Download - The Newborn Infant Slides 3
-
8/8/2019 The Newborn Infant Slides 3
1/107
The Newborn
Leah F. Fajutagana,M.D. MPH
-
8/8/2019 The Newborn Infant Slides 3
2/107
-
8/8/2019 The Newborn Infant Slides 3
3/107
Question #1
Organogenesis is completed by :
a. 13th week of life
b. 12th week of life
c. 10th week of life
d. 14th week of life
-
8/8/2019 The Newborn Infant Slides 3
4/107
-
8/8/2019 The Newborn Infant Slides 3
5/107
Question #2
In utero, the link between mother and fetus isthrough:
a)Placental circulation onlyb)Umbilical vessels( artery and vein)
c)Placental circulation and umbilical vessels
d)Umbilical vein only
-
8/8/2019 The Newborn Infant Slides 3
6/107
Question #3
The oxygenated blood that passes through theumbilical veins, hepatic veins, inferior venacava, and shunted to the foramen ovale into theleft ventricle and ascending aorta supplies:
a)Lower half of the body
b)Brain and upper half of the body
c)both
-
8/8/2019 The Newborn Infant Slides 3
7/107
Circulatory System
In utero, the link between the mother and fetusis through the placental circulation andumbilical vessels.
Fetal circulation : 2 shunts
Patent foramen ovale-bet. two auricles/atrium
Patent ductus arteriosus- bet. Pulmonary arteryand aorta
Oxygenated blood passes through the umbilicalvein, ductus venosus in the liver, hepatic veins,
-
8/8/2019 The Newborn Infant Slides 3
8/107
Circulatory System
Inferior vena cava then reaches the right atrium
The right atrium receives unoxygenated bloodfrom the superior vena cava and oxygenated
blood from the inferior vena cava. Oxygenated blood in the right atrium, shunted
to the patent foramen ovale left atrium leftventricle ascending aorta to supply the brain
and upper half of the body.
Unoxygenated blood R ventricle Pulmonaryartery descending aorta lower of the body.
-
8/8/2019 The Newborn Infant Slides 3
9/107
Events when the infant is born:
Placental circulation stops soon as the cord isclamped respiration occurs infants lungs
expand pulmonary circulation is established. Pressure in the R atrium decreases patent
foramen ovale closes
Increase oxygenation causes muscular
constriction of patent ductus arteriosus hencethis shunt closes.
Adult type of circulation is established
-
8/8/2019 The Newborn Infant Slides 3
10/107
Respiratory System
The newborn infant has all the equipmentnecessary for respiration- lungs,chemoreceptors, and baroreceptors
In utero, lungs are unexpanded but notcollapsed, air spaces are filled with fluid
The fluid gushes out of mouth and nose duringNSD, fluid is replaced by air.
Full term newborn, may have pauses duringregular breathing
Premature's may shift from regular to apneicepisodes of 5-10 seconds
-
8/8/2019 The Newborn Infant Slides 3
11/107
Respiratory system
Surfactant - phospholipid substance produce byalveolar cells.
Lowers the surface tension of the alveolar liningepithelium preventing atelectasis.
Component: lecithin and sphingomyelin
High lecithin to sphingomyelin ratio indicates
lung maturity and lower ratio means lungs isless mature.
-
8/8/2019 The Newborn Infant Slides 3
12/107
Question #4
Swallowing movements of fetus is observed onwhat Age of gestation:
a) 13The week AOGb)12th week AOG
c) 15th week AOG
d)10th week AOG
-
8/8/2019 The Newborn Infant Slides 3
13/107
Gastrointestinal System
Swallowing is observed as early as 12th week ofgestation
No excretion via gastrointestinal tract occurs
unless the anal sphincter relaxes ffg a hypoxicepisode.
Epithelial debris accumulates in the SI and asthe liver starts to function,conjugated bilirubinfinds its way to the SI Meconium.
Meconium is black viscid substance composedof mucopolysaccharide and epithelial debris.
-
8/8/2019 The Newborn Infant Slides 3
14/107
-
8/8/2019 The Newborn Infant Slides 3
15/107
Question #5
Urine is produced by the fetus at what AOG.
a)15th week AOG
b)16th
week AOGc)12th week AOG
d)13th week AOG
-
8/8/2019 The Newborn Infant Slides 3
16/107
Question #6
The 10% weight loss in newborn infants is dueto:
a) Diuresisb)Expulsion of meconium
c)Withholding of water and calories
d)All of the above
-
8/8/2019 The Newborn Infant Slides 3
17/107
Renal System
The kidneys produce urine as early as the 4thmonth of gestation
Renal function as measured by glomerularfiltration rate, tubular mass and resorption,renalplasma flow reach the adult levels about the 2nd year of life.
