Normal Newborn Dr Varsha Atul Shah Consultant Dept. of Neonatal& Dev Medicine Singapore General Hospital
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
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
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
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
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
Immediate care after birthPrevent hypothermiaEye, skin, cord careGive injection vitamin KBreastfeed within ½ hour of birthSearch for malformations
Increased risk of malformationSingle umbilical arterySimian creaseDysmorphic featuresAsymmetric cry due to absence of DepressorAngularis Oris MuscleExcessive drooling of saliva
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
Essential postnatal careNurse in thermal comfort(warm to touch, pink soles)Check umbilicus, skin, eyesGood sucking at breastScreen for danger signalsAdvice on immunization
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
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
Care of the eyes Clean at birth and subsequently daily For sticky eyes use normal saline or appropriate medicationu Nasolacrimal duct blockage, Massaging helps
Danger signs Lethargy r Bleeding Hypothermia r Yellow palms/ sole Respiratory distress l Excessive wt lossr Cyanosis s Vomitingr Convulsions s Diarrhoear Abd distension
Infant Classification -by Gestational AgeATerm : 37-41+6/7 weeks Preterm: <37 weeksk Post-term: 42 or more weeks
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
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.
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.
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
Decreasing lanugo hair over the back is a sign of increasing gestational age.
Dubowitz L, Dubowitz V:Gestational Age of the Newborn
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
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
Milky white or blood-streaked vaginal discharge is the result of maternal hormone withdrawal.
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