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Normal Newborn

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Introduction:

1. Definition of neonatal period:

A period from

birth 4 weeks postnatal.

After the initial observation for neonatal

condition requiring immediate intervention,

the baby is sent to the normal newborn

nursery or maternity floor for the purpose of

follow up and stabilization.

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The role of the neonatal nurse

& physician inside the normal

newborn nursery or maternity

floor:

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Admission Care: The role of the nurse is:

- To carry out good interpersonal communication.

- To take complete history about the mother and

neonate.

- To be sure that the neonate has identification band.

- To perform complete physical assessment (General

appearance, V.S, Gestational age assessment).

- Prevention of hemorrhage (administer vit K if not

given in the delivery room).

- Documentation.

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Assessment:

The initial assessment:

APGAR scoring system

Purpose:

is to assess the newborn´S immediate adjustment to

extrauterine life

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APGAR Score

Score /

Item

2 1 zero

Heart beats

> 100 b/min

Strong

< 100 b/min

Or weak beats

No heart

beats

Cry &

breathing

Strong

crying

weak crying /

irregular

breathing

No cry /

breathing

Color Pink body &

face

Pink body & blue

extremities

Pale or

blue body

Movement &

tone

Active Some movements Flaccid

Grimace Try to keep

cath. away

Grimace of face No

response

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Transitional assessment (Periods of

reactivity):

I) First period of reactivity:

Stage 1: during the first 30 min. through which

the baby is characterized as Physiologically

unstable ( ), very alert, cries vigorously, may

suck a fist greedily, & appears very interested

in the environment.

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Stage 2: it lasts for about 2-4 hours, through

this period; all V.S & mucus production are

decreased. The newborn is in state of sleep

and relative calm.

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II) Second period of reactivity: it lasts for

about 2-5 hours, through which the newborn is

alert and responsive, heart & respiratory rate,

gastric & respiratory secretions are increased &

passage of meconium commonly occurs.

Following this stage is a period of stabilization

through which the baby becomes

physiologically stable & a vacillating pattern of

sleep and activity.

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passage of meconium

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Assessment of Gestational age:

(High-risk neonate)

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Systematic Physical examination:

- Growth measurements

- Vital Signs

- General appearance:

. Posture:

Flexion of head & extremities,

taking them toward chest & abdomen

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Posture

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. Skin:

General description:

At birth; color:

bright red, texture: soft and has good

elasticity.

Edema is seen around eye, face, and

scrotum or labia.

Cyanosis of hands & feet (acrocyanosis)

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General description of the skin

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Acrocyanosis

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1. Vernix Caseosa: Soft yellowish cream layer

that may thickly cover the skin of the

newborn, or it may be found only in the

body creases and between the labia.

The debate of wash it off or to keep

it.

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Vernix Caseosa

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2. Lanugo hair:

- Distribution

- The more premature baby is, the heavier

the presence of lanugo is.

- It disappears during the first weeks of life

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Lanugo hair

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3. Mongolian spots:

Black coloration on the lower back, buttocks,

anterior trunk, & around the wrist or ankle.

They are not bruise marks or a sign of mental

retardation, they usually disappear during

preschool years without any treatment.

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Mongolian spots

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Mongolian spots

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Mongolian spots

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4. Desquamation:

- Peeling of the skin over the areas of bony

prominence that occurs within 2-4 weeks of

life because of pressure and erosion of

sheets.

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Desquamation

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5. Milia:

- Small white or yellow pinpoint spots.

- Common on the nose, forehead, &

chin of the newborn infants due to

accumulations of secretions from the sweat &

sebaceous glands that have not yet drain

normally.

They will disappear within 1-2 weeks, they

should not expressed.

• superficial epidermal inclusion cysts that contain laminated

• keratinized material.

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Milia

6-Erythema Toxicum

• A benign, self-limited, evanescent eruption,

• in '" 50% of full-term infants; preterm less common.

• firm, yellow-white, 1- to 2-mm papules or pustules with a

surrounding erythematous flare

• sparse or numerous,

• palms and soles are usually spared.