The newborn is unable to concentrate urineadequately, thus his urine is dilute
-
8/8/2019 The Newborn Infant Slides 3
18/107
Renal System
10% weight loss is observed during the 1st daysof life and regained after the 1st week of life.
Weight loss maybe due to: Diuresis, expulsionof meconium, and withholding of water andcalories- physiologic
-
8/8/2019 The Newborn Infant Slides 3
19/107
Question #7
Vaginal bleeding on the first few days of life ispathologic.
a)Trueb) False
-
8/8/2019 The Newborn Infant Slides 3
20/107
Endocrine System
Maternal estrogenic effects on both male andfemale newborn infants are manifested inhypertophied mammary tissue. Sometimessecretes milky discharge called witch milk.
Hymeneal tags and mucoid vaginal dischargewith vaginal bleeding may also be present.
Infant born to diabetic mother has hyperplasticislets of langerhans, result in excessive insulinproduction causing hyperglycemia.
-
8/8/2019 The Newborn Infant Slides 3
21/107
Endocrine System
Infants are usually fat and have facies cushingoid
The pituitary- adrenal axis and thyroid glandfunction separately from that of the mother.
-
8/8/2019 The Newborn Infant Slides 3
22/107
Question #8
A violent startle reaction of an infant whensudden noise or movements occur in theenvironment.
a) Moro reflex
b)Righting reflex
c)Tonic reflex
d)Rooting reflex
-
8/8/2019 The Newborn Infant Slides 3
23/107
Central Nervous System
Rapid growth of the brain is usually observedduring the last half of fetal life with a peak nearor at the time of birth, then decreases over thefirst year of life.
All limbs are in flexion, the hands are closedand thumbs are adducted.
During the waking state, the infant manifestsgeneralized muscular activity.
Any sudden noise/ vigorous movement aroundmay evoke violent startle reaction- Moro reflex
-
8/8/2019 The Newborn Infant Slides 3
24/107
Central Nervous System
Important Specific Reactions:
Moro reflex, grasp reaction, swimming reflex,tonic and righting reflexes
Reflexes associated with feeding: sucking,rooting,and tongue retrusion reflex
Hunger/ or discomfort from any cause, infantcries and increases his motor activity.
After feeding, if kept dry and warm, he is quiteand relaxed.
Cerebral cortex participates very little at this
stage.
-
8/8/2019 The Newborn Infant Slides 3
25/107
Question #9
Which of the ffg blood picture is true at birth:
a) Hemoglobin value is low
b) Hemoglobin value is highc)Predominance of lymphocytes
d)Segmenters normal
-
8/8/2019 The Newborn Infant Slides 3
26/107
Hematologic System
At birth, infant has high hgb 15-20g/dl due torelative hypoxia in utero causing stimulation ofthe bone marrow.
Blood volume is from 80-90ml/kg- depend onearly clamping of the umbilical cord (
-
8/8/2019 The Newborn Infant Slides 3
27/107
Hematologic System
Lymphocytic predominance is attained as theinfant grows older.
Hgb start to drop on the third day of
life( physiologic anemia), 10-12g/dl is reachedon the 2nd- 3rd month of life.
Physiologic anemia is due to:
Relative dec. in bone marrow erythropoieticactivity, relative inc. in the rate of hemolysis,and hemodilution due to the rapid expansionof bld volume.
-
8/8/2019 The Newborn Infant Slides 3
28/107
Immunologic System
Newborn infant- completely developed
if challenged by antigenic stimuli can produceantibodies.
Abs present in the newborn infant are maternalin origin: 7S or IgG antibodies
Antibodies in cord blood =/ > maternal blood
are: Tetanus antitoxin, diphtheria antitoxin, smallpox
agglutinins, antistreptolysin, toxoplasma Abs,and Rh antiblocking Abs
-
8/8/2019 The Newborn Infant Slides 3
29/107
Immunologic System
19 s gamma globulins specific for protectingagainst gram (-) and some gram (+) organismsdo not cross the placental barrier.
Infants prone to gm (-) infections
-
8/8/2019 The Newborn Infant Slides 3
30/107
Question #10
The main source of energy of a newborn is/ are
a)Brown adipose tissue
b)White adipose tissuec)White and brown adipose tissue
d)None of the above
-
8/8/2019 The Newborn Infant Slides 3
31/107
Thermoregulation
Newborn infant is homoiotherm ( stable T )
Infants maintain deep body temp. constant bet.
36-37 0C. Factors that affect thermoregulation:
Chemical thermoregulation
Physical thermoregulation Thermal stimulation
-
8/8/2019 The Newborn Infant Slides 3
32/107
Thermoregulation
1.Chemical thermoregulation: 2 response
Shivering thermogenesis- heat productionaccompanied by electrical activity of skeletalmuscle
Non-shivering thermogenesis- without visibleor electrical muscular activity
Newborn has both white and brown adiposetissue, utilize for non shivering thermogenesis.
