newborn screening tests for disorders that, if left untreated, may

8/14/2019 Newborn Screening Tests for Disorders That, If Left Untreated, May

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Newborn Screening tests for disorders that, if left untreated, may lead to mental retardation, healthcomplications, or even death.

An affected baby looks healthy at birth because symptoms do not begin to show until a much later age.Once the signs and symptoms set in, the ill effects are often already permanent. Early detection of thesedisorders is crucial. Diagnosed children can continue to live normal and healthy lives as long as they aregiven treatment on time and consistently follow up with a specialist.

The Philippine Newborn Screening Project says that 33,000 children out of the 2 million Filipino babiesborn yearly are at risk from the disorders that NBS addresses. Currently, NBS tests for five disorders:

• Congenital Hypothyroidism - A lack or absence of thyroid hormone, which is necessary for growth of the brain and the body. Treatment is required within the first four weeks to prevent stunted physicalgrowth and mental retardation. One out of 3,369 babies are at risk.

• Congenital Adrenal Hyperplasia - An endocrine disorder that causes severe salt loss, dehydration, andabnormally high levels of male sex hormones. Left undetected and untreated, a baby may die withinseven to 14 days. One in 7,960 newborns are at risk.

• Galactosemia - A condition in which babies are unable to process galactose, which is the sugar present in milk. Increased galactose levels in the body lead to liver and brain damage, and to the

development of cataracts. One in 82,250 may be affected.

• Phenylketonuria - The inability to properly utilize the enzyme phenylalanine, which may lead to braindamage. One in 109,666 may be at risk.

• Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD) - A condition where the body lacks theenzyme called G6PD, which may cause hemolytic anemia resulting from exposure to oxidativesubstances present in certain drugs, foods and chemicals. Parents of G6PD-positive babies are given alist of these substances. While this is the mildest disorder that is covered in NBS, one out of 55 babiesmay be affected.

APGAR Score

Introduction

Your baby?s first exam in life that she needs to pass with flying colours is theApgar Test. Developed by Virginia Apgar, an anesthesiologist, it is performed oneminute after birth and then repeated after five minutes. Dr. Apgar has identifiedcertain critical signs that are measured and rated immediately after birth. Theresults reflect the baby ?s general condition and help the doctors to determine thenature of the baby?s post-delivery care.

The rating scale

The baby is rated on a scale of zero to two on the following five signs:

• Appearance or colour • Pulse or heart rate • Grimace or reflex irritability • Activity or muscle tone • Respiration

The babies are rated in the following manner:



Appearance: If the baby is pink all over, she will get the maximum score of 2. If the body is pink with the exception of the arms and legs , which are blue, thebaby will score 1. She will get a minimum score of 0, if her body is blue all over.

Pulse: The baby scores 2 if her pulse rate is above 100 beats a minute. If herpulse rate is below 100, she will score 1 and if it not detectable, she will score 0.

Reflex irritability: The doctor will slap the baby on the soles of her feet. If shecries lustily in response, she will score 2. A grimace or slight cry will get her ascore of 1. If she does not respond at all, she will score 0.

Activity: A baby that flails its arms and legs or otherwise displays a lot of activityat birth scores a two in this category. If the baby moves her limbs slightly, shewill receive a score of 1. If the baby is limp and flaccid, and shows no activity,she will score 0.

Breathing: Strong efforts to breathe, accompanied by crying are a sign that the

baby?s lungs are in good working order. She will receive a score of 2. Slow,irregular breathing rates a 1. No respiration gets the lowest score of 0.

What the scores mean

The baby?s scores in these five categories are added up to give the Apgar score.(The maximum score is 10). It has been observed that most babies scorebetween 7 and 10 points one minute after birth, indicating that the baby isgenerally in good health and will require only routine post-deliver care. Babieswho score between 4 and 6 are in fair condition, though they may require help tobreathe. They may be put on oxygen or if there is mucus in the throat it will have

to be removed to prevent any obstruction in the baby? breathing. Those babiesthat have a total score below 4 are normally pale, limp and unresponsive. Theywill require immediate life-saving efforts. The baby?s lungs will have to beexternally inflated and the throat will have to be suctioned to clear the airpassage. Such babies will have to be closely monitored in the intensive care untiltheir bodies take over and they can wing it on their own.

