normal newborn - wordpress.com · 2014-10-13 · normal newborn. objectives quickly ... newborn...
TRANSCRIPT
objectives
Quickly identify any danger signs
Assess the normal adaptations of a
newborn after birth
Identify conditions requiring special care or
follow-up observation.
Identify any birth defect or birth trauma;
Monitor growth
Counsel the mother
TERMS:
Neonatal Period:
Birth --> 28 days of life
Term Infant:
38 - 42 weeks of gestation
Transition Period: Phases of instability
during the first 6-8 hours after birth
(?????)
Gestational Age & Birth Weights
Gestational Age:– Pre-term: < 37 weeks
– Term: 37-41 6/7 weeks
– Post-term: 42 or more weeks
Term Infant (weight classification)– LGA: >4000 g
– AGA: 2500-3999 g
– SGA: <2500 g
Gestational
Age
Classification
Pre-term, term, and
post term infants
must all be plotted to
determine if they are
SGA, AGA, and LGA
with regards to
weight, length, and
head circumference.
LGA
AGA
SGA
X X X
danger signs for newborn
not feeding well
Fast breathing, difficult breathing with severe
chest in drawing ,grunting ,cyanosis
Convulsions
hypothermia, fever
Reduced movement, and jaundice appearing
anywhere on the first day or palmer or sole
jaundice at any age
Newborn examination indications
Immediately after birth
Before discharge from maternity unit
Whenever there is any concern about the
infant's progress
Examination precaution
Hand washing,hand washing ,hand
washing
Thermal environment
Light and noise
Brief examination time
General examination
Attention : at initial ex
Congenital anomalies
Infant has successful transition from fetal
life to air breathing
Gestational age ,delivery medication
Any sign of infection or metabolic disease
APGAR Score
Score 0 1 2
Heart Rate Absent <100bpm >100bpm
Respiratory effort Absent, irregular Slow, crying Good
Muscle tone(activity) Limp Some flexion of
extremities
Active motion
Reflex irritability (nose
suction)
No response Grimace Cough or sneeze
Color Blue, pale Acrocyanosis Completely pink
Newborn first exam
Postnatal assessment of gestational
age
New Ballard Score
Accuracy within 1-2 weeks
2 parts– Neurologic characteristic
– Physical characteristic
Part of general examination
General(Growth parameters)
Weight (Naked) N:( 2.5-˂4 kg) full term
,loss of weight is expected by 5-10% in the
first few days
Length(straight) N:(48-53cm ) full term
Head circumference(3 measurements)
N:(33-38 cm) full term
Vital Sign
Heart RateHR 120-160
Respiratory Rate
RR 40-60 periodic rather than regular
Temperature skin: 36-36.5 C
rectal :36.5-37.5 C
Blood Pressure
General
Well, Distress or not?
skin
– Pink is normal
– Acro cyanosis is normal
– Cyanosis
-- pallor
– Jaundice
– Common variants skin rash
• Erythema toxicum, mongolian spot
Vigorous cry is assuring
Weak cry
– sepsis, asphyxia, metabolic, narcotic use
High pitch cry
– CNS causes, kernicterus
Erythema Toxicum Erythematous
macules and firm 1-3
mm yellow or white
papules
Etiology obscure
Papule contain
eosinophils and are
sterile
Appear in the first 3-
4 days of life
– Range: Birth to 14
days
Benign and self
limited
Mongolian Spots
Slate-gray to blue-
black lesions
Usually over
lumbosacral area and
buttocks
Accumulation of
melanocytes within
the dermis
Generally fade by age
1year
Head Forceps and vacuum
marks
Caput succedaneum
– Boggy edema in presenting part of head
– Cross suture lines
– Disappear in few days
Cephalhematoma
– Subperiosteal
– Weeks to resolve
– Dose not cross sutures
Newborn Scalp Hematomata
Chest
Distress signs(,Tachypnea,Nasal flaring,asymetric chest
rise,supra-sternal, intercostal, sub costal retraction
Grunting ).
Deformities(Pectus excavatum, carinatum)
Auscultate
– Air entry, symmetry
– crepitation
Breast hypertrophy
– Milk production
– No redness
Abdomen
Inspection– Scaphoid
– Distention
– Abdominal wall defect (gastroschisis)
Palpation; baby sucking and use warm hands
– Liver 2.5 cm
– Spleen may palpable
– Umbilical vessels• 2 artery, one vein
– Hernias ; umbilical and inguinal
Genitalia
Penile size
Hypospadias, epispadias
Testes– 2% crypoorchid
– Hydrocele
Female:– Prominent clitoris and majora
– Vaginal skin tag
– Vaginal discharge /blood
– Labial fusion
Anus : Patency and location
Hip and Extremities
Erb’s palsy: extended arm and internal rotation with limited
movement
Humorus fracture ,clavicle fracture
Digital abnormality
– Syndactaly, brachdactaly, polydactaly
Single palmar crease
Hip dislocation
Feet deformities
Back and spine
– abnormal curvature
– Sinus tract, tuft of hair
Neonatal reflexes
Also known as developmental, primary,
or primitive reflexes.
They consist of autonomic behaviors
that do not require higher level brain
functioning. They can provide
information about lower motor neurons
and muscle tone.
They are often protective and disappear
as higher level motor functions emerge.
Moro
Onset: 28-32 weeks GA
Well-established: 37 weeks GA
Disappearance: 4-6 months
How to elicit and what is the response?
An absent or inadequate Moro response on
one side : hemiplegia, brachial plexus palsy,
or a fractured clavicle
Persistence beyond 6 months of age is :
indicate severe neurological defects