• Peak incidence 2nd day of life,

• new lesions may erupt during the 1st few days as the rash

waxes and wanes.

• Onset may occasionally be delayed for a few days to

weeks in premature infants.

Erythema Toxicum

• The pustules form below the stratum corneum or deeper in

the epidermis

• eosinophils can be demonstrated in Wright-stained

• Cultures are sterile.

• The cause of erythema toxicum is unknown.

• mimic pyoderma, candido sis, herpes simplex, transient

neonatal pustular melanosis, and miliaria

• The course is brief, and no therapy is required.

• Incontinentia pigmenti and eosinophilic pustular folliculitis

also have eosinophilic infiltration but can be distinguished

by their distribution, histologic type, and chronicity.

• transient, benign, self-limited dermatosis

• of unknown cause– present at birth,

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8-Jaundice

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Physiological Jaundice

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Head:

The Anterior fontanel: is diamond in shape,

located at the junction of 2 parietal & frontal

bones. It is 2-3 cm in width & 3-4 cm in length.

It closes between 12-18 months of age.

The posterior fontanel: is triangular in shape,

located between the parietal & occipital bones.

It closes by the 2nd month of age.

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Fontanels should be flat, soft, & firm. It

bulge when the baby cries or if there is

increased in ICP.

Two conditions may appear in the head:

Caput succedaneum & cephalhemtoma

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Caput succedaneum

• An edematous swelling on the presenting portion

of the scalp of an infant during birth, caused by

the pressure of the presenting part against the

dilating cervix. The effusion overlies the

periosteum with poorly defined margins.

• Caput succedaneum extends across the midline

and over suture lines. Caput succedaneum does

not usually cause complications and usually

resolves over the first few days. Management

consists of observation only.

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Caput succedaneum

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Caput succedaneum

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Caput succedaneum

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Cephalhematoma:

Cephalhematoma is a subperiosteal collection

of blood secondary to rupture of blood vessels

between the skull and the periosteum, in which

bleeding is limited by suture lines (never cross

the suture lines).

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Cephalhematoma

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Cephalhematoma

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Head Circumference

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8. Eyes:

- Usually edematous eye lids

- Gray in color. True color is not determined

until the age of 3-6 months.

- Pupil: React to light

- Absence of tears

- Blinking reflex is present in response to touch

- Can not follow an object (Rudimentary

fixation on objects).

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Normal Eye

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Eyelid Edema

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Dysconjugate Eye Movements

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Subconjunctival Hemorrhage

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Congenital Glaucoma

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Congenital Cataracts

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9. Ears:

Position:

Startle Reflex:

Pinna flexible, cartilage present.

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Normal Ears

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Ear Tag

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10. Nose:

Nasal Patency (stethoscope).

Nasal discharge – thin white mucous

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Normal Nose

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Dislocated Nasal Septum

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11. Mouth & Throat:

- Intact, high arched palate.

- Sucking reflex – strong and coordinated

- Rooting reflex

- Gag reflex

- Minimal salivation

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12. Neck:

Short, thick, usually surrounded by skin

folds.

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Neck

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System assessment of the neonates:

1. Gastrointestinal System:

Mouth should be examined for abnormalities

such as cleft lip and/or cleft palate.

Epstein pearls are brittle, white, shine spots

near the center of the hard palate. They mark

the fusion of the 2 hollows of the palate. If

any; it will disappear in time.

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Cleft Palate

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Cleft Lip

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Cheeks: Have a chubby appearance

due to development of fatty sucking

pads that help to create negative

pressure inside the mouth which

facilitates sucking.

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Epstein Pearls & cheeks

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Normal Tongue Ankyloglossia

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Ankyloglossia

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Gum: May appear with a quite irregular

edge.

Sometimes the back of gums contain whitish

deciduous teeth that are semi-formed, but

not erupted

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Irregular edges with Natal Teeth

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Natal Tooth

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13. Abdomen:

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Abdomen

• Cylindrical in

Shape

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Normal Umbilical Cord

• Bluish white

at birth with

2 arteries &

one vein.