The five minute score

The Apgar test is repeated after five minutes. While the one-minute score is anindication to doctors as to the nature of the immediate care required post-delivery, the five minute score was thought to be a good predictor of the baby?ssurvival and development in early infancy.



Newborn - Reflexes

What reflexes should be present in a newborn?

Reflexes are involuntary movements or actions. Some movements are spontaneous,occurring as part of the baby's usual activity. Others are responses to certain actions.Reflexes help identify normal brain and nerve activity. Some reflexes occur only inspecific periods of development. The following are some of the normal reflexes seen innewborn babies:

•

root reflexThis 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" inthe direction of the stroking. This helps the baby find the breast or bottle tobegin feeding.

• suck reflexRooting helps the baby become ready to suck. When the roof of the baby'smouth is touched, the baby will begin to suck. This reflex does not begin untilabout the 32nd week of pregnancy and is not fully developed until about 36weeks. Premature babies may have a weak or immature sucking abilitybecause of this. Babies also have a hand-to-mouth reflex that goes withrooting and sucking and may suck on fingers or hands.



• Moro reflexThe Moro reflex is often called a startle reflex because it usually occurs when ababy is startled by a loud sound or movement. In response to the sound, thebaby throws back his/her head, extends out the arms and legs, cries, thenpulls the arms and legs back in. A baby's own cry can startle him/her andbegin this reflex. This reflex lasts about five to six months.

• tonic neck reflexWhen a baby's head is turned to one side, the arm on that side stretches outand the opposite arm bends up at the elbow. This is often called the "fencing"position. The tonic neck reflex lasts about six to seven months.

• grasp reflexStroking the palm of a baby's hand causes the baby to close his/her fingers ina grasp. The grasp reflex lasts only a couple of months and is stronger inpremature babies.

• Babinski reflexWhen the sole of the foot is firmly stroked, the big toe bends back toward thetop of the foot and the other toes fan out. This is a normal reflex up to about 2years of age.

• step reflexThis reflex is also called the walking or dance reflex because a baby appears totake steps or dance when held upright with his/her feet touching a solidsurface.

Newborn - Sleep Patterns

What are the sleep patterns of a newborn?The average newborn sleeps much of the day and night, waking only for feedingsevery few hours. It is often hard for new parents to know how long and how often anewborn should sleep. Unfortunately, there is no set schedule at first and manynewborns have their days and nights confused - they think they are supposed to beawake at night and sleep in the daytime.

Generally, newborns sleep about eight to nine hours in the daytime and about eighthours at night. Most babies do not begin sleeping through the night (six to eighthours) without waking until about three months of age, or until they weigh 12 to 13pounds. Newborns and young infants have a small stomach and must wake every fewhours to eat. In most cases, your baby will awaken and be ready to eat about everythree to four hours. It is not necessary to wake a baby for feedings unless you havebeen advised to do so by your baby's physician. However, do not let a newborn sleeplonger than five hours at a time in the first five to six weeks. Some premature babiesneed more frequent feedings and must be awakened to eat.

Watch for changes in your baby's sleep pattern. If your baby has been sleepingconsistently, and suddenly is waking, there may be a problem such as an earinfection. Some sleep disturbances are simply due to changes in development orbecause of overstimulation.

Never put a baby to bed with a bottle propped for feeding. This is a dangerouspractice that can lead to ear infections and choking.

What are the sleep states of a newborn?Babies, like adults, have various stages and depths of sleep. Depending on the stage,the baby may actively move or lie very still. Infant sleep patterns begin forming



during the last months of pregnancy - active sleep first, then quiet sleep by about theeighth month. There are two types of sleep:

• REM (rapid eye movement sleep)This is a light sleep when dreams occur and the eyes move rapidly back andforth. Although babies spend about 16 hours each day sleeping, about half of this is in REM sleep. Older children and adults sleep fewer hours and spendmuch less time in REM sleep.

• Non-REM sleep:Non-REM has 4 stages:

o Stage 1 - drowsiness - eyes droop, may open and close, dozing

o Stage 2 - light sleep - the baby moves and may startle or jump withsounds

o Stage 3 - deep sleep - the baby is quiet and does not move

o Stage 4 - very deep sleep - the baby is quiet and does not move

A baby enters stage 1 at the beginning of the sleep cycle, then moves intostage 2, then 3, then 4, then back to 3, then 2, then to REM. These cyclesmay occur several times during sleep. Babies may awaken as they pass fromdeep sleep to light sleep and may have difficulty going back to sleep in thefirst few months.

