Growth and
Development: The
Newborn Baby
1
Fetal Circulation: Circulatory
Pathways

Placenta:

1.
2.
3.
The organ responsible for
Delivery of nutrients
Removal of waste products
Delivery of oxygenated blood to
the fetus.
2
Circulatory Pathways:

Fetal lungs:




Are filled with fetal lung liquid
not used to oxygenate blood. Because the
alveoli are filled with liquid
most of the arteries and arterioles are
surrounded by liquid which increases
resistance to blood flow through the vessel.
This results in most of the blood flow
bypassing the lungs and therefore directed to
the systemic periphery.
3
Circulatory Pathways:

Umbilical vein & Ductus
Venosus:



A vessel which delivers oxygenated
blood from the placenta to the fetus.
The umbilical vein enters portal
venous system where it empties most
of the blood flow into the ductus
venosus which connects to the
inferior vena cava.
Average oxygen saturation of blood is
80% in the umbilical vein before it
mixes with unoxygenated blood in
the ductus venosus. After mixing, the
oxygen saturation is approximately
67%.
4
Circulatory Pathways:

Foramen ovale:


The majority of inferior vena
cava blood flow crosses the
foramen ovale and into the
left atrium bypassing the
lungs, some blood flow enters
the right ventricle.
The foramen ovale is
anatomical opening between
the right atrium and left
atrium which closes shortly
after birth.
5
Circulatory Pathways:

Ductus arteriosus:

A vessel that connects the
main pulmonary artery to
the aorta.
6
Circulatory Pathways:

The blood flow that does enter the right atrium
(mainly from the superior vena cava) enters the
right ventricle and then the main pulmonary artery
where the blood flow then enters the ductus
arteriosus which connects to the aorta. Once
again, most blood flow bypasses the lungs and is
directed to the systemic circulation. Blood flow is
flowing in a right to left direction. The ductus
arteriosus should functionally close within 15
hours and structurally within a few weeks (in
mature infants).
7
Circulatory Pathways:

Umbilical arteries:

2 vessels that allows unoxygenated
blood to flow from the descending
aorta back to the placenta.
8
9
Changes at Birth

The First Breath:

The lungs are filled with air
instead of fluid. Higher oxygen
levels in the blood and alveoli
filled with air instead of fluid
allows for vascular resistance to
decrease. This results in a
greater increase in pulmonary
blood flow.
10
Changes at Birth

Anatomical Changes:




Placenta is removed from circulation.
Higher pressure in the left atrium due to
increased pulmonary blood flow cause
the foraman ovale to close.
Higher concentrations of oxygen in the
blood, decreased prostaglandin levels
and decreased pulmonary vascular
resistance closes the ductus arteriosus.
When the umbilical cord is clamped, the
umbilical vein closes, systemic vascular
resistance is increased and this causes the
ductus venosus to close.
11
Figure 28.13
12
Physiologic adjustment to
extrauterine life:

First period of reactivity:


Resting period:


lasts for ½ hour, baby is alert & exhibit exploring
searching activities, making sucking sounds, rapid
H.R & R.R.
lasts 90 minutes, baby generally sleeps, slower
H.R & R.R.
Second period of reactivity:

between 2-6 hours of life. Baby is a wake, gagging
and choking on mucus. Gain alert & responsive
and interest to surrounding.
13
Assessment of well being:
Apgar Scoring



Is an assessment scale
applied at 1 minute and 5
minutes after birth.
Give a score (0,1, or 2)
for each sign.
It serves as a baseline for
future evaluation.
14
InRev1
The Apgar Scale
Score
Characteristic
Heart rate
0
Absent
1
2
Less than 100 beats per More that 100 beats
minute
per minute
Efforts to breathe Absent
Slow, irregular
Good; baby is crying
Muscle tone
Flaccid,limp
Weak, inactive
Strong, active motion
Skin color
Body pale
or blue
Body pink, extremities
blue
Body and extremities
pink
Frown, grimace
Vigorous crying,
coughing, sneezing
Reflex irritability
No response
15
Apgar score



A score under 4 is in
serious danger and need
resuscitation.
A score of 4-6 may need
clearing of the airway
and O2 supplement.
A score of 7-10 is good
16
The Newborn Baby

Weight:


differs depending on the race, nutritional,
intrauterine and genetic factors. Normal rates 2.74.0 kg.
Newborn loses 5-10% of birth weight during
the 1st few days because of:





No longer under the influence of salt & fluidretaining maternal hormones.
Diuresis: to remove part of body fluids.
Limited by low caloric content of colostrum.
Time needed to establish sucking.
Stools.
17
The Newborn Baby




