NEW BORN

Definition: New born (nb) is the child of the first month of life (first 28 days).

Birth → traumatized n.b. → high mortality: -in the first month  = ½ of infant mortality -the first week = 2/3 of the first month mortality

Criteria for evaluating the degree of maturity of

the n.b. 1. Temporal criterion: GA assessment calculation from the first day of last

menstrual period full term: GA = 37 - 42 weeks

premature: GA <37 weeks

lower limit of viability (WHO criteria):- GA = 22 weeks- W over 500g

postmature GA > 42 weeks.

Criteria for evaluating the degree of maturity of the n.b.

2. Morphofunctional criteria: GA characteristics can be assessed by evaluating:- skin- flag ear- genitals- mammary glands.

The Ballard score used is to be performed at 3-42 hours after birth.

Criteria for evaluating the degree of maturity of the n.b.

3. Neurological Criteria - findings passive posture and tone → muscle tone increases with GA and has a caudo-cephalic development :

 at 28 weeks of gestation → hypotonic; at 32 weeks → all 4 extremities in extension; at 34 weeks → batracian position; at 40 weeks → all four extremities are in flexion.

Criteria for evaluating the degree of maturity of the n.b.

4. Anthropometric Criteria

(interpretation of W, H according to GA)

After birth weight (Wb): N.b. normal NG: 2500 - 4000 g (mean 3000 g) N.b. macrosomia: greater than 4000 g Gn N.b. small: less than 2500 g

After the value of WI at birthIP = G (g) ∕ T (cm3) X 100

N.b. full termN.b. full term AGAAGA IP = 2,3 - 3IP = 2,3 - 3

SGASGA IP < 2,3IP < 2,3

LGALGA IP > 3IP > 3

N.b. prematureN.b. premature AGAAGA IP = 2 – 2,3IP = 2 – 2,3

SGASGA IP < 2IP < 2

LGALGA IP > 2,3IP > 2,3

N.b. postmatureN.b. postmature AGAAGA IP = 2,3 - 3IP = 2,3 - 3

SGASGA IP < 2,3IP < 2,3

LGALGA IP > 3IP > 3

Criteria for evaluating the degree of maturity of the n.b.

N.b. with Wb <2500 g:

N.b. LBW (Low Birth Weight): Wb = 2500-1500 g N.b. VLBW (Very Low Birth Weight):

Wb = 1499-1000 gN.b. ELBW (Extremly Low Birth Weight):

Wb below 1000 g.

Hight at birth (Hb): 47-55 cm, 50 cm on average.

The anatomic and physiological features of the full term newborn

Head: The face is small.

 Anterior fontanelle (bregma) FA = 3cm/4cm, progressively closed until the age of 18 months.

 Posterior fontanelle (lambda) birth → closed / open (6-8 mm) close to 6-8 weeks.

Sagittal suture is sometimes wide – congenital soft skull.

 Nose: short, concave, nostrils look forward.

 Ears: rule and implanted.

Neck: short.

Chest: almost cylindrical.

Abdomen: high, exceeding ribs, abdominal wall muscle tone is low.

Umbilical cord (UC): mummification → training → disposal trench to fall between the 6th and 10th-day- the epidermization of umbilical wound → gradually from periphery to center

 - end-healing by the 3rd week

- umbilical scar vessels are clogged due to shrinkage

Lower limbs: short Intern condyles are less developed limbs → încurbarea axis.

Vertebral column → almost straight after birth.

SKIN:- intense red (erythema newborn)- blue palms and plants.

Redness n.b. is the result:- abundance of short and wide capillaries,- imperfection vasomotor function,

 - thinness epidermis (stratum horn missing and melanin pigment).

Vernix caseosa:- fat blanket, yellowish, covering the skin especially on dorsal region, chest, neck and flexion creases;

- secreted by the sebaceous glands and specialized cells of the amnion;

- rich in glycogen, fatty acids, cholesterol and protein.

Vernix caseosa:Features:

 - fetal protection against the cold;- protection against skin maceration by amniotic fluid; - food intake;- bactericidal and antihaemolytical.