What are the different alert phases of a newborn?Babies also have differences in how alert they are during the time they are awake.When a newborn awakens at the end of the sleep cycles, there is typically a quietalert phase. This is a time when the baby is very still, but awake and taking in theenvironment. During the quiet alert time, babies may look or stare at objects, andrespond to sounds and motion. This phase usually progresses to the active alertphase in which the baby is attentive to sounds and sights, but moves actively. Afterthis phase is a crying phase. The baby's body moves erratically, and he/she may cryloudly. Babies can easily be overstimulated during the crying phase. It is usually bestto find a way of calming the baby and the environment. Holding a baby close orswaddling (wrapping snugly in a blanket) may help calm a crying baby.

It is usually best to feed babies before they reach the crying phase. During the cryingphase, they can be so upset that they may refuse the breast or bottle. In newborns,crying is a late sign of hunger.

Helping your baby sleep:Babies may not be able to establish their own sleeping and waking patterns,especially in going to sleep. You can help your baby sleep by recognizing signs of sleep readiness, teaching him/her to fall asleep on his/her own, and providing theright environment for comfortable and safe sleep.

What are the signs of sleep readiness?

Your baby may show signs of being ready for sleep when you see the following signs:

• rubbing eyes• yawning• looking away• fussing



How can you help your baby fall asleep?

Although it is surprising, not all babies know how to put themselves to sleep. When itis time for bed, many parents want to rock or breastfeed a baby to help him/her fallasleep. Establishing a routine like this at bedtime is a good idea. However, be surethat the baby does not fall asleep in your arms. This may become a pattern and thebaby may begin to expect to be in your arms in order to fall asleep. When the babybriefly awakens during a sleep cycle, he/she may not be able to go back to sleep onhis own.

Most experts recommend allowing a baby to become sleepy in your arms, thenplacing him/her in the bed while still awake. This way the baby learns how to go tosleep on his own. Playing soft music while your baby is getting sleepy is also a goodway to help establish a bedtime routine.

What sleeping positions are best for a newborn?For many years in the United States, babies have been put to bed on their stomachs.In most other countries, babies sleep on their backs. Research has found a link

between sudden infant death syndrome (SIDS) and babies who sleep on theirstomachs (in the prone position).

Experts now agree that putting a baby to sleep on his/her back is the safest position.Side-sleeping may also be used, but this also has a higher risk than back sleeping.Other reports have found soft surfaces, loose bedding, and overheating with too manyblankets also increase the risk for SIDS. When infants are put to sleep on theirstomachs and they also sleep on soft bedding, the risk for SIDS is even higher.Smoking by the mother is also a major risk for SIDS, as are poor prenatal care andprematurity. Since the American Academy of Pediatrics (AAP) made the "back-to-sleep" recommendation in 1992, the SIDS rate has dropped more than 40 percent.

Back sleeping also appears to be safer for other reasons. There is no evidence thatbabies are more likely to vomit or spit up while sleeping on their back. In fact,choking may be more likely in the prone position.

A task force of The US Consumer Product Safety Commission (CPSC), the AmericanAcademy of Pediatrics (AAP), and the National Institute of Child Health and HumanDevelopment (NICHD), offer the following recommendations for infant bedding:

• Place your baby on his/her back on a firm, tight-fitting mattress in a crib thatmeets current safety standards.

• Remove pillows, quilts, comforters, sheepskins, stuffed toys, and other softproducts from the crib.

• Consider using a sleeper as an alternative to blankets with no other covering.

• If using a blanket, put your baby with his/her feet at the foot of the crib. Tucka thin blanket around the crib mattress, only as far as the baby's chest.

• Make sure your baby's head remains uncovered during sleep.

• Do not place your baby on a waterbed, sofa, soft mattress, pillow, or othersoft surface to sleep.

According to the task force report, bed sharing or co-sleeping may be hazardous for

babies in certain conditions. The report advises the following:



• Parents should consider placing the infant's crib near their bed for moreconvenient breastfeeding and parent contact.