Brown adipose tissue more effective supplier ofheat
-
8/8/2019 The Newborn Infant Slides 3
33/107
Thermoregulation
2. Physical thermoregulation defines themechanism of heat loss from the body core to thesurface, from the surface to the environment.
3. Thermal insulation heat exchange bet thebody and environment.
Internal thermal insulation -subcutaneous fat
layer, skin blood flow External thermal insulation- clothing and
incubator temp.
-
8/8/2019 The Newborn Infant Slides 3
34/107
Thermoregulation
Cold environment, more energy utilized for heatproduction and increase oxygen consumption.
Normal fetal heart tone (term) 120-160/min Fetal bradycardia (120/min) are signs of fetaldistress
Hypoxia is the most common cause of fetaldistress
Fetus: Assessment of Growth
-
8/8/2019 The Newborn Infant Slides 3
35/107
Fetus: Assessment of Growth,Maturity and well being
12th week of life- intrauterine assessment
X-ray and UTZ
periodic determination of bi parietal diameter Fetal size and implantation
Measurement of fetal head and amountamniotic fluid
Estimation of gestational age
Fetus: assessment of Growth
-
8/8/2019 The Newborn Infant Slides 3
36/107
Fetus: assessment of Growth ,Maturity and well being
Lung maturity- analysis of the amount ofsurfactant in the amniotic fluid
Placental maturity index- determined by thedegree of calcification (by UTZ)
Fetal distress can be assess through cardiacrhythms and fetal movements
Fetus: assessment of growth
-
8/8/2019 The Newborn Infant Slides 3
37/107
Fetus: assessment of growth,maturity and well being
Biochemical test for monitoring fetal well being
1.Non- stress test (NST)
2.Oxytocin challenge Test (OCT) Fetus is challenged with maternal oxytocin drip to
produce 3 uterine contraction every ten minutes
3 late decelerations suggests fetus at risk
Fetal Assessmnet growth
-
8/8/2019 The Newborn Infant Slides 3
38/107
Fetal Assessmnet, growth,maturity and well being
High Risks factors:
1.Maternal
2.Fetal3.Placental
Maternal infections
1.TORCHES, diabetes, toxemia, thyroid disorders
Congenital malformations
2.Ingestion of teratogenic drugs- malformation ordeath
Fetus: Assessment of Growth
-
8/8/2019 The Newborn Infant Slides 3
39/107
Fetus: Assessment of Growth ,maturity, and well being
Heroin and alcohol- withdrawal and growthretardation
Maternal age and poor obstetric history Fetal factors:
Erythroblastosis fetalis, error of metabolism, sexlinked disorders, gladular dysfunction, lung
maturity, growth retardation, prematurity,malpresentation and hypoxia
Fetus: Assessment of growth
-
8/8/2019 The Newborn Infant Slides 3
40/107
Fetus: Assessment of growth,Maturity, and well being
Placental factors;
Placental insufficiency, cord and amniotic fluidabnormality( meconium staining, oligo and
polyhyramnios
Q ti #11
-
8/8/2019 The Newborn Infant Slides 3
41/107
Question #11
A newborn was noted pale, with a heart rate of
-
8/8/2019 The Newborn Infant Slides 3
42/107
Question #12
A newborn was delivered cyanotic, with fairmuscle tone,doesn't cough or sneeze onsuctioning, HR >100, and irregular respiration.
What is the best management?
a)Assisted ventilation
b)Tracheal intubation
c)O2 by mask
d) Slapping of the sole
Q ti # 13
-
8/8/2019 The Newborn Infant Slides 3
43/107
Question # 13
Babies with an Apgar score of 7 at one minuteis considered:
a)Moderately depressed
b)Severely depressed
c)Vigorous
d)Needs resuscitation
M t f th N b
-
8/8/2019 The Newborn Infant Slides 3
44/107
Management of the Newborn
Initial care
Clinical Appraisal
Resuscitation Temperature regulation
Physical examination
I iti l C
-
8/8/2019 The Newborn Infant Slides 3
45/107
Initial Care
Done in the delivery room or where the deliverytook place with good lighting conditions.
First objective is the establishment of a clearairway
Gentle suctioning of secretions from the mouth,then the pharynx, and nose
The nose is suctioned last to avoid suddeninspiratory gasp which may result in theaspiration of the amniotic fluid in the mouth.
Clinical Appraisal
-
8/8/2019 The Newborn Infant Slides 3
46/107
Clinical Appraisal
The evaluation of the baby's condition is notedright after birth, with the first gasp, cry andonset of sustained respiration.
Clearing of the newborn airway start as soon asthe head is delivered.