If a stray → hypothrombin emphasized.

Physiological desquamation: - appears a few days after birth; - furfuraceous / lamellar.

N.b. toxic erythema (Erythema Neonatorum Toxicum)= awareness of maternal protein / antigen passed through the intestinal mucosa to which the child has formed an antibody;

 - microscopic →infiltration of eosinophils;- cultures are negative;

N.b. toxic erythema (Erythema Toxicum Neonatorum)- onset 24-48 hours after birth;

 - small erythematous areas, centered by a yellow papule;

 -located on the front, back, buttocks and extremities; comply with plants and palms;

 - ± other symptoms allergic coryza, swelling of eyelid edema;

-resolves spontaneously without scarring; - strict hygiene is recommended;- not given any treatment.

Maternal nevi:- red spots, badly defined;

 - upper eyelid, bridge, neck;- disappear after a few months ± brown spots.

Mongolian spot: - blue stain; - variable size; - region lumbo - sacral;- without pathological significance.

Maternal nevi Mongolian spot

Lanugo: - baby fine hair covering the skin; - after birth → shoulders, back, head, limbs;- most abundant on n.b. premature

Nails: - not have longitudinal ribs; -finger pulp outperforms the hands and feet barely touching.

Sweat glands are less developed.

Lanugo

Sebaceous glands: - are well developed; - 3-6 days after birth in both sexes occur in the wings, nose, cheeks, forehead and chin point elements, small yellowish-white sebaceous gland cysts disappear spontaneously = milium facial

Adipose panicle is developed on the face, limbs and no less than the abdomen.

Muscle:- incomplete development of cortical centers and nerve pathways to the predominant physiological muscle hypertonia → flexion;

 → hypotonic neck muscles → head support.

Respiratory:thorax → cylindrical ribs → horizontal, ant. diameter >post. breathing type → abdominal.

Respiratory Rate (RR) 60 resp / min n.b., 45 resp / min to 1 month 35 resp / min at 1 year.

Sometimes irregular pace → apnea crisis, rhythm Cheyne - Stokes → sometimes unequal amplitude.

The mechanism first breaths: - chemical and humoral factors = CO2 accumulation lack of O2

by placental disruption;

 - ambient excitations of free nerve terminations leather;

- thorax to relax, limbs. sup. pass the abduction → volume increase of vacuum pleural rib → CRI air suction → vagus nerve stimulation ends.

Cardiovascular:

Heart → globular, situated transversely;- apexian shock → sp. IV, at 1-2 cm outside m.c. l.;-myocardium elastic and connective tissue  →least developed; - epicardial → very thin; - heart sounds → are more powerful charge.

Arteries → increased content of elastic fibers + large calibre → hypotension general physiological size.

Peripheral Circulation:

 -slow → cold extremities, cyanotic (SaO2 = normal) - vascular permeability and capillary fragility ↑.

Heart rate: 160 beats / min. the n.b., 120 beats / min at the end of the first month.

Blood pressure: ~ 70-80 mm Hg SBP ~ DBP 40-50 mm Hg

Hemoglobin (Hb) and hematocrit (Ht):

- higher values if the umbilical cord is pinched "late" (after cessation of pulsations);

- shows changes in physiological function of Wb and the child's age.

The values of hemoglobin, hematocrit and reticulocyte count in the first week of life

Umbilical Umbilical Cord Cord

First 24 First 24 hourshours

24 – 72 24 – 72 hourshours

First weekFirst week

Hb (g%)Hb (g%) 17 - 1817 - 18 18 - 1918 - 19 17 - 1817 - 18 1717

Ht (%)Ht (%) 50 - 5550 - 55 55 - 6055 - 60 50 - 5550 - 55 5050

ReticRetic. . (%)(%) 3 - 53 - 5 3 - 53 - 5 1 - 31 - 3 0 - 10 - 1

Erythrocytes: birth = 5-6 mil/mm3

after 24-48 hours → hemolysis → 4-5 mil/mm3

increased mechanical fragility increased metabolic activity shortened life span.

