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Normal newborn final

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  • 1. Normal Newborn Dr Varsha Atul Shah Consultant Dept. of Neonatal& Dev Medicine Singapore General Hospital
  • 2. Newborn Adaptation At Birtho Circulatory changes (gas exchange from placenta to the lungs)g Reabsorption of fetal lung fluidf Closure of patent ductus arteriosust Stabilization of cardiac rhythm Establishment of regular breathing Temperature regulationl Changes in carbohydrate metabolism
  • 3. Circulatory changesg Reduction of pulmonary vascular resistance, increased PBF by 10 foldsm Increase in left atrial pressure Closes foramen ovalev Increase systemic vascular resistancec Rt to lt flow at PDA diminishes, closes PDA PS: failure to achieve reduce PVR cause PPHN
  • 4. Fetal Circulation
  • 5. Circulation in thenormal newborn
  • 6. Lung changes Lung fluid absorption (failure cause TTNB, Transient Tachypnea of Newborn)b RR rises to 60/mini Transient grunting, mild retraction, ala nasi flare may be seen
  • 7. Carbohydrate Metabolisma Cessation of maternal glucose supplye Decline in glucose level by 2 hrss 20-30% CHO comes from milk Gluconeogenesis from AA, glycerol, lactate
  • 8. Temperature regulationl Low ambient temp, evaporation, radiation, convection, conduction loss of heat –Hypothermiao Achieve Neutral thermal environmentt Drying, swaddling, skin-skin contact, radiant warmer, leave vernix, wrapping, early feeding
  • 9. Immediate care after birthPrevent hypothermiaEye, skin, cord careGive injection vitamin KBreastfeed within ½ hour of birthSearch for malformations
  • 10. Increased risk of malformationSingle umbilical arterySimian creaseDysmorphic featuresAsymmetric cry due to absence of DepressorAngularis Oris MuscleExcessive drooling of saliva
  • 11. Quick screening for malformationsScreen from top to bottom and in midlineOrifice examination – Anal opening – Oesophagus patency* – Choanal atresia– * SGA baby, polyhydramnios, excessive drooling,• single umbilical artery
  • 12. Essential postnatal careNurse in thermal comfort(warm to touch, pink soles)Check umbilicus, skin, eyesGood sucking at breastScreen for danger signalsAdvice on immunization
  • 13. 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 healingoccurs
  • 14. Care of the skinDry using soft prewarmed clean clothBathing soon after birth is not recommendedDo not make vigorous attempts toremove vernix caseosaInspect for superficial infections
  • 15. Care of the eyes Clean at birth and subsequently daily For sticky eyes use normal saline or appropriate medicationu Nasolacrimal duct blockage, Massaging helps
  • 16. Danger signs Lethargy r Bleeding Hypothermia r Yellow palms/ sole Respiratory distress l Excessive wt lossr Cyanosis s Vomitingr Convulsions s Diarrhoear Abd distension
  • 17. Infant Classification -by Gestational AgeATerm : 37-41+6/7 weeks Preterm: <37 weeksk Post-term: 42 or more weeks
  • 18. Infant Classification -by birthweighta Macrosomia: 4000 gm or more Normal birthweight: 2500-3999 gmh Low birthweight: <2500 gm Very low birthweight: <1500 gmi Extremely low birthweight: <1000 gm
  • 19. 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/dayk with 2-5 g/kg/day of protein for cellular growth.
  • 20. Infant Classification -by Gestational SizesS Appropriate for gestational ageg Large for gestational agei Small for gestational agei classify based on maturity and intrauterine growthPS:Energy stores in the fetus builds up mostly during the 3rd trimester of the pregnancy.
  • 21. Gestational Age AssessmentA Maternal datesS Early Ultrasound dating Dates of first recorded fetal activitye Dates of first recorded fetal heart soundse Dubowitz or Ballard scores
  • 22. Decreasing lanugo hair over the back is a sign of increasing gestational age.
  • 23. Dubowitz L, Dubowitz V:Gestational Age of the Newborn
  • 24. Physical Examination of the Newbornt Purpose - detect malformations or deformations - determine manifestations of various neonatal diseases - evaluate the effects of labour and delivery on newborn
  • 25. Physical Examinationt General appearance - cyanosis, nasal flaring, intercostal retractions, grunting, meconium staining of skin, perfusion, level of spontaneous activity, tone, cryVital 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
  • 26. Physical Examinationt Skin - harlequin color change, hair tufts, mongolian spots, naevus flammus, malia malenocytic naevus, haemangiomas, pustular melanosis, erythema toxicume Skull - cranial synostosis, fontanels, craniotabes, caput succedaneum, subgaleal hemorrhage
  • 27. Milia
  • 28. Erythema Toxicum
  • 29. Epstein Pearls
  • 30. Mongolian Spots
  • 31. Capillary Haemangioma
  • 32. Physical Examinationt Face - facial asymmetry, preauricular tags/pits/sinus,low setears, hypertelorism, cleft lip/palate, red reflex, white reflexl Neck and chest - sinuses, cystic hygromas, sternomastoid tumour, webbed neck, thick nuchal folds, clavicular fracture,chest wall asymmetry, breast tissue formation, supernumerary nipples
  • 33. Physical Examinationt Lung examination - RR, breath sounds, shift of cardiac impulse, bowel soundsn Heart - normal heart sounds, murmurs, peripheral pulses, b/po Abdomen - distension, masses, umbilical hernia, omphalocoele, omphalitis, gastroschisis
  • 34. Umbilical Cord
  • 35. Physical Examinationt Genitalia examination - testicular descend, scrotal pigmentation, vaginal discharge, mucosal tags, imperforate hymen, clitoral enlargementn Extremities - symmetry, polydactyl, syndactyl, simian creases, absent fingers, clubfoot, fractured Spine - sacral tufts, scoliosis, lipoma, meningomyelocele
  • 36. Milky white or blood-streaked vaginal discharge is the result of maternal hormone withdrawal.
  • 37. Physical Examinationt 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
  • 38. Neonatal Immunization In Singapore
  • 39. ImmunizationAge Vaccine Optional0-7 days BCG, Hep B1 month 2nd Hep B3 months OPV,DPT, Hib/Pneumococ/Rota4 months OPV,DPT, Hib/Pneumococcal5 months OPV, DPT, Hib/Pneumococ/Rota6 Months Hep B15 months MMR Chicken Pox/flu18 months OPV, DPT Hib/PneumococcalSchool entry(4-5 yrs) OPV, DT
  • 40. Visit site for Formative assessments MCQ :http://www.geraldtan.com/school/5- paedsneonate.html http://www.geraldtan.com/school/