• If a mother chooses to have her infant sleep in her bed to breastfeed, careshould be taken that the baby sleeps in a non-prone position, soft surfaces orloose covers are avoided, and the bed is moved away from the wall and otherfurniture to avoid the baby becoming entrapped between them.

• Adults other than the parents, children, or other siblings should not share abed with an infant.

• Parents who choose to bed share with their infant should not smoke or usesubstances such as drugs or alcohol that may impair their ability to awaken.

To prevent overheating, the report recommends that the infant should be lightlyclothed for sleep and the room temperature kept comfortable for a lightly clothedadult. Avoid over bundling and check the baby's skin to make sure it is not hot to thetouch.

Additional research has found that infants should not be put to sleep on a sofa, aloneor with another person, as this practice increases the risk for SIDS.

While babies should sleep on their backs, other positions can be used during the timebabies are awake. Babies can be placed on their stomachs while awake to helpdevelop muscles and eyes and to help prevent flattened areas on the back of thehead.

Newborn - Senses

The senses of a newborn:

Babies are born fully equipped with all the necessary senses of sight, hearing, smell,taste, and touch. However, some of these senses are less precise than others. Beloware some of the ways newborn babies express their senses:

• visionA newborn's eyes are a little more than half the size of an adult's eyes. Theygrow the most in the first year, then slowly grow until puberty. MostCaucasian babies have light gray or blue eye color, but this often changes by 6months of age. Over the first few months, babies may have uncoordinated eyemovements and may even appear cross-eyed. Babies are born with the abilityto focus only at close range - about 8 to 10 inches or the distance between amother's face to the baby in her arms. Babies are able to follow or track anobject in the first few weeks. Focus improves over the first two to three yearsof life to a normal 20/20 vision. Newborns can detect light and dark butcannot see all colors. This is why many baby books and infant stimulation toyshave distinct black and white patterns.

• hearingDuring pregnancy many mothers find that the baby may kick or jump inresponse to loud noises and quiet with soft, soothing music. Hearing is fullydeveloped in newborns. Babies with normal hearing should startle in responseto loud sounds, pay quiet attention to the mother's voice, and briefly stopmoving when sound at a conversational level is begun. Newborns seem toprefer a higher-pitched voice (the mother's) to a low sounding voice (males).They also have an ability to tune out loud noises after hearing them severaltimes.



It is estimated that serious hearing loss occurs in about one to three of every1,000 healthy newborns. Without screening or testing, hearing loss may notbe noticed until the baby is more than 1 year old. If hearing loss is notdetected until later years, there will not be stimulation of the brain's hearingcenters. This can affect the maturation and development of hearing, and candelay speech and language. Social and emotional development and success in

school may also be affected. It is now recommended that all newborns bescreened for hearing loss before leaving the hospital.

• tasteTaste buds begin forming early in fetal development. It is known that babiesprefer sweet tastes over sour or bitter tastes. Babies also show a strongpreference for breast milk and breastfeeding, especially after the first fewmonths.

• smellThe brain's olfactory (smell) center forms very early in fetal development.Studies have found that newborns have a keen sense of smell. Within the firstfew days they will show a preference for the smell of their own mother,especially to her breast milk.

• touchThroughout the last months of pregnancy, a baby is snugly cocooned in theuterus, with arms and legs tucked. At birth, babies are suddenly thrust into abright, cold world, where their arms and legs can suddenly move freely. Thisnew freedom can make babies frantic and they may flail and thrash about.Placing a hand on the baby's abdomen, or cuddling close can help a baby feelmore secure. Swaddling (wrapping snugly in a blanket) is another techniquefor babies who need to feel tucked and secure. Some mothers find their babiesrespond and calm when they are "worn" in a sling or carrier. This may behelpful for colicky or high-need babies. Holding a baby for feedings is also

important. Breastfeeding ensures that a baby spends several hours inmother's arms.

Newborn - Crying

What are the crying patterns of a newborn?

The first cries of a newborn baby are often music to the ears of parents. However,over the next weeks and months this "music" can become grating and painful. This isespecially true when all attempts fail to stop the crying.

Surprisingly, crying does not produce tears until after the first month or two. Crying is

the way babies communicate. They cry because of hunger, discomfort, frustration,fatigue, and even loneliness. Sometimes, cries can easily be answered with food, or adiaper change. Other times, it can be a mystery and crying stops as quickly as itbegins.