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Meconium Stained Umbilical Cord

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14. Circulatory system:

Heart:

Apex- lies between 4th & 5th intercostal

space, lateral to left sternal border.

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15. Respiratory system:

• Slight

substernal

retraction

evident during

inspiration

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15. Respiratory system Cont.:

• Xiphesternal

process

evident

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15. Respiratory system Cont. :

Respiratory is chiefly abdominal

Cough reflex is absent at birth, present by 1-2

days postnatal.

Possible signs of RDS are:

- Cyanosis other than hands & feet.

- Flaring of nostrils.

- Expiratory grunt-heard with or without

stethoscope.

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16. Urinary System:

Normally, the newborn has urine in the bladder

and voids at birth or some hours later.

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Female genitalia

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Female genitalia Cont.

• Labia & Clitoris

are usually

edematous.

• Urethral meatus is

located behind the

clitoris.

• Vernix caseosa is

present between

labia

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Normal Male genitalia

• Urethral opening is at

tip of glans pens.

• Testes are palpable in

each scrotum.

• Scrotum is usually

pigmented, pendulous

& covered with rugae.

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17. Endocrine system:

Swollen breasts:

Appears on 3rd day in both sex, & lasts for 2-3

weeks and gradually disappears without

treatment.

N.B: The breasts should not be expressed as

this may result in infection or tissue damage.

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Maternal hormonal withdrawal

• Female

genitalia,

normal with

vaginal

discharge

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Infantile menstruation

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18. The Central Nervous system:

Reflexes:

Successful use of reflex mechanism is a

strong evidence of normal functioning

CNS.

• Moro

• Stepping &

placing

• Grasp

• Sucking

نوزاد

چرخش سر

حرکات بی هدف اندام ها

مکیدن

نگاه چشمی

خنده غیرارادی

ترجیح چهره و صدای مادر

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• Moro Reflex

• C5-6

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Extremities

• Nail

beds

pink

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Extremities Cont.

• Meconium

Stained

fingernails

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Extremities

• Creases on

anterior two

thirds of

sole.

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Common feet abnormalities

• Club Feet

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Immediate Care of the

Newborn:

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Immediate Care of the Newborn:

1. Clear airway.

2. Established respiration.

3. Maintenance of body temperature.

4. Protection from Hge.

5. Identification.

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The Four modalities by which the infant lost his/ her body temperature: 1- Evaporation: Heat loss that resulted from expenditure of internal thermal energy to convert liquid on an exposed surface to gases, e.g.: amniotic fluid, sweat. Prevention: Carefully dry the infant after

delivery or after bathing.

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2- Conduction: Heat loss occurred from direct contact between body surface and cooler solid object. Prevention: Warm all objects before the infant comes into contact with them.

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3- Convection: Heat loss is resulted from exposure of an infant to direct source of air draft. Prevention: · Keep infant out of drafts · Close one end of heat shield in

incubator to reduce velocity of air.

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4- Radiation:

It occurred from body

surface to relatively distant objects that

are cooler than skin temperature.

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:تابع الأهداف التعليميه

يعرفة انعُبصر انًكىَه نًقيبس أبجبر وكيف ويتي يتى .3

.إستخذايه ويٍ ثى إدراك أهًيته

.يعرفة كيفية انعُبيه ببنحبم انسري4.

تقذيى انعُبيه انروتيُيه نهًىنىد فىر الإطًئُبٌ عهي ثببت 5.

.انعلايبت انحيىيه حىل يعذلاتهب انطبيعيه

إدراك أهًية ويًيزات انبذء انًبكر في إعطبء انرضبعه 6.

.انًىنىد, انطبيعيه سىاء ببنُسبه نلأو أ

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*) General management:

1- Infant should be warmed quickly by wrapping

in a warm towel.

2- Uses extra clothes or blankets to keep the

baby warm.

3- If the infant is in incubator, increase the

incubator’s temperature.

4- Use hot water bottle (its temperature 50 °C).

5- Food given or even intravenous solution

should be warm.

6- Avoid exposure to direct source of air drafts.

7- Check body temperature frequently.

8- Give antibiotic if infection is present.

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Thank you