APGAR SCORE
-
8/8/2019 The Newborn Infant Slides 3
47/107
APGAR SCOREsign 0 1 2
A- appearance(color)
Blue; pale Body pinkExtremities blue
Completely pink
P-Pulse(HR) absent Below 100 Over 100
G- Grimace No respone grimace Cry, cough or sneeze
A- Activity(muscle tone)
limp Some flexion of extremities
Active motion
R- respiration absent Slow; irregular Good strong cry
APGAR SCORE
-
8/8/2019 The Newborn Infant Slides 3
48/107
APGAR SCORE
Recorded at 1 minute and 5 minutes One minute scoring gives the index of necessity
of resuscitation
Five minute -valuable in predicting mortality andneurologic deficit of infant at one year old
Scores: one minute
7-10 vigorous 4-6 moderately depressed, assisted
ventilation
0-3 severely depressed, tracheal intubation,
oxygen administration
APGAR score
-
8/8/2019 The Newborn Infant Slides 3
49/107
APGAR score
HEART RATE is the most important parameter
nHR bet 100-160/ min
HR < 100- usually asphyxiated- newborn need
assistance HR >160 indicates distress
Respiratory rate
Muscle tone Reflex irritability
color
Temperature Regulation
-
8/8/2019 The Newborn Infant Slides 3
50/107
Temperature Regulation
The baby should be dried and wrapped in ablanket soon after birth.
The fall in temperature in a newborn is about 2-3 degrees celcius after birth
The heat losses/ unit body weight in newborn is4x that of an adult due to its greater surface
area in relation to the body weight. Prematures are more affected
Physical Examination
-
8/8/2019 The Newborn Infant Slides 3
51/107
Physical Examination
2 Stages Initial Examination
Detailed Examination
Initial Examination1.Color- persistent cyanosis after sustained
respiration and given high conc. of oxygen indicate failure of the ductus to close, high
pulmonary resistance or preductalcoarctation.
Deeply asphyxiated babies are pale due tosevere cutaneous vasoconstriction.
Initial Examination
-
8/8/2019 The Newborn Infant Slides 3
52/107
Initial Examination
Pallor is also prominent in erythroblastosis andfetomaternal and feto-fetal transfusion.
2.Respiration
Grunting with prolonged expiration is an earlysign of respiratory distress syndrome (RDS)
Diaphragmatic hernia- respiratory distress
appears after sustained respiration has beenestablished. Diminished breath sounds andscaphoid abdomen.
Initial examination
-
8/8/2019 The Newborn Infant Slides 3
53/107
Initial examination
3. Umbilical vessels and placenta
Presence of single umbilical artery- anomaliesfound in genito - urinary/ gastrointestinal
tracts, skeletal and cardiovascular and CNS. Placental exam done to detect infection and
placental insufficiency.
Question #14
-
8/8/2019 The Newborn Infant Slides 3
54/107
Question #14
A newborn was delivered via NSD, edema withecchymosis was noted on the head andborders are not well defined merging with the
rest of the tissues. The most likely diagnosis is:a)Cephalhematoma
b) Caput succedaneum
c)Craniotabesd)Cranial meningocele
Question #15
-
8/8/2019 The Newborn Infant Slides 3
55/107
Question #15
At birth, the liver is always palpable about 2-3cm below the right costal arch.
a)True
b)False
Question #16
-
8/8/2019 The Newborn Infant Slides 3
56/107
Question #16
The ffg are normally seen in newborn babies,except:
a) Milia
b)Erythema toxicum
c)Mongolian spots
d)Petechia
DETAILED EXAMINATION
-
8/8/2019 The Newborn Infant Slides 3
57/107
DETAILED EXAMINATION
Measurements of weight, length, circumferenceof head, chest, and abdomen, cardiac andrespiratory rate and temperature.
1.Skin- babies are covered with vernixcaseosa, to protect the skin from maceration inutero.
Pinkish, smooth and elastic with fair amount ofsubcutaneous tissue.
Lanugo hair maybe present in the back,shoulders and upper arms.
DETAILED EXAMINATION
-
8/8/2019 The Newborn Infant Slides 3
58/107
DETAILED EXAMINATION
Preterm infants has less subcutaneous tissueand skin is almost transparent
Post term, has paler or dry and desquamatingskin; pallor/plethora noted.
Mottling of the skin occurs when the body isexposed to cold, due to instability of thecirculation
Mongolian spots- blue grey pigmented areas,seen in buttocks, back and extremities
Milia- small whitish papules which covers the
nose made up of sebaceous glands
DETAILED EXAMINATION
-
8/8/2019 The Newborn Infant Slides 3
59/107
DETAILED EXAMINATION
Erythema toxicum- small, firm, yellow-white 1-2mm papules topped by vesicles at the tip andsurrounded by patch of erythema.