You will soon learn differences in cries, from a cry of "I'm hungry" to "I've beenoverstimulated." It is important to respond to your baby's cries. Contrary to old wives'tales, young babies cannot be spoiled by being picked up when crying. Being held isreassuring and comforting when a baby cannot express him/herself any other way.

Some techniques to help console a crying baby include the following:

• Take care of physical problems first - hunger, diaper change, need to burp.• Walk with baby in a sling or in a stroller.• Rock your baby in a rhythmic, gentle motion.



• Try a baby swing or rocking cradle.• Gently pat or stroke on the back or chest.• Try swaddling the baby.• Go for a ride in the car.• Turn on some white noise (such as a washing machine or vacuum cleaner).

No matter how frustrated you may become, NEVER SHAKE A BABY. This can causesevere injury to the baby's fragile brain. If you become angry or frustrated, allowsomeone else to take over for a while. If you are alone, put the baby down in a safeplace, such as the crib, and go to another room for a few moments. This will give youtime to collect yourself. Then you can return to your baby and try a different tactic tocomfort your baby.

Newborn Immunizations

According to the Centers for Disease Control and Prevention (CDC), vaccine-preventable childhood diseases in the United States are near an all-time low. But,some viruses and bacteria are still active and can cause serious illness. It is importantthat all children, especially infants and young children, receive recommendedimmunizations on time. In other countries, many vaccine-preventable diseases arerelatively common. Because of travel, these diseases could return to the US, resultingin increased, and unnecessary, illness, disability, and death among children.

What is hepatitis B vaccine?

Immunizations start at birth. The first immunization given is the hepatitis B vaccine.Listed below are some facts about hepatitis B:

• Hepatitis B is a disease of the liver caused by hepatitis B virus.

• Potentially, there may not be any symptoms present when first infected (thelikelihood of early symptoms decreases with the person's age); if present:yellow skin or eyes, tiredness, stomach ache, loss of appetite, nausea, or jointpain may occur.

• The younger the person is when infected with hepatitis B, the greater thelikelihood of staying infected and having life-long liver problems, such asscarring of the liver and liver cancer.

• The disease is spread through contact with the blood of an infected person orby having sex with an infected person.

Hepatitis B vaccine will prevent this disease. This vaccine is given to nearly allnewborns. Additional doses are given before the age of 18 months. If newborns areexposed to hepatitis B before, during, or after birth, both the vaccine and a specialhepatitis B immune globulin dose are given within 12 hours of birth. The other twodoses of the vaccine are also given before the age of 18 months.



Summary of the neurologic examination with respect to gestational age

Respiratory and Cardiovascular SystemsRespiratory SystemBaby’s respiration organs begin their work right after the moment of arrival together with his first cry.Breath frequency and intensity changes under the influence of different exogenous and endogenousirritators. Baby’s organism needs much of oxygen, and high frequency of respiration covers thisnecessity. Lungs of a newborn baby are rich in blood vessels and poor in the elastic tissue.

The newborn baby’s nose is little, his nostrils are extremely narrow, the mucous membrane is tender with

a big number of blood vessels that is why even the least inflammation may cause difficulties withbreathing.

Because of the horizontal ribs position and week intercostal muscles a baby breathes often and notdeeply. Because of this respiration peculiarity his lungs do not get filled with oxygen completely, whichleads to oxygen dearth. If your baby spends much time in a badly aired room, it may grow progressivelyworse and it may even cause flatulence. While a baby is crying, his bungs get ventilated better, so aweak baby’s cry may even be useful sometimes.

Cardiovascular SystemBefore the moment of birth baby’s respiration is placental. After the first breath his lungs open and getfilled with blood.

Heart mass of a newborn baby is relatively big. It weights 0,8 % of his body mass. The heart is of a

roundish form and it is situated in the middle of the chest. The correlation of atriums and ventricles of anewborn baby is different than adult people have: babies’ atriums are of a bigger size.



Newborn baby’s pulse is relatively often: up to 120-140 beats per minute. It is quite uneven. Thefrequency of baby’s heartbeats depends on his cry, movements, raised temperature, and other reasons.While your little one is crying, his pulse may be up to 180-200 beats per minute. But the pulse frequencydecreases, as a baby gets older. So, at the age of 6 months, baby’s pulse is about 125-130 beats per minute, and it is 115-120 beats per one minute, when your child is 12 months old.