Recaptures birth wt
within 10 days.
Head-to-heel length:
birth length is 48 –
53 cm.
H.C: 33-35 cm.
C.C: 2 cm less than
H.C.
18
Classification of infants based on
gestational ages and birth weights




Preterm or premature: infant
born before the end of 37
weeks, regardless of weight
Term or full term: born
between 38 & 42 weeks,
regardless of weight
Postterm: an infant born after
42 weeks regardless of weight
Low birth weight: any infant
at birth who weighs less than
2500 gm
19




Small for gestational age (SGA): any newborn whose
weight is below the 10th percentile, This means that they
are smaller than 90 percent of all other babies of the same
gestational age (according to intrauterine growth curve)
regardless of gestation
Appropriate for gestation age (AGA): any newborn
whose intrauterine growth has been normal (according to
intrauterine growth curve) for that length of gestation
Large for gestational age (LGA): any infant born whose
weight is above the 90th percentile regardless of gestation
Intrauterine growth restriction (IUGR): failure of fetus
to grow as expected during gestation
20
21
Appearance of newborn



Flexion posture.
Looks , red or cyanotic.
Body covered with
varying amount of
lanugo and vernix
caseosa.
22
Vital signs

Temp:


37.2 at birth fall because
of heat loss, little s.c fat &
immature tep. Regulating
center (drying, wrapping, &
put them under the radiant
heat + kangaroo care).
Pulse:

120-160 bpm. ↑ at the
moment of birth to 180
bpm. 1 hour after birth ↓ to
120-140 bpm.
23
Vital signs

Respiration:


first few minutes 80 b/m↓ to 30-60 b/m
when newborn at rest. Usually irregular
with short periods of apnea
Blood pressure:

80/60 mm/Hg ↑ at 10th day to 100/50
mm/Hg.
24
Head



Large head, overridden sutures.
Head molded to fit cervix.
Caput succedaneum:





Edema of the soft scalp tissue at the presenting part of the
head.
Accumulation of serum in the tissues above the bone
Cross suture lines
Disapear in few days
Cephalhematoma:




Localized collection of blood between the skull bone and its
periosteum
May involve one or both parietal bones
Weeks to resolve
Dose not cross sutures
25
26
Caput Succedaneum
Cephalohematoma
27
Caput succedaneum
28
cephalheamatoma
29
30
Molding of infant’s head
31
Fontanelles

6 fontanelles.




Anterior fontanelle,
diamond shaped, 2.54 cm, will closes at
12-18 mon.
Posterior fontanelle,
triangular, 0.5-1.0 cm,
closed at 2 mon.
Pair of anteriolateral
fontanelle close at 3
mon.
Pair of posteriolateral
fontanelle close at 12
mon.
32

Eyes: tearless cry (lacrimal ducts
mature at 3 months) permanent eye color
between 3-12 mon.



Ears: pinna tends to bend easily.
Nose: large for face.
Mouth: prominent, large, & short
tongue. Natal teeth are unusual. Thrush
indicates candida infection.

Neck: short & chubby with many folds.
Head lags
33
Skeletal system





Arms are slightly longer than legs. Hands
clenched into fists. 3 normal creases. Flat sole
of the feet
Hips inspect for symmetry—skin folds should
match ortolani maneuver for hip dysplasia
Check for tufting of hair at base of spine
(spina bifida, occulta)
Clubfoot
Absence of limb or digit
34
35
Skin






Vernix casoesa
Acrocyanosis
Lanugo
Bruising, petechiae
from birthing
Mongolian spots—
generally back and
buttocks
Milia
36
Milia


Small, whitishyellow papules
found close to
the skin surface
Particularly
common
around eyes
and midface
37
Skin




Down syndrome—
simian crease on
palm
Strawberry mark—
nevous
Vasculosus—
hemangioma
Erythema toxicumnewborn rash
38
Strawberry mark—nevous
Vasculosus—hemangioma
Vasculosus—hemangioma
Erythema toxicum
39
Appearance of newborn


Chest: looks small (compared to head),
engorged breasts (maternal hormone).
Ronchi because of mucus.
Abdomen: protuberant. Bowel sound
should be present within an hour.
Umbilical cord white gelatinous
structure with red & blue streaks for the
1st hour. Begin to dry breaks free by 6th10th day. Check for concave abdomen
40
Circulatory & hemopoietic









Resting hr 100-160
Hr above 160 or below 100 should be reevaluated
Blood volume: 80-85 ml/kg, average about 300 ml
but can have an additional 100 ml if cord is not cut in
reasonable length of time
Fetus needs additional blood cells for O2 exchange
Hgb 14-24 g/dl
Infant Hgb F – higher O2 affinity
Hgb A production largely replaces Hgb F by 4 months
Iron stores good for 5 months
Blood coagulation: born with long coagulation time
(lower level of vit. K).
41
GI SYSTEM