2. Head- rounded if babies are born by cesarean
section, varying degrees of molding if delivered byNSD.
Caput succedaneum- edema w/or w/o ecchymosis,extend across the midline and across the suture line,
disappears after few days Cephalhematoma-due to subperiostial bleeding,
does not cross the suture line.
Detailed Examination
-
8/8/2019 The Newborn Infant Slides 3
60/107
Detailed Examination
Craniotabes- soft areas in the parietal bones,pingpong ball' when pressed;preterm infants
If persist beyond infancy, pathologic as seen in
Rickets and Osteogenesis imperfecta.
Cranial meningocele pulsating mass whichbecome more tense when the baby cries.
Fontanels- vary in size small or closed microcephaly /
craniocynostosis.
Tense fontanel- increase ICP
Detailed examination
-
8/8/2019 The Newborn Infant Slides 3
61/107
eta ed e a at o
Face- symmetrical Down syndrome- common facies seen at birth
Eyes: Subconjunctival hemorrhages, congenitalcataracts; fundoscopic exam prior to
discharge Ears: low set ears associated with chromosomal
disorders and renal anomalies; ear tags
Nose- patency; cleft palate; high palatine arch
Tongue- small; large seen in cretin; Tonguetie- short lingual frenulum
Neck- Laxity /webbing found in down syndromeand Turner; cystic hygroma;
Detailed Examination
-
8/8/2019 The Newborn Infant Slides 3
62/107
Chest- size, shape and movement shld benoted. RR= 40/min
Heart 120-140/min; slowing of HR- congenitalheart block, anoxia, intracrnial hemorrhage
Mammary glands- engorged, (+) witch milk
Abdomen- globular
Distention and vomiting after feeding- intestinalobstruction
Liver is palpable 2-3 cm below the R coastalarch
Detailed Examination
-
8/8/2019 The Newborn Infant Slides 3
63/107
Detailed Examination
Genitalia- hymen with prominent tags; clitoris large; labiaminora prominent than majora
Female- mucoid nonpurulent/ bloody vaginal
discharge Male- size of the penis and scrotum varies; hydrocele
may be present.
Extremities
Creases of the palms and sole should be examined forpeculiar lines like simian line in Down syndrome
Non development of distal portion- hemimelia
Detailed Examination
-
8/8/2019 The Newborn Infant Slides 3
64/107
Nondevelopment of proximal portion-phocomelia
Palpation of the femoral pulses should be done
for early detection ofCoarctation of Aorta Neurological examination
Muscle tone and reflexes should be tested
Moro, grasp, rooting and sucking reflexesshould be elicited
Nursing Care
-
8/8/2019 The Newborn Infant Slides 3
65/107
g
Routine newborn care
Vitamin K 1mg or 0.5 mg in preterm- to preventprothrombin defficiency
Erythromycin ophthalmic ointment- topreventophthalmia neonatorum
Cord care with 70% isoprophyl alcohol
Thermoregulation Breastfeeding- started as soon as baby can
suck
Physiologic process in thenewborn
-
8/8/2019 The Newborn Infant Slides 3
66/107
newborn
events Term Preterm
Anemia time 6-12 weeks 5-10 wks
Hgb 9.5-11gms 8-10 gms
Weight loss < /=10% of the BW 1
st
10 days 14-21 days
Jaundice Time 3-4 days 5-7 days
level 6-8mg/dl 10-12 mg/dl
Passage of
meconium
0-48 hrs 99% 95%
Passage of urine 0-24 hrs 95% 95%
24-48 hrs 100% 100%
Question #16
-
8/8/2019 The Newborn Infant Slides 3
67/107
All of the ffg are contributory factors inperinatal morbidity and mortality except:
a)Maternal age
b)Multiple pregnancies
c)Paternal age
d) Socioeconomic status
HIGH- RISK INFANTS
-
8/8/2019 The Newborn Infant Slides 3
68/107
1. Babies of low birth weight
Factors related to perinatal morbidity andmortality
Maternal age,race, marital status, past obstetrichistory, multiple pregnancies.
Premature babies born before the 37th week ofgestation, BW < 2500 g
Small for gestational age babies born term butBW
-
8/8/2019 The Newborn Infant Slides 3
69/107
2. Post-term infants
Babies delivered after 42 weeks of gestation
Babies have little vernix, absent lanugo hair, pale
skin usually dry and desquamating with fingernails are longer.
Common among babies born of toxemic mothers,mothers with renal dse, with chronic illness,elderly primigravid or mothers with placental
abnormalities.
HIGH RISKS INFANTS
-
8/8/2019 The Newborn Infant Slides 3
70/107
3. Multiple pregnancies or twinning Babies are delivered prematurely or small for
gestational age
Malformations are common in multiple
pregnancies.
