood (ingested maternal blood or
minor bleeding of alimentary tract vessels).
• Passage of meconium should occur within the first 24 to 48 hours, although it
may be delayed up to 7 days in very low–birth-weight infants.
• Transitional Stools
• Usually appear by third day after initiation of feeding; greenish brown to
yellowish brown, thin, and less sticky than meconium; may contain some milk
curds.
• Milk Stool
• Usually appears by fourth day In breastfed infants stools are yellow to golden,
are pasty in consistency,and have an odor similar to that of sour milk.
• In formula-fed infants stools are pale yellow to light brown, are firmer in
consistency, and have a more offensive odor.
HAEMATO-POIETIC SYSTEM (BLOOD)
CHANGES IN HAEMATO-POIETIC
SYSTEM
• The blood volume of the newborn depends
on the amount of placental transfer of
blood.
• The blood volume of a full-term infant is
about 80 to 85 ml/kg of body weight
Immediately after birth.
• The total blood volume averages 300 ml.
FLUID ELECTROLYTE BALANCE
FLUID-ELECTROLYTE BALANCE
• Changes occur in the total body water volume, extracellular fluid volume,
and intracellular fluid volume during the transition from fetal to postnatal life.
• At birth, the total weight of an infant is 73% fluid compared with 58% in an
adult.
• Infants have a proportionately higher ratio of extracellular fluid than adults.
CONTD…
• FACTORS MAKE INFANTS MORE PRONE TO DEHYDRATION AND
ACIDOSIS:
• Infant’s rate of metabolism is twice that of an adult in
relation to body weight.
• As a result, twice as much acid is formed, leading to more
rapid development of acidosis.
• Immature kidneys cannot sufficiently concentrate urine to
conserve body water.
RENAL SYSTEM
CHANGES IN RENAL SYSTEM IN
NEONATES
• Total volume of urine per 24 hours is about 200 to
300 ml by the end of the first week.
• The bladder voluntarily empties when stretched by a
volume of 15 ml, resulting in as many as 20 voidings
per day.
• The first voiding should occur within 24 hours.
• The urine is colorless and odorless and has a specific
gravity of about 1.020.
INTEGUMENTARY SYSTEM
CHANGES IN INTEGUMENTARY
SYSTEM OF NEONATES
• At birth, all of the structures within the skin are present, but many of the
functions of the integument are immature.
• The growth phases of hair follicles usually occur simultaneously at birth.
• During the first few months, the synchrony between hair loss and re growth is
disrupted, and there may be overgrowth of hair ortemporary alopecia.
• The eccrine glands, which produce sweat in response to heat or emotional
stimuli, are functional at birth, and palmer sweating on crying reaches levels
equivalent to those of anxious adults by 3 weeks of age.
• The eccrine glands produce sweat in response to higher temperatures than
those required in adults, and the retention of sweat may result in miliaria.
MUSCULO-SKELETAL SYSTEM
CHANGES IN THE MUSCULOSKELETAL SYSTEM
• At birth, the skeletal system contains more cartilage than
ossified bone, although the process of ossification is fairly rapid
during the first year.
• The six skull bones are relatively soft and are separated only
by membranous seams. The sinuses are incompletely formed in
newborns.
• muscular system is almost completely formed at birth.
ENDOCRINE SYSTEM
CHANGES IN ENDOCRINE SYSTEM
• Ordinarily, the endocrine system of newborns is adequately
developed, but its functions are immature.
• The effect of maternal sex hormones is particularly evident in
newborns.
• The labia are hypertrophied, and the breasts of both genders
may be engorged and secrete milk from the first few days of
life to as long as 2 months of age.
• Female newborns may have pseudomenstruation (more often
seen as a milky secretion than actual blood) from a sudden
drop in progesterone and estrogen levels.
SENSORY FUNCTION
CHANGES IN SENSORY FUNCTION
• VISION:
• At birth, the eye is structurally incomplete.
• Tear glands usually do not begin to function until 2 to 4 weeks of age.
• The pupils react to light, the blink reflex is responsive to minimal stimulus, and the
corneal reflex is activated by a lighttouch.
• HEARING:
• After the amniotic fluid has drained from the ears, infants probably have
auditory acuity similar to that of adults.
• SMELL:
• Newborns react to strong odors such as alcohol and vinegar by turning their
heads away.
• Breastfed infants are able to smell breast milk and will cry for their mothers when
they smell leaking milk
CONTD….
• TASTE:
• The newborn has the ability to distinguish among tastes.
• TOUCH:
• At birth, infants are able to perceive tactile sensation in any part of the body,
although the face (especially the mouth), hands, and soles of the feet seem to
be most sensitive.
DEFENSE AGAINST INFECTION
• Infants are born with several defenses against
infection.
• The first line of defense is the skin and mucous membranes,
which protect the body from invading organisms.
• The second line of defense is the macrophage system,
which produces several types of cells capable of attacking
a pathogen.
• The neutrophils and monocytes are phagocytes, which
means they can engulf, ingest, and destroy foreign agents.
• The third line of defense is the formation of specific
antibodies to an antigen.
THANK YOU