characteristics of newborn

8/2/2019 Characteristics of Newborn

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In medical contexts, newborn or neonate (from Latin, neonatus, newborn) refers to an

infant in the first 28 days after birth.

Healthy newborn infant born at term, cries immediately after birth and

establish satisfactory rhythmic pulmonary respiration.

POSTURE:-

The newborn assumes the same posture after birth as in utero.

MEASUREMENTS:-

Length 50 cm (20 inches). Weight2.8 to 3.5 kg. Head circumference 3335 cm. Chest circumference 30 - 33 cm.

VITAL SIGNS OF THE NEWBORN INFANTS

TEMPERATURE

Infants temperatureat birth is slightly higher than the mothers. The temperature drops immediately after birth in response to the extra uterine

environment due to

Skin is very thin and does not contain much subcutaneous fat. The infants heat regulating mechanism has not fully developed.

The temperature rises normal within about8 hours. Normal body temperature for a healthy baby is between 97 and 100.4 degrees

Fahrenheit (36 to 38 degrees Celsius) - American Academy of Pediatrics

(AAP).

PULSE
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The pulse rate is normally irregular, due to immaturity of the cardiac regulatorycenter in the medulla.

The normal pulse ranges for an infant is 120 to 150 beats per minute (bpm). The rate may raise when infant is crying and drop when infant is sleeping. The apical pulse is considered the most accurate.RESPIRATION

Respirations in the neonate are irregular in depth, rate and rhythm. It varies from 35 to 50 per minute. Normally, respirations are gentle, quiet, rapid, and shallow.BLOOD PRESSURE

In infants the flush and Doppler* methods of blood pressure measurement areusually used.

Normal blood pressure at birth is determined by the birth weight of the baby. A newborn has a normal blood pressure of about70 over 42 mm of Hg.

CHARACTERISTICS OF NEWBORN INFANTS HEAD

Infants head is one fourth of his total body length. Normal head circumference is 3335 cm (13- 14). FONTANELS (SOFT SPOTS) The fontanels are openings at the points of union of

the skull bones. There are normally several fontanels on a newborn's skull, mainly

at the top, back, and sides of the head.

1. Anterior fontanel (bregma) The anterior fontanel is diamond shaped and is located at juncture of

two parietal and two frontal bones.

It is 2 to 3 cm in width and 3 to 4 cm in length. It usually closes between 12 to 18 months.

2. Posterior fontanel (lamda) The posterior fontanel is triangular and located between the occipital

and parietal bones.
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It is much smaller than the anterior fontanel. It usually closes between 1 to 2 months.

Figure 1 Sutures of skull

Figure 2 Fontanels


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MOLDING Molding is the temporary reshaping of the fetal head as it passes through the

birth canal during childbirth.

During the molding process the over lapping of skull bones occurred and itreduces the diameter of the skull temporarily.

This elongated look usually disappears a few hours after birth.

Figure 3 Molding

Figure 4 Molding


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CAPUT SUCCEDANEUM A caput succedaneum is an edema of the scalp at the neonates presenting

part of the head.

It often appears over the vertex of the newborns head as a result of pressureagainst the mothers cervix during labor.

The edema in caput succedaneum crosses the suture lines. It may involve wide areas of the head or it may just be a size of a large egg.

Causes

Mechanical trauma of the initial portion of scalp pushing through a narrowedcervix

Prolonged or difficult delivery Vacuum extraction

Management

Needs no treatment. The edema is gradually absorbed and disappears aboutthe third day of life.

Figure 5 Caput succedaneum and Cephalhematoma


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CEPHALHEMATOMA It is an accumulation of blood between the periosteum and a flat skull bone. The collection of blood does not cross a suture line. A Cephalhematoma may not be evident during the first few days of life

because of the presence of a large caput succedaneum.

Aspiration of this sanguineous collection should not be done because ofdanger of infection.

The condition usually clears within few weeks.Causes

Rupture of a periostal capillary due to the pressure of birth Instrumental delivery.

Management

Observation and support of the affected part. Transfusion and phototherapy may be necessary if blood accumulation is

significant.

DIFFERENCE BETWEEN A CAPUT SUCCEDANEUM AND CEPHALHEMATOMA

INDICATORS CAPUT SUCCEDANEUM CEPHALHEMATOMA

Location Presenting part of the head Periosteum of skull bone and

bone

Extent of

Involvement

Both hemispheres; CROSSES

the suture lines

Individual bone; DOES NOT

CROSS the suture lines

Period of Absorption 3 to 4 days Few weeks to months

Treatment None Support


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It appears primarily in full term infants, while premature and post mature birthsgenerally lack any.