Management:
Babies of low birth weight and other high risks
infants are placed in heated incubators tomaintain body temperature between 36-37oCwith humidity of 60-70% and oxygen flow of40%
HIGH RISKS INFANTS
-
8/8/2019 The Newborn Infant Slides 3
71/107
Heated bassinets are used with piped -inhumidified oxygen in a hood just to enough torelieve cyanosis and respiratory distress.
Feeding witheld for smaller infants for 2-3 daysto prevent fatigue and danger of aspiration.
Infants
-
8/8/2019 The Newborn Infant Slides 3
72/107
Infants who appear well are fed 4-6 hrs afterbirth.Sterile water or 5% glucose at 2-3 hrsinterval, given by gavage.
Initial volume 2-3 ml for infant 1000-1500,increase the amount by 2ml/feeding/day.Ideally, 120-140 cal/kg/day reached by the endof 2nd week.
Protein intake 4-5gms/kg/day
Ballard Maturationalassessment
-
8/8/2019 The Newborn Infant Slides 3
73/107
assessment
Commonly used technique of gestational ageassessment
2 Criteria:
Physical maturity- relies on anatomical changes
Neuromuscular relies on muscle tone
Assigns scores to various criteria, the sum is
extrapolated to the gestational age of the baby. Scoring relies on intrauterine changes that fetus
underwent during its maturation
Neuromuscular rating
-
8/8/2019 The Newborn Infant Slides 3
74/107
Posture- total body muscle tone is reflected in infantsposture at rest
Square window- wrist flexibility and resistance to
extensor stretching Arm recoil- paassive flexor tone of the biceps muscle
Popliteal anglematuration of passive flexor tone abovethe knee joint
Scarf sign- passive flexor about the shoulder girdle
Heel to ear passive flexor about the pelvic girdle
-
Ballard ScoringPhysical Maturity Rating
-
8/8/2019 The Newborn Infant Slides 3
75/107
Physical Maturity Rating
-1 0 1 2 3 4 5
SKIN
Sticky,friable
transparent
Gelatinous, red
translucent
Smoothpink,
visibleveins
Superficial peeling/
rash, fewveins
Crackingpale
areas
Parchment deep
crackingno veins
Leathery,cracked,
wrinkled
LANUGO none sparse abundant thinning Baldareas
Mostlybald
PLANTARSURFACE
Heel-toe40-50mm-150mmnocreases
Faint redmarks
Anteriortranversecreases
Creasesant. 2/3
Creasesoverentiresole
Ballard scoringPhysical Maturity Rating
-
8/8/2019 The Newborn Infant Slides 3
76/107
Physical Maturity Rating
-1 1 2 3 4 5
BREASTIMPERCEPTIBLE
BARELYIMPERCEPTIBLE
FLATAREOLANO BUD
STIPPLEDAREOLA1-2MMBUD
RISEDAREOLA3-4MM
Full areola5-10mm
EYE/EARLids fusedloosely-1Tightly- 2
Lids openpinna flatstaysfolded
sl. curvedpinna; soft,slow recoil
Wellcurvedpinna, softready torecoil
Formedand firminstantrecoil
Thickcartilageear stff
GENITALIA- MALE
Scrotum
flat,smooth
Scrotum
empty,faintruggae
Testes in
uppercanal, rareruggae
Testes
descending fewruggae
Testes
down goodruggae
Testes
pendulousdeepruggae
GENITALIA-FEMALE
Clitorisprominentlabia flat
Clitorisprominentsmall labia
minora
Clitorisprominentenlarging
minora
Majora andminora =prominent
Majoralargeminora
smll
Majoracoverminora and
clitoris
Maturity Rating
-
8/8/2019 The Newborn Infant Slides 3
77/107
SCORE WEEKS-10 20
-5 22
0 24
5 26
10 28
15 30
20 32
25 34
30 36
35 38
40 40
45 42
50 44
Maturity rating
-
8/8/2019 The Newborn Infant Slides 3
78/107
Example:
Neuromuscular maturity score = 13
Physical maturity score = 28------
total 41
AOG 40 weeks
Diagnosis: newborn
-
8/8/2019 The Newborn Infant Slides 3
79/107
Chart: Live term baby girl delivered via NSD,AS 9/9, BW 3 kg, 41 weeks by ballards,Appropriate for gestational age (AGA)
Question #17
-
8/8/2019 The Newborn Infant Slides 3
80/107
Which of the ffg is the most common site offatal and disabling injuries in the newbornduring delivery .
