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Normal newborn final
1. Normal Newborn
Dr Varsha Atul Shah
Consultant
Dept. of Neonatal& Dev Medicine
Singapore General Hospital
2. Newborn Adaptation At Birth
o Circulatory changes (gas exchange from placenta to the lungs)
g Reabsorption of fetal lung fluid
f Closure of patent ductus arteriosus
t Stabilization of cardiac rhythm
Establishment of regular breathing
Temperature regulation
l Changes in carbohydrate metabolism
3. Circulatory changes
g Reduction of pulmonary vascular resistance, increased PBF by
10 folds
m Increase in left atrial pressure
Closes foramen ovale
v Increase systemic vascular resistance
c Rt to lt flow at PDA diminishes, closes PDA
PS: failure to achieve reduce PVR cause PPHN
8. Lung changes
Lung fluid absorption (failure cause TTNB, Transient
Tachypnea of Newborn)
b RR rises to 60/min
i Transient grunting, mild retraction, ala nasi flare may
be seen
9. Carbohydrate Metabolism
a Cessation of maternal glucose supply
e Decline in glucose level by 2 hrs
s 20-30% CHO comes from milk
Gluconeogenesis from AA, glycerol, lactate
10. Temperature regulation
l Low ambient temp, evaporation, radiation, convection,
conduction loss of heat –Hypothermia
o Achieve Neutral thermal environment
t Drying, swaddling, skin-skin contact, radiant warmer, leave
vernix, wrapping, early feeding
11. Immediate care after birth
Prevent hypothermia
Eye, skin, cord care
Give injection vitamin K
Breastfeed within ½ hour of birth
Search for malformations
12. Increased risk of malformation
Single umbilical artery
Simian crease
Dysmorphic features
Asymmetric cry due to absence of Depressor
Angularis Oris Muscle
Excessive drooling of saliva
13. Quick screening for malformations
Screen from top to bottom and in midline
Orifice examination
– Anal opening
– Oesophagus patency*
– Choanal atresia
– * SGA baby, polyhydramnios, excessive drooling,
• single umbilical artery
14. Essential postnatal care
Nurse in thermal comfort
(warm to touch, pink soles)
Check umbilicus, skin, eyes
Good sucking at breast
Screen for danger signals
Advice on immunization
15. Care of umbilical stump
Inspect 2 to 4 hours after ligation for bleeding
Do not apply anything, keep cord
clean and dry
Inspect for discharge or infection till healing
occurs
16. Care of the skin
Dry using soft prewarmed clean cloth
Bathing soon after birth is not
recommended
Do not make vigorous attempts to
remove vernix caseosa
Inspect for superficial infections
17. Care of the eyes
Clean at birth and subsequently daily
For sticky eyes use normal saline or appropriate
medication
u Nasolacrimal duct blockage, Massaging helps
18. Danger signs
Lethargy r Bleeding
Hypothermia r Yellow palms/ sole
Respiratory distress l Excessive wt loss
r Cyanosis s Vomiting
r Convulsions s Diarrhoea
r Abd distension
19. Infant Classification
-by Gestational Age
ATerm : 37-41+6/7 weeks
Preterm: <37 weeks
k Post-term: 42 or more weeks
20. Infant Classification
-by birthweight
a Macrosomia: 4000 gm or more
Normal birthweight: 2500-3999 gm
h Low birthweight: <2500 gm
Very low birthweight: <1500 gm
i Extremely low birthweight: <1000 gm
21. Term infant
A well term infant loses up to 10% of birth weight in
the first week of life;
f Birth weight is regained by 10-14 day and thereafter
gains 30g/day.
r His caloric intake/requirement is 100-120 kcal/kg/day
k with 2-5 g/kg/day of protein for cellular growth.
22. Infant Classification
-by Gestational Sizes
S Appropriate for gestational age
g Large for gestational age
i Small for gestational age
i classify based on maturity
and intrauterine growth
PS:Energy stores in the fetus builds up mostly
during the 3rd trimester of the pregnancy.
23. Gestational Age Assessment
A Maternal dates
S Early Ultrasound dating
Dates of first recorded fetal activity
e Dates of first recorded fetal heart sounds
e Dubowitz or Ballard scores
26. Physical Examination
of the Newborn
t Purpose
- detect malformations or deformations
- determine manifestations of various neonatal
diseases
- evaluate the effects of labour and delivery
on newborn
27. Physical Examination
t General appearance
- cyanosis, nasal flaring, intercostal retractions, grunting, meconium staining
of skin, perfusion, level of spontaneous activity, tone, cry
Vital signs
- HR (120-160 beats/min), RR (30-60 breaths/min), To, b/p, Wt, length and
OFC In term healthy infants, the core temperature will fall after birth by about
0.8-2 degrees Celsius.
l Gestational age assessment
28. Physical Examination
t Skin
- harlequin color change, hair tufts, mongolian spots, naevus
flammus, malia malenocytic naevus, haemangiomas, pustular
melanosis, erythema toxicum
e Skull
- cranial synostosis, fontanels, craniotabes, caput
succedaneum, subgaleal hemorrhage
44. Milky white or blood-streaked vaginal
discharge is the result of maternal
hormone withdrawal.
45. Physical Examination
t Hip assessment
- Barlow test, Ortolani manoeuver to determine whether femoral head
can be displaced from acetabulum and replaced respectively
Neurologic assessment
- tone, alterness, primitive reflexes (Moro’s, palmar grasp, rooting
reflex), deep tendon reflexes, spontaneous motor activity, cranial nerves