Functions

Moisturizing the infant's skin, and facilitating passage through the birth canal. It serves to conserve heat and protect the delicate newborn skin from

environmental stress.

Vernix is also thought to have an antibacterial effect. Chemical role of Vernix in protecting the infant from infection.

Figure 7 Vernix caseosa

3. MILIA

Tiny white spots very often appear on a newborn's face and gums during the firstweek. The spots are called milia (say "MIL-ee-uh").

Sometimes they also appear on the roof of the mouth (palate), where they are calledEpstein pearls.
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Milia occur when dead skin becomes trapped in small pockets at the surface of theskin or mouth.

Milia are common in newborn infants. Milia go away by themselves in a few weeks and aren't harmful.

Figure 8 Milia

4. STROKE BITES

A stork bite is a common type of birthmark seen in a newborn. It is most often temporary. The medical term for a stork bite is nevus simplex. A stork bite is also called a salmon patch. A stork bite usually looks pink and flat. A baby may be born with a stork bite, or the birthmark may appear in the first

months of life.

Stork bites may be found on the forehead, eyelids, nose, upper lip, or back of theneck.


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A stork bite is due to a stretching (dilation) of certain blood vessels. It may become darker when the child cries or the temperature changes. It may fade when you push on it. No treatment is needed.

Figure 9 Stroke bite

5. HEMANGIOMA - Hemangiomas are simply a collection of extra blood vessels in the skin.

They may have different appearances depending on the depth of the increased numbers of

blood vessels.

Strawberry Hemangioma is an abnormal collection of blood vessels in the skincharacterized by a bright red color and well-defined border.


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ADeep or CavernousHemangioma is a large, collection of blood vessels beneaththe skin surface characterized by a soft, bluish, or skin colored mass.

ACombined Hemangioma is a combination of a deep and superficial (strawberry)hemangioma.

TYPICAL GROWTH PATTERN OF HEMANGIOMAS

Age of Child Hemangiomas

Birth often not present or noticeable

1-2 months becomes noticeable

1-6 months grows most rapidly

12-18 months begins to shrink (involute)

Figure 10 Hemangioma


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6. MONGOLIAN SPOTS (CONGENITAL DERMAL MELANOCYTOSIS OR DERMAL

MELANOCYTOSIS)

Mongolian spots are flat, blue, or blue-gray skin markings near the buttocks thatcommonly appear at birth or shortly thereafter.

Mongolian spots are noncancerous skin markings and are not associated withdisease.

The markings may cover a large area of the back. Symptoms include:

a) Blue or blue-gray spots on the back, buttocks, base of spine, shoulders, andother body areas

b) Flat area with irregular shape and unclear edgesc) Normal skin textured) The spots are usually 2 - 8 centimeters wide

Figure 11 Mangolian spot


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7. PETECHIAE

These are small, blue-red dots on the infants body caused by the breakage of tinycapillaries.

They may be seen on the face as a result of pressure exerted on the head duringbirth.

True petechia does not blanch on pressure.

Figure 12 Petechiae

8. ERYTHEMA TOXICUM

Erythema toxicum is a common, noncancerous skin condition seen in newborns. Its cause is unknown. The main symptom is a rash of small, yellow-to-white colored papules surrounded

by red skin.

There may be a few or several papules. They usually appear on the face and middle of the body, but may also be seen on the

upper arms and thighs.

Erythema toxicum may appear in 50 percent or more of all normal newborn infants. It usually appears in term infants between the ages of3 days and 2 weeks.
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Figure 13 Erythema toxicum

CHARACTERISTICS OF NEWBORN INFANTS EYES, EARS AND NOSE

1. EYES

The eyes are blue or gray at birth, changing to the permanent colour in 3 to 6months.

Eye movements are not coordinated. The eye lids may be edematous for about 2 days after birth. Chemical conjunctivitis may follow instillation of silver nitrate drops into the eyes

soon after birth to prevent ophthalmia neonatorum.

The lacrimal apparatus is small and non functioning at birth, but lacrimal fluid ispresent in the eyes to some degree from birth. It has two functions:

to cleanse the eyes. to prevent drying of the conjunctiva.