Assessments for Newborn BabiesEach newborn baby is carefully checked at birth for signs of problems or complications. A complete

physical assessment will be performed that includes every body system. Throughout the hospital stay,

physicians, nurses, and other healthcare providers continually assess a baby for changes in health and

for signs of problems or illness. Assessment may include:Apgar scoring: The Apgar score is one of the first checks of your new baby's health. The Apgar score is

assigned in the first few minutes after birth to help identify babies that have difficulty breathing or have

a problem that needs further care. The baby is checked at one minute and five minutes after birth for

heart and respiratory rates, muscle tone, reflexes and color.

Each area can have a score of zero, one or two, with 10 points as the maximum. A total score of 10

means a baby is in the best possible condition. Nearly all babies score between eight and 10, with one

or two points taken off for blue hands and feet because of immature circulation. If a baby has a difficult

time during delivery, this can lower the oxygen levels in the blood, which can lower the Apgar score.

Apgar scores of three or less often mean a baby needs immediate attention and care. However, only 1.4

percent of babies have Apgar scores less than seven at five minutes after birth.

Birthweight and measurements: A baby's birthweight is an important indicator of health. The

average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs. (3.2 kg). In

general, small babies and very large babies are at greater risk for problems. Babies are weighed daily inthe nursery to assess growth, fluid, and nutrition needs. Newborn babies may lose as much as 10

percent of their birthweight. This means that a baby weighing 7 pounds 3 ounces at birth might lose as

much as 10 ounces in the first few days. Premature and sick babies may not begin to gain weight right

away.

Most hospitals use the metric system for weighing babies. This chart will help you convert grams to

pounds:Converting grams to pounds and ounces: 1 lb. = 453.59237 grams; 1 oz. = 28.349523 grams; 1000

grams = 1 Kg.



Measurements: Other measurements are also taken of each baby. These include the following:

• head circumference - the distance around the baby's head (normally about one-half the baby's

body length plus 10 cm)

•

abdominal circumference - the distance around the abdomen

• length - the measurement from crown of head to the heel

Physical examination: A complete physical examination is an important part of newborn care. Each

body system is carefully examined for signs of health and normal function. The physician also looks for

any signs of illness or birth defects. Physical examination of a newborn often includes assessment of:

• vital signs:

o temperature - able to maintain stable body temperature 98.60 F (370 C) in normal

room environmento pulse - normally 120 to 160 beats per minute



o breathing rate - normally 30 to 60 breaths per minute

• general appearance - physical activity, tone, posture, and level of consciousness

• skin - color, texture, nails, presence of rashes

• head and neck

o appearance, shape, presence of molding (shaping of the head from passage through

the birth canal)

o fontanels (the open "soft spots" between the bones of the baby's skull)

o clavicles (bones across the upper chest)

• face - eyes, ears, nose, cheeks

• mouth - palate, tongue, throat

• lungs - breath sounds, breathing pattern

• heart sounds and femoral (in the groin) pulses

•

abdomen - presence of masses or hernias• genitals and anus - for open passage of urine and stool

• arms and legs - movement and development

Gestational assessment: Assessing a baby's physical maturity is an important part of care. Maturity

assessment is helpful in meeting a baby's needs if the dates of a pregnancy are uncertain. For example,

a very small baby may actually be more mature than it appears by size, and may need different care

than a premature baby.

An examination called The Dubowitz/Ballard Exam for Gestational Age is often used. A baby'sgestational age often can be closely estimated using this exam. The Dubowitz/Ballard Exam evaluates a

baby's appearance, skin texture, motor function, and reflexes. The physical maturity part of the exam is

done in the first two hours of birth. The neuromuscular maturity examination is completed within 24

hours after delivery. Information often used to help estimate babies' physical and neuromuscular

maturity are shown below.



Physical maturity: The physical assessment part of the Dubowitz/Ballard Exam looks at physical

characteristics that look different at different stages of a baby's gestational maturity. Babies who are

physically mature usually have higher scores than premature babies.

Points are given for each area of assessment, with a low of -1 or -2 for extreme immaturity to as much

as 4 or 5 for postmaturity.