a)Spinal cord
b)Intracranial cavity
c)Nerve
d)abdominal
DISEASES OF THE NEWBORN
-
8/8/2019 The Newborn Infant Slides 3
81/107
Birth injuries
1.Intracranial injuries- most common site offatal and disabling injuries
S/S: cyanosis or pallor, apnea and respiratorydifficulty, poor response to stimuli, convulsion,bulging fontanel
Usually caused by difficult delivery
Prognosis: usually die on the 1st 72 hrs or survivebut develop cerebral palsy, epilepsy or mentaldefficiency
Mgt:: keep the baby warm, give O2, Vit K,Sodium phenobarbital
Do lumbar uncture
Birth injuries
-
8/8/2019 The Newborn Infant Slides 3
82/107
2. Spinal cord injuries
Cause by difficulty in the delivery of theshoulder in head presentation and head in
breech presentation Paralysis may occur due to compression of the
cord by edema and hemorrhage
3. Nerve injuries
May result with excessive tension on one side ofthe neck producing brachial palsy.
Nerve Injuries
-
8/8/2019 The Newborn Infant Slides 3
83/107
1. Erb- Duchenne paralysis
Injury to C5-C6, loss of function of biceps,deltoid, brachialis and brachioradialis
2. Klumpke's paralyis Injury to C7-C8, wrist and hand movement are
lost
3. Horner's Syndrome Injury to the sympathetic nerve fibers with
concomitant meiosis of the pupil and eyelidptosis of the same side
Birth Injuries
-
8/8/2019 The Newborn Infant Slides 3
84/107
4. Fractures
Involve the long bones or the clavicleassociated with difficult delivery
Mgt: immobilization of the affected extremity 5. Intra-abdominal injuries
Hemorrhages from the liver, adrenal glands and
spleen are encountered in breech extraction Mgt: blood transfusion and exploratory
laparotomy
Question #18
-
8/8/2019 The Newborn Infant Slides 3
85/107
All of the ffg pathogens are likely cause of earlyonset neonatal sepsis except
a)Group b streptococcus
b)Escherichia coli
c)Staphylococcus epidermidis
d)Hemophilus Influenza
Question #19
-
8/8/2019 The Newborn Infant Slides 3
86/107
Late onset neonatal sepsis in full term infants isassociated with which of the ffg?
a)75% rate of meningitis
b)Group B Streptococcus
c)Escherichia coli
d)Onset as late as 60 days of life
e)All of the above
Question #20
-
8/8/2019 The Newborn Infant Slides 3
87/107
The most common focus of infection of group bStreptococcal early onset disease of thenewborn is the
a)Lungs
b)Skin
c)Menibges
d)Urinary tract
INFECTIONS IN THE NEWBORN
-
8/8/2019 The Newborn Infant Slides 3
88/107
Predisposing factors:
1. maternal infections
UTI, Toxoplasma gondii, rubella,
cytomegalovirus, herpes, syphylis (TORCH) 2.Infections acquired after delivery
3. prematurity
Infections in the Newborn
-
8/8/2019 The Newborn Infant Slides 3
89/107
Routes of Entry:
1. Hematogenous- microorganism is carried intothe intervillous spaces of the placenta to the
fetal bloodstream 2. Ascent of the vaginal bacteria into the
amniotic cavity after rupture of the membrane
3.Ingestion/aspiration of infected fluid
4. direct contact with infected material in thebirth canal
Sepsis Neonatorum
-
8/8/2019 The Newborn Infant Slides 3
90/107
Common bacterial causes: E.coli, Klebsiellaaerobacter, proteus specie, pseudomonasaerogenosa, Group B streptococci.
Candida albicans, chlamydia Two types:
1.Early onset
2.Late onset
Sepsis Neonatorum
-
8/8/2019 The Newborn Infant Slides 3
91/107
Early onset- usually serious and progressivemultisystemic infection during the first week oflife.
Most cases there is a history of obstetricalcomplications like prematurity or low birthweight
Mortality is high
Late onset insidious and ecognized after thefirst week
Obstetric complication less characteristic
Clinical Manifestation:
-
8/8/2019 The Newborn Infant Slides 3
92/107
Maternal history can greatly help the diagnosisof infection.
S/S: Poor feeding, lethargy, hyporeflexia,,irritability, apnea, cyanosis, jaundice,abdominal distention, petechia, diarrhea andtemperature instability.
Laboratory:
CBC- wbc >30,000/cu.mm or
-
8/8/2019 The Newborn Infant Slides 3
93/107
Mgt:
Early onset- gm (-) enteric bacilli and grp Bstrep are prevalent
Late onset Staph Aureus and hospitalacquired enteric bacilli like pseudomonas andserratia
DOC: Penicillin 100,000U/K/day q 12 combined
with aminoglycoside ( gentamycin 5-7mg/kg/day or amikacin 10-15 mg/kg/day q12.) given for 7-10 days
Jaundice in the Newborn
-
8/8/2019 The Newborn Infant Slides 3
94/107
The degree of jaundice is measured in terms ofbilirubin concentration.