The cornea should be transparent and clear and the iris of the eye should be round.2. EARS

The infant ears tend to be folded and creased. A line drawn through the inner and outer canthi of the eye should come to the top

notch of the ear.

The infant usually responds to sound at birth.


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Low set ears may be an indication of mental retardation, renal anomalies, orcraniofacial malformation.

3. NOSE

At birth, the nose and mouth are often filled with mucus.CHARACTERISTICS OF NEWBORN INFANTS MOUTH AND THROAT

Cleft lip and palate are birth defects that affect the upper lip and the roof of themouth.

Precocious dentition or supernumerary teeth may be observed in the lowerincisor area or elsewhere on the gums.

Epstein pearls are temporary accumulations of epithelial cells. Oral Thrush is a fungal infection of mouth. It is caused by an overgrowth of

Candida Albicans.

Figure 14 Oral thrush
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Figure 15 Cleft lip and palate

Figure 16 Epstein pearls


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CHARACTERISTICS OF NEWBORN INFANTS NECK

The neck appears short in comparison with the size of the baby and is creased.CHARACTERISTICS OF NEWBORN INFANTS CHEST

The chest is bell shaped and at birth is approximately the same circumference as theabdomen and about 1 inch less than the head circumference.

The thorax of the newborn is almost circular. The infant does not use thoracic cage in breathing, but uses the diaphragm and

abdominal muscles.

The breasts may be swollen because of hormonal activity originating from themother, and pale milky fluid (witchs milk) can be expressed.

CHARACTERISTICS OF NEWBORN INFANTS HEMATOLOGIC SYSTEM

The blood volume of the newborn infant is about10 to 12% of body weight. The blood contains relatively high number of red blood cells (RBC- 4 to 6.6

millions of cells/mm3) and a high hemoglobin level (Hb 14.5 to 22.5 gm/dl) at

birth.

Most of the newborn babies have reduced levels of vitamin K in their blood,resulting in prolonged in prothrombine clotting times.

Physiological jaundice may be seen in approximately 55 to 70% of all neonates onthe second to fourth day of life when the level of bilirubin increases from the normal

level.

CHARACTERISTICS OF NEWBORN INFANTS OESOPHAGUS, STOMACH

AND INTESTINE

The cardiac sphincter is not well developed as the pyloric sphincter. The stomach contents are emptied immediately into the duodenum. Digestion is slowed by food high in protein or fat. Meconium, the first fetal material, is a sticky, odorless material, greenish black to

brownish green, which is passed from 8 to 24 hrs after birth.


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The stools of the breast fed infant are yellow and pasty; between 2 and 4 passed aday.

Figure 17 Anatomy of stomach

CHARACTERISTICS OF NEWBORN INFANTS ABDOMEN

The normal neonates abdomen appears rounded and slightly protuberant. Peristaltic waves may be observed on the abdominal surface of thin neonates but

cannot be seen in infants who are well nourished.

The umbilical cord, the connection between the fetus and placenta, is bluish white,gelatinous structure at birth. It normally contains two umbilical arteries and one

vein encased in Whartons jelly. During the first day of life, the cord begins to dry and shrink. It changes in colour

from a dull yellow-brown to black. It sloughs off by 6 to 10 days after birth.

The liver usually can be felt about2 to 3 cm below the right costal margin.


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The tip of the spleen may be palpable by about1 weekafter birth in the left upperquadrant.

Before the intestines fill with air, the experienced nurse may be able to palpate thekidneys.

Figure 18 Umbilical cord

CHARACTERISTICS OF NEWBORN INFANTS ANOGENITAL AREA

The newborn infant should pass meconium within the first 24 hrs after birththrough a patent rectum.

IN MALES The size of the male newborn genitalia, penis, and scrotum varies. The prepuce or foreskin, of the penis may adhere to the glans. The urethral opening should be at the tip of the penis. The scrotum of the many male neonates is oedematous.


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The testes usually descended into the scrotum by the 8th month ofintrauterine life.

INFEMALES The female genitalia may be slightly swollen from the action of maternal

hormones.

The labia minora and clitoris appear large. Large amounts of Vernix caseosa may be evident. Pseudo-menstruation - The vagina exudes a mucous discharge that

occasionally may be blood tinged. This is caused by hormones transmitted

from mother to newborn daughter.