Leukocytes: leukocyte number make changes quickly in the first days of life PMN →structural and functional immaturity.

Leukocytes and leukocyte formula values at nb

First dayFirst day First weekFirst week

LeuLeukkococyyte /mmte /mm33 18 000 – 20 00018 000 – 20 000 12 00012 000

PMN (%) PMN (%) 55 – 6055 – 60 45 – 5045 – 50

Ly (%) Ly (%) 3030 40 40

Mo (%)Mo (%) 1010 5 – 105 – 10

Eo (%)Eo (%) 22 22

Haemostasis:

deficient in the first 6 months of life; platelets = 150 000 - 300 000/mm3; coagulation factors dependent on vitamin-K = low; clotting time = prolonged

The digestive system → features: mouth → adaptations for sucking; intestinal microbial flora; meconium.

Intestinal microbial flora: of the fetus intestinal tract = sterile. during birth colonize the oral cavity: Staphylococcus, colibacillus, streptococci, etc.. After ~ 2 weeks: the n.b. breast-fed → bacillus bifidus, the n.b. bottle-feed → bacillus coli.

Meconium: n.b. stool within 2-3 days viscous and dark green; consists of: - bile components: cholesterol, fat, mineral salts, bile

pigments, - amniotic elements: lanugo, squamous cell skin cells,

flat - elements of the digestive tract: intestinal cells, gastric

juice, intestinal, pancreatic, with their yeast.

It is followed by a transitional stool, brown, curdled milk.

Stools typical human milk: yellow-orange occur in 2-3 days are 4-6 in 24 hours.

Meconiu Transition stool

Salivary amylase: present at birth; and acts in the gut - compensates deficit amylase pancreas.

Lingual lipase - normal activity at birth.

Gastric lipase: increased activity in n.b. preferentially hydrolyzes TG - compensates low pancreatic lipase activity.

Pancreatic enzyme secretion: protease - normal activity; lipase - low activity; amylase - absence.

Intestinal enzyme secretion = complete

Liver: 2 cm below the ribs; are deficient at birth: liver detoxification activity synthesis of coagulation factors, the lipoprotein and cholesterol.

Spleen - up to 1 cm below the rib.

Urogenital: Kidney - functional deficit: glomerular filtration - reduced (further increase); dilution capacity - normal ability to concentrate - limited; reduced capacity to excrete electrolytes; postnatal hemolysis - transient hyperuricemia - infarcts uratic - brick-red deposit on the diapers.

Diuresis = 75-100 ml / kg

Urination: appear to achieve reflex

bladder capacity; the number of 10 -

20/day.

.

External genitalia:♂:

penis is short scrotal skin? cross-ply testicles are descended into the scrotum / channels are palpeaza inghino-scrotal hydrocele? frequently encountered phimosis? considered physiological

♀: vulvar region - completely closed large labia, clitoris and labia minora cover

Nervous System myelination of axons - CNS maturation

Immature nervous system expression: exaggerated reflexes; plantar reflex = positive (Babinski reflex); spontaneous motor activity = generalized, anarchic contraction;

Babinski reflex

catatonia (attitudes → persistent tendency); subcortical phenomena (sucking and swallowing,

screaming and crying) are present at birth (phylogenetically older segments are more developed than the crust).

Primitive reflexes: signifies the integrity of subcortical centers;

disappear after 4-5 months (cortical inhibition occurs);

their asymmetry indicates SN lesions (intracranial hemorrhage, brachial plexus palsy).

Sense organs:

Seeing: n.b. not to color, but the eyes react to light;

eye movements are uncoordinated (convergent strabismus is almost physiological transient);

lacrimal glands are small and secret tears after 3 weeks age.

Hearing: present at birth; n.b. react to strong auditory stimuli; ear - anatomical features: - ear canal = narrow, directed obliquely; - trunk = wide, short, horizontal - mastoid = small and compact; pneumatization ear occurs with the first inspiration and swallowing.

Taste: n.b. different from the sweet bitter taste.

Sense of smell: present at birth (olfactory centers → among the first maturation).