Clinically: yellow color of the skin, mucousmembranes of the mouth and sclerae.
Etiology:
1.overproduction of bilirubin liver cells arenot able to cope with the increased load of
indirect bilirubin 2.Undersecretion of bilirubin- caused by
decrease conjugation of IB.
Over production of bilirubin
-
8/8/2019 The Newborn Infant Slides 3
95/107
Eg; Isoimmune hemolytic anemias arise fromblood group incompatibilities bet. fetus and themother w/c results in formation by the mother ofantibodies against her infants red cells.
Type O mother with type A or B infant, Type Ohas both Anti- A and Anti B agglutinins easilytraverse the placenta to fetal circulationresulting to hemolysis.
Occurs in rh (-)mother who has an rh (+) infant
Undersecretion of bilirubin
-
8/8/2019 The Newborn Infant Slides 3
96/107
Eg: Physiologic jaundice
Deficient in glucoronyl transferase activity in thefirst few days of life.
Jaundice on the 2nd or 3rd day of life andsubsides on the 5th day.
Phototherapy and exchangetransfusion
-
8/8/2019 The Newborn Infant Slides 3
97/107
BILIRUBIN LEVEL Bilirubin level
Birth weight Phototherapy Exchange transfusion
-
8/8/2019 The Newborn Infant Slides 3
98/107
Indirect bilirubin 20mg/dl
Double volume exchange transfusion using thepatent umbilical vein
Donors blood should match mothers blood toprevent heolytic reaction
If IB not rising rapidly: Phenobrbitaladministration and Phototherapy
Phenobarbital increasing glucoronyltransferase necessary for conjugation andincrease y transport protein
Management
-
8/8/2019 The Newborn Infant Slides 3
99/107
Phototherapy -reduce bilirubin throughphotoisomerization in intracanalicular andinterstitial spaces to soluble breakdown
products, excreted rapidly in bile and urine. Infant unclothed and exposed to ten 20 watt
daylight or blue fluorescent light at 30 inchesabove
Baby's eyes should be shielded, to avoid retinaldegeneration
Management
-
8/8/2019 The Newborn Infant Slides 3
100/107
Complictions of phototherapy:
1.Dehydration
2.Diarrhea
3.Bronze baby syndrome
4.thrombocytopenia
Breast milk Jaundice(Physiologic)
-
8/8/2019 The Newborn Infant Slides 3
101/107
Parameters Breastfeeding jaundice Breast milk jaundice
Onset 3rd-4th DOL Start to rise on 4th Dol,may reach 20-30mg/dl onday 14, then decreaseslowly, normal by 4--12
weeksPathophysiology Dec. milk intake increase
enterohepatic circulationDue to B- glucoronidasein breastmilk whichincrease entrerohepaticcirculation
Management Fluid and caloricsupplementation
Stop breastfeeding, rapiddec in bilirubin in 48 hrs
Kernicterus
-
8/8/2019 The Newborn Infant Slides 3
102/107
High level of indirect bilirubin above 15-20mg/dl Dangerous because its depositon in the basal
ganglia of the CNS occurs producing toxicity tothe brain.
S/s: lethargy, hypotonia and poor feeding
Mgt: double volume exchange transfusion usingthe umbilical vein, phototherapy, phenobarbital
5mg/kg/day Donors blood should match mothers blood to
prevent hemolytic reaction.
Hyaline Membrane Disease
60% of preterm infants
-
8/8/2019 The Newborn Infant Slides 3
103/107
60% of preterm infants
-
8/8/2019 The Newborn Infant Slides 3
104/107
CXR: diffuse reticogranular infiltrate throughoutthe lung field with typical air-filledtracheobronchial tree- air bronchogram
Mgt: Baby dried and keep warm
O2 by hood, Mechanical ventilation
Correction of the acid base balance
Apnea of the newborn
-
8/8/2019 The Newborn Infant Slides 3
105/107
Apnea of the new born-respiratory pause is prolonged,>20 seconds, HR decrease 80/min
Periodic breathing respiratory pause is shorter 5-10secs alternating with breathing movement.
Common among pre- term infants;
Term infants apnea occur few hrs after birth- due toaccumulation of secretions around the oropharynx
Etiology unknown
May lead to CNS damage
Apnea of the newborn
-
8/8/2019 The Newborn Infant Slides 3
106/107
Management:
Physical stimulation
Theophylline LD 5mg/kg IV, MD 2mg/kgTID
oral Reduces apnea by increasing alveolar
ventilation through cntral stimulations.
-
8/8/2019 The Newborn Infant Slides 3
107/107
THANK YOU!GOOD LUCK TO EVERYONE