CHARACTERISTICS OF NEWBORN INFANTS URINE

The bladder contains urine at birth and may empty immediately or after severalhours.

The urine is dilute because of the immaturity of kidneys. Loss of large amount of water may result in temporary hemoconcentration.

CHARACTERISTICS OF NEWBORN INFANTS SKELETAL STRUCTURE

The bones of the newborn are soft because they are composed of chiefly of cartilage. The skeleton is flexible and the joints are elastic to ensure a safe passage through

the birth canal.

The back is normally straight and flat when the baby is lying prone. The lumbar andsacral curves develop later, when the infant sits up and begins to stand.

The legs are small, short, or bowed or curved outward with the feet turned inward. Some common anomalies of the neonate can be noted in the extremities, e.g., club

foot, syndactyl (a union of the fingers or toes), and polydactyl (supernumerary

digits).


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Figure 19 Curves in vertebral column

Figure 20 Club foot


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Figure 21 Syndactyl

CHARACTERISTICS OF NEWBORN INFANTS MUSCULAR DEVELOPMENT

The movements of the neonates are random and uncoordinated.CHARACTERISTICS OF NEWBORN INFANTS NERVOUS SYSTEM

The nervous system is strikingly immature when compared with that of the child oradult.

Figure 22 Polydactyl


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REFLEXES1. ROOTING Touching or stroking the cheek near the corner of the mouth. Head

turns in the direction of stimulation so that the neonate can find food. When the

breast touches the cheeks, the neonate turns toward the nipple.

Figure 23 Rooting reflex

2. SUCKING Touching the lips with the nipple of the breast or bottle or otherobject, sucking movements that enable the newborn to take in food.

Figure 24 Sucking reflex

3. SWALLOWING Accompanies the sucking reflex. Food reaching the posterior ofthe mouth is swallowed.

4. GAGGING When more is taken into the mouth than can be successfullyswallowed. And immediate return of undigested food.


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5. SNEEZING & COUGHING Foreign substance entering the upper or lowerairways, clearing of the upper air passages by sneezing, the lower air passages

by coughing.

6. EXTRUSION Substance placed on anterior position of tongue, extrusion of thesubstance to prevent swallowing.

Figure 25 Extrusion

7. BLINKING Exposure of eyes to bright light from a flash light or otoscope orsudden movement of object toward eye. Protection of the eye by rapid eye lid

closure.

8. DOLLS EYETurn the newborns head slowly to the right or left side, normallyeyes do not move.

Figure 26 Doll's eye


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9. PALMAR GRASP Object placed in the newborns palm, grasping of object byclosing fingers around it.

10.PLANTAR GRASP Touching the sole of the foot at the base of the toes, toesgrasp around very small object.

Figure 27 Palmar grasp & Plantar grasp

11.DANCING (STEP IN PLACE) Hold neonate in vertical position with the feettouching a flat, firm surface. Rapid alternating flexion and extension of the legs

as in stepping.

Figure 28 Dancing reflex


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12.BABINSKI Stroking the lateral aspects of the sole of the foot with a relativelysharp object from the heel up toward the little toe and across the foot to the big

toe. Fans of the toes (positive Babinski sign).

Figure 29 Babinski reflex

13. TONIC NECK (FENCING POSITION) Turning the head quickly to one sidewhile infant is supine, arm and leg on the side the head is turned toward extend

and arm and leg on the opposite side flex. Both hands may make fists.

Figure 30 Tonic neck reflex


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14.MORO (STARTLE) Startling the infant with a loud voice or apparent loss ofsupport due to a change in equilibrium

Figure 31 Startle reflex

CHARACTERISTICS OF NEWBORN INFANTS SPECIAL SENSES

TOUCH The sense of touch is the most highly developed of the special senses and is

most acute on the lips, tongue, and ears and fore head.

VISION Childs vision development begins before birth. Newborns focus on black and white objects at a distance of 9 to 12 inch.

HEARING

Hearing occurs after the first cry. The infant normally make some response to sound.


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TASTE A newborn has the ability to discriminate taste, because taste buds are

developed and functioning even before birth.

Sweet fluids are accepted, where as acid, sour, or bitter ones are resisted. SMELL

The sense of smell is present in newborns as soon as the nose is clear ofmucus and amniotic fluid.

The only evidence of smell is that many newborn infants appear to smellbreast milk and search for the nipple.

characteristics of newborn

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