Sense of touch: well developed at birth; stand out in some archaic reflexes (the cardinal points, and lashing).

Thermal Adaptation: n.b. - thermal instability

Thermogenesis: is limited; major role - brown fat (interscapular, neck, axilla, mediastinum, between the esophagus and trachea, around the pancreas, kidneys and adrenal glands);

Thermogenesis: low ambient temperature - cutaneous receptors -

catecholamines release and oxidation of fatty acids in brown fat → heat;

immaturity of neural centers→ often n.b. not respond to infection by fever.

Thermolysis - rated: large skin surface; with abundant blood supply; reduced subcutaneous fat tissue.

New born can maintain constant temperature (36.5 °C at the abdominal skin and central temperature 37 ° C) in terms of thermal ambient comfort from 21 to 26 °C.

Nonspecific immunity: mechanical barrier (skin and mucous membranes) - low: extreme thinness of the stratum corneum; extremely reduced sweat secretion; mucosa - important degree of permeability.

Nonspecific cellular immunity - small role in n.b.: reduce leukocyte response to an infection; low phagocytic capacity; absence of limiting infectious process; infections tend to generalize.

nonspecific humoral immunity: Lysozyme inhibits some bacteria - saprophytic colonization of normal mouth flora; serum complement system, and properdin opsoninelele - poor; interferon synthesis - normal.

Specific immunity: cell: T and B lymphocytes - functional maturity.

Ig G: values equal to those in maternal blood; only crossing the placenta (third trimester of pregnancy); Ac contain - antibacterial, antiviral, antitoxin depending on the degree of stimulation of the mother; decrease around the age of 3 months and then increase (immunogenesis own).

Ig M: does not cross the placenta; own synthesis begins 5-6 days after birth.

The serum IgA: do not cross the placental barrier, appear in blood n.b. age 2 weeks.

Secretory Ig A (IgAs): between the serum and secretory Ig A correlation does not exist; IgAs synthesis is a priority in respiratory and gastrointestinal mucosa; at 2 weeks they are found in appreciable amounts in all mucous membranes.

Ig E: does not cross the placenta; is synthesized in the mucosa, tonsils, adenoids and lymph nodes.

Ig D: are produced in cells in palatine tonsils and lymph nodes; found in small amounts in serum.

Phenomena characteristic of newborn period

1. Physiological decrease in weight n.b. within 3-4 days lose 6-10% of Wb (150-200g); 8-10 days after returns to the original weight. Determined by: fluid losses (urine, meconium, perspiration, respiration, evaporation from the skin); regime of starvation and thirst in the early days (maternal lactation failure) - ± book burning tissues of its own tissues; massive destruction of leukocytes and erythrocytes.

Phenomena characteristic of newborn lives

2. Physiologic jaundice: occurs in 70-80% of n.b. between the 2nd and 4th day of life; maximum intensity on day 4-5; disappear within two weeks (sometimes 3-4 wks.) clinical manifestations of BT values> 40 mg / l; him to be called physiological → BT <120 mg / l; no hepato / splenomegaly; normal colored urine and stool; drowsiness, muscle weakness (not to disrupt sucking).

Phenomena characteristic of newborn lives2. Physiologic jaundice: Extrahepatic Causes: absence of placenta as a way to eliminate bilirubin; crisis of massive destruction of red cells = red blood cells - training in excess of bilirubin; capillary permeability - jaundice is most evident on the skin. Hepatic causes: uridindifosfatglucuroniltransferaza deficiency (UDPGT) glucuronic acid deficiency.

Phenomena characteristic of newborn lives

Predisposing factors: Late removal of meconium (↑ BT); eating late (↑ BT); CO pinching late↑ blood volume ↑ hemolysis ↑ BT; Wb under 3kg and over 4.5 kg ↑ intense jaundice.

Treatment: usually not necessary. Exception: phototherapy in some n.b. prematurely (preventing kernicterus).

Phenomena characteristic of newborn lives3. Genital crisis (hormone): occurs 3-6 days after birth in both sexes; lasts ~ 2 weeks; caused by maternal hormones that go into circulation nn uterine contractions during birth.