• skin - ranges from sticky and red to smooth to cracking or peeling lanugo (the soft downy hair

on a baby's body) is absent in immature babies then appears with maturity and then disappears

again with postmaturity

• plantar creases - these creases on the sole of the feet range from absent to covering the entire

foot depending on the maturity

• breast - the thickness and size of breast tissue and areola (the darkened nipple area) are

assessed

• eyes and ears - eyes fused or open and amount of cartilage and stiffness of the ear tissue are

assessed



• Increased oxygen in the lungs causes a decrease in blood flowresistance to the lungs.

• Blood flow resistance of the baby's blood vessels also increases.• Amniotic fluid drains or is absorbed from the respiratory system.• The lungs inflate and begin working on their own, moving oxygen into

the bloodstream and removing carbon dioxide through exhalation.

TEMPERATURE REGULATION

A developing baby produces about twice as much heat as an adult. That heatdissipates as blood flows into the mother's circulation via the placenta and iscooled. A small amount of heat is removed through the developing baby'sskin, the amniotic fluid, and the uterine wall.

After delivery, the newborn begins to lose heat. Receptors on the baby's skinsend messages to the brain that the baby's body is cold. The baby's bodythen creates heat by shivering and by burning stores of brown fat , a type of fat found only in fetuses and newborns.

LIVER

In the fetus, the liver acts as a storage site for sugar (glycogen) and iron.When the baby is born, the liver has various functions:

• It produces substances that help the blood to clot.• It begins breaking down waste products such as excess red blood

cells.• It produces a protein that helps break down bilirubin. If the baby's bodydoes not properly break down bilirubin, it can lead to newborn jaundice .

GASTROINTESTINAL TRACT

A baby's gastrointestinal system doesn't fully function until after birth.However, in the womb, it does allows the baby to absorb nutrients from theplacenta.

In late pregnancy, the fetus produces a tarry green or black waste substance

called meconium. Meconium is the medical term for the newborn infant's firststools. Meconium is composed of amniotic fluid, mucous, lanugo (the fine hair that covers the baby's body), bile, and cells that have been shed from the skinand the intestinal tract. In some cases, the baby passes stools (meconium)while still inside the uterus.

URINARY SYSTEM

The developing baby's kidneys begin producing urine by 9 - 12 weeks into thepregnancy. After birth, the newborn will usually urinate within the first 24 hoursof life. The kidneys become able to maintain the body's fluid and electrolytebalance.

http://www.nlm.nih.gov/medlineplus/ency/article/001559.htm




The rate at which blood filters through the kidneys (glomerular filtration rate)increases sharply after birth and in the first 2 weeks of life. Still, it takes sometime for the kidneys to get up to speed. Newborns have less ability to removeexcess salt (sodium) or to concentrate or dilute the urine compared to adults.This ability improves over time.

IMMUNE SYSTEM

The immune system begins to develop in the fetus, and continues to maturethrough the child's first few years of life. The womb is a relatively sterileenvironment. But as soon as the baby is born, he or she is exposed to avariety of bacteria and other potential disease-causing substances. Althoughnewborn infants are more vulnerable to infection, their immune system canrespond to infectious organisms.

Newborns do carry some antibodies from their mother, which provideprotection against infection. Breastfeeding also helps improve a newborn'simmunity.

SKIN

Newborn skin will vary depending on the length of the pregnancy. Prematureinfants have thin, transparent skin. The skin of a full-term infant is thicker.

Characteristics of newborn skin:

•

A fine hair called lanugo might cover the newborn's skin, especiallypreterm babies. The hair should disappear within the first few weeks of the baby's life.

• A thick, waxy substance called vernix may cover the skin. Thissubstance protects the fetus from constant exposure to amniotic fluid inthe womb. Vernix should wash off during the baby's first bath.

• The skin might be cracking, peeling, or blotchy, but this should improveover time.

Other possible skin changes in the newborn:

•

Acne may be seen from birth, but it should go away within a fewmonths.• Milia are small white spots on the cheeks and nose. They are filled with

a waxy protein called keratin. They should disappear within the first fewweeks.

• Mongolian spots are blue-gray or brown spots can emerge on the skinof the buttocks or back, mainly in dark-skinned babies. They shouldfade within a year.

• Stork bites are small red patches on the baby's forehead, eyelids, backof the neck, or upper lip are caused by stretching of the blood vessels.They often go away within 18 months.





newborn screening tests for disorders that, if left untreated, may

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