Baby learns to coordinate breathing, sucking
and swallowing
Bacteria not present in gut
vitamin k
Digestion-simple CHO and protein. (Starches
and fats are not easily digested at this time)
Feeding varies—cues hand to mouth movement
and sucking fingers intensify when hungry
Prevent regurgitation by not overfeeding,
frequent burping and positioning the head
slightly elevated
42
GI 2




Stool—meconium—greenish
black
Stools change and the
stooling pattern change
indicates good bowel
functioning
Color time and character of
first stool should be
documented.
Diarrhea stool—loss of fluid
quickly
43
Immune system



Passive immunity from mom
Immunoglobulins gradually
develop
High risk of infection in first
few month—abnormal
discharges or rashes should
be evaluated
44
Renal system






Should void in first 24 hour
Frequency depends on intake
Not able to concentrate urine
May see blood in diaper of female
Hypospadias
Extrophy of bladder
45
Hepatic system






Iron storage
Conjugation of bilirubin—function not well
developed at birth—
Physiologic jaundice—after 24 hours—
preterm increase and more severe
Pathologic jaundice—before 24 hours
Kernicterus—billiruben higher than 25
Breastfeeding—may occur up to 2 weeks pp
46
Anogenital



Patent anus (check for imperforate
anus). Meconium within 24 hour.
Male genitalia: edematous scrotum,
check for undescended testicles, epi or
hypospadias.
Female genitalia: swollen vulva
(maternal hormones),
pseudomenstruation.
47
Neuromuscular system




The newborn is born with
certain specific responses that
are triggered by specific
stimuli.
Some of these reflexes, such
as rooting and sucking, appear
to have survival implications.
Other reflexes appear to be
precursors for later voluntary
motor behavior.
The newborn’s reflexes may
also give information about the
health of the child’s nervous
system.
48
Sucking




Onset: ~28weeks GA
Well-established: 32-34 weeks
GA
Disappears: starting around 12
months
Elicited by the examiner stroking
the lips of the infant.
49
Rooting

This reflex begins when the
corner of the baby's mouth is
stroked or touched. The baby
will turn his/her head and
open his/her mouth to follow
and "root" in the direction of
the stroking. This helps the
baby find the breast or bottle
to begin feeding.
50
Moro Reflex

The Moro reflex is often called a
startle reflex because it usually
occurs when a baby is startled by
a loud sound or movement. In
response to the sound, the baby
throws back his/her head, extends
out the arms & legs, with fingers
extended in “c” shape, cries, then
pulls the arms and legs back in.
lasts about five to six months.
51
Grasp reflex

Stroking the palm of a
baby's hand causes
the baby to close
his/her fingers in a
grasp. The grasp
reflex lasts only a
couple of months and
is stronger in
premature babies.
52
Tonic Neck Reflex

When a baby's head is
turned to one side, the
arm on that side
stretches out and the
opposite arm bends up
at the elbow. lasts
about six to seven
months.
53
Babinski reflex

When the sole of the
foot is firmly stroked,
the big toe bends
back toward the top
of the foot and the
other toes fan out.
This is a normal
reflex up to about 2
years of age.
54
Step reflex

This reflex is also
called the walking or
dance reflex
because a baby
appears to take
steps or dance
when held upright
with his/her feet
touching a solid
surface.
55
Senses


Hearing: able to hear in utero, within days
after birth hearing become acute.
Vision: see as soon as they are born
(blinking reflex). Can’t follow objects past the
midline. Best focus on black & white.
Newborns see best using peripheral vision,
out of the corner of their eyes, and when
objects are about 9-12 in. (22.86-30.48 cm)
away.
56
Senses



Touch: The sense of touch in newborns is
well developed, particularly around the
mouth. They are sensitive to temperature,
pressure, and pain.
Smell: well developed, newborns are often
able to recognize the smell of their mother
within the first few days of life.
Taste: prefer sweet tastes and usually do not
like sour, bitter, and salty tastes.
57
58
The Newborn’s States




Sleeping
Newborns sleep an average of 16-18
hours daily.
Newborns usually follow a sleep-wake
cycle of around 4 hours of sleep
followed by 1 hour of wakefulness.
By 3 or 4 months newborns usually
sleep through the night.
59
The Newborn’s States


Crying
Basic Cry


Mad Cry




More intense and louder.
Pain Cry


Starts softly and builds in volume and
intensity. Often seen when the child
is hungry.
Starts with a loud wail, followed by
long pause then gasping.
Be calm and patient
Do not shake baby
Know signs of emergencies
60
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