Clinic in both sexes: milium facial mammary gland swelling (pressure ~ colostrum secretion, wringing favors infection).

Phenomena characteristic of newborn lives 3. Genital crisis (hormone)

♀ vulva and vagina: edema congestive mucosa ± whitish vaginal discharge, sometimes with bloody streaks

♂ swollen testicles hydrocele uni / bilateral swelling of the penis

Phenomena characteristic of newborn lives

4. Albuminuria Physiology: disappears after a week; is due to increased glomerular permeability.

5. Infarcts uratice: and white tissue damage in the early days? increased elimination of uric acid and urate in the urine; urine = cloudy → red brick warehouse on the diaper (amorphous urate and uric acid salts).

Phenomena characteristic of newborn lives

6. Transient fever: sometimes occurs in the 3rd, 4th day; lasts between 12-48 hours; can reach 39-40 °C. Cause = dehydration: - insufficient intake of fluids - loss of fluids from the first days of life. Disappears after hydration.

7. Meconium = stool in the first 2-3 days.

Assessment of infant health APGAR score evaluates: Appearance (skin color) Pulse (heart beat frequency) Grimace (reflex response to stimuli) Attitude (muscle tone) Respiration (breathing frequency)

These parameters: Inquire at 1, 5, 10 and 20 min after birth; Is marked with 0, 1 or 2.

SignSign 00 11 22

AAppearance ppearance (Skin Color) (Skin Color)

Blue-gray, Blue-gray, pale all over pale all over

Normal, Normal, except for except for extremities extremities

Normal over Normal over entire body entire body

PPulseulse AbsentAbsent Below 100 Below 100 bpm bpm

Above 100 Above 100 bpm bpm

GGrimace rimace (Reflex (Reflex Irritability) Irritability)

No Response No Response Grimace Grimace Sneeze, cough, Sneeze, cough, pulls away pulls away

AActivity ctivity (Muscle Tone) (Muscle Tone)

Absent Absent Arms and Legs Arms and Legs Flexed Flexed

Active Active Movement Movement

RRespiraespirationtion Absent Absent Slow, irregular Slow, irregular Good, crying Good, crying

New born care

New born care

Delivery room: aseptic; temperature of 24-26 ° C. application of the umbilical cord clamps, 2-3 cm from its insertion (after cessation of pulsations), then cutting it. the newborn is welcomed into the fields / sterile napkins on the table with radiant heat. vacuum nasopharyngeal secretions after expulsion, a suction probe / para rubber. assessment of health status n.b. by performing the Apgar score.

New born care

New born care

New born care

New born care

Prophylaxis of gonococcal oftalmy: Ag nitrate solution 1% (1 drop in each conjunctival sac bottom); Ophthalmic ointment erythromycin / tetracycline.

Prevention of haemorrhagic disease - 1 mg vit. K1 i.m. antero-external face of the thigh at all n.b.

New born care Hepatitis B vaccination → 0.5 ml, i.m, antero-external face of the thigh.

Wb, Hb, HCb, TCb

detection of possible malformations.

In the newborn section → neonatologist: correct classification; detection of possible pathologies.

New born care

New born care

Neonatal Screening - detection of genetic diseases, metabolic, hematologic and endocrine diseases. Washing n.b. immediately after birth is not indicated for not remove vernix caseosa.

After the fall of the umbilical cord, the wound is to fully epidermization daily.

The first is general bathroom after umbilical wound healing (until then → toilet partial).

New born care

Rooming-in system: emotional tie between mother and child; acquisition of correct habits and nutrition care.

New born care

Immunizations

BCG vaccine

(age 4-7 days) all n.b. G> 2500g; no signs of acute

febrile infections / dermatological diseases.

New born care

Prevention of rickets: is initiated in the 7-10 day life Vitamin D ~ 500 U.I. Daily (2 Vigantol drops / day p.o.).

Nutrition: Perfect – breast-feeding; In special cases - combined / bottle-